Figure 1: The several methods of anvil insertion for esophagojejunostomy using a circular stapler after total gastrectomy. (a) Anvil insertion using a small-head purse-string instrument. (b) Anvil insertion after laparoscopic hand-sewn purse-string sutures. (c) Insertion of an anvil attached with a thread through an esophagotomy at the anterior wall of the esophagus. (d) An oral anvil insertion method (OrVil).