The Premium Plus CEEA stapler places a circular, double staggered row of titanium staples. The instrument is activated by squeezing the handles firmly as far as they will go. Immediately afer staple formation, the knife blade resects the excess tissue, creating a circular anastomosis. The diamter of the staple line is 21mm. This size does not have the TILT-TOP anvil feature (only available on 25,28, 31 and 34mm sizes).