Esophagojejunal anastomosis after totally laparoscopic total gastrectomy remains clinically challenging due to deep location, technical difficulty, and demanding teamwork. Current techniques include linear stapling, circular stapling, and hand-sewn anastomosis. Hand-sewn anastomosis requires advanced laparoscopic skill, offers poor reproducibility, and is thus limited in use. Linear stapling, while relatively simple, necessitates resection of 4.5-6.0 cm of normal esophagus and may compromise the proximal margin in high or ill-defined tumors. Circular stapling preserves more distal esophagus and allows higher resection, better aligning with anatomical and functional goals. However, conventional circular stapling methods, such as the reverse puncture and OrVil™ techniques, can be cumbersome, dependent on specialized instruments, or carry higher complication risks. Recently, hand-sewn purse-string sutures and novel laparoscopic purse-string suture clamps and multi-functional seal caps have provided new solutions for totally laparoscopic circular anastomosis. Each step of this procedure, from purse-string creation and anvil placement to mesenteric division, stapler insertion, and anastomosis, may present specific challenges, and technical errors at any step may lead to surgical failure. Thus, proficiency in managing these intraoperative situations is crucial for safe and broader adoption of the technique.