PURPOSE: To present a novel technique to deliver the endothelial graft in small incision Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) and to compare graft trauma between forceps delivery and the novel technique. DESIGN: Laboratory investigation with an interventional case report. METHODS: Ten pairs of human donor corneas were sectioned using an automated microkeratome system (Moria ALTK System, Antony, France). The recipient model was prepared by creating a 3 mm clear corneal wound in another human donor cornea. For each pair of corneas, one endothelial graft underwent single-fold delivery with forceps, while the other was delivered with the novel cartridge based technique. Each graft was stained with 0.25% trypan blue and 0.2% alizarin red, and digital photomicrographs were taken. A proportion of graft injury was calculated and differences were analyzed. Subsequently, a patient requiring DSAEK underwent the modified novel insertion technique. RESULTS: After insertion, the mean proportion of graft endothelial injury from forceps delivery through the ex vivo model was 26.02% (n = 10, standard deviation [SD] +/- 14.85%). The mean proportion of graft endothelial injury from cartridge delivery was 9.85% (n = 10, SD +/- 4.33%). The median difference between the two methods was -13%, representing less endothelial injury with the cartridge. This difference was statistically significant (P = .006). The patient who underwent DSAEK with this technique had improved visual acuity and a clear graft at five months. CONCLUSIONS: In our surgical model, inserting an endothelial graft through a small corneal wound using a novel cartridge-based technique created significantly less endothelial damage than with forceps insertion. Clinically, this technique was performed without complication.