Biomedical Engineering – From Theory to Applications

Male Circumcision: An Appraisal of Current Instrumentation
Fig. 7. The Plastibell device is a clear plastic ring with handle and has a deep groove running
circumferentially. Upper diagram: How it is used for an infant circumcision (diagram
modified from Elder (2007)). Lower image: Dr Terry Russell, Brisbane, Australia, displaying
the range of sizes available.
The Plastibell continues to be available in sizes applicable from newborn to early puberty.
The metallic precursor, the Ross Ring (Ross, 1939), also came in adult sizes, but adult
Plastibell circumcision appears to be unknown. The metallic ring is long discontinued,
rendered obsolete by its disposable plastic equivalent. Cosmetic results have met with
unanimous parental acceptance (Duncan et al., 2004).
Dr Terry Russell in Brisbane, Australia, developed in 1993 a simple, pain-free method
involving 2 hours EMLA cream with the penis wrapped in cling wrap (done by the parents
prior to arrival at the clinic), followed by a modified Plastibell circumcision (Russell &
Chaseling, 1996). The technique is described in detail on his website
(http://www.circumcision.com.au). Dr Russell has used it in 30,000 circumcisions on boys
of all ages from neonate to puberty, including 400 older boys every year. More recently he
has obtained excellent results with another topically applied anaesthetic cream, LMX4 (4%
lidocaine) that is faster acting, more effective and has fewer side effects (C.T. Russell,
personal communication). Because complete local anaesthesia is achieved by EMLA or
LMX4 cream, Dr Russell reports that no pain is experienced for 5 hours after the Plastibell is
applied, so claims the circumcision is completely pain free at all stages. The only major
complication in 30,000 circumcisions was one boy who developed mild
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