Manual for Male Circumcision under Local Anaesthesia

Male circumcision under local anaesthesia
Version 3.1 (Dec09)
Fig. 6.5 Clamping the foreskin
Open and remove the clamp then hold the foreskin with artery
forceps on each side of the crushed area, at the 11 o’clock and
1 o’clock positions. Using scissors make a cut at the 12 o’clock
position, through the crushed skin. Special care should be
taken not to insert the artery forceps or scissors into the
urethra. (Fig. 6.6).
Fig. 6.6 The dorsal slit
[NOTE TO ARTIST: Use Fig 6.10 without the suture]
Step 3. Using scissors cut the foreskin free, following the
previously marked circumcision line (Fig. 6.7). Some surgeons
use the bell of the Plastibell as a guide. This has the
advantage of protecting the glans but the disadvantage that a
new Plastibell device is required each time.
It may be necessary in older boys to trim the mucosal layer of
the foreskin to 2–3 mm from the corona. If this layer is left too
long, the suture line can slip back over the glans, constricting it
and making it appear as if the foreskin has not been removed
(“concealed glans”). Control any significant bleeding by
clipping the blood vessel with an artery forceps and then tying.
Bipolar diathermy may be used, if available. Minor bleeding
can be controlled with simple pressure for five minutes.
Infant and paediatric circumcision Chapter 6 - 10