Manual for Male Circumcision under Local Anaesthesia

Male circumcision under local anaesthesia
Version 3.1 (Dec09)
The Gomco clamp method
The Gomco clamp has different bell sizes that can be used for
infants, older children and adults. In addition, the crushing of
the foreskin is circular (unlike with the Mogen clamp, which is
linear).. A disadvantage of the Gomco clamp is that, unlike the
Mogen clamp, it consists of four parts – base plate, rocker arm
or top plate, nut and bell. A number of bells of different sizes
are also needed. There is a risk that parts of the clamp may be
mislaid or lost during cleaning and sterilization. Before the start
of the procedure and before any anaesthetic is given the
surgeon must check that likely sizes of Gomco clamps are
available. Once the procedure has started and the correct size
has been selected the clamp should be assembled to ensure
parts are complete and fit correctly.
Meticulous care must be used to not mismatch device parts. If
a small bell is used with a larger base plate the device will not
crush the foreskin or protect the glans, possibly resulting in
haemorrhage and penile laceration. Correctly matched and
sized parts must be used.
Component parts from different clamps or manufacturers are
not interchangeable and care must be taken to ensure that the
clamp is assembled only from its original parts.
The Gomco clamp should also be thoroughly checked and not
used if it has stripped threads, a warped or bent base plate, a
bent arm, twisted forks on the rocker arm, or a scored or
nicked bell. The clinic may mark clamp parts to ensure that
they are correctly reassembled. If so, the manufacturer should
be consulted on the best way to do this. Some marking
methods may weaken the device or make it difficult to sterilize
it.
Fig. 6.19 The Gomco clamp. A: assembled device. B: rocker
arm. C: nut. D: base plate. E: bell.
Infant and paediatric circumcision Chapter 6 - 20