Manual for Male Circumcision under Local Anaesthesia

Male circumcision under local anaesthesia
Version 3.1 (Dec09)
Fig. 6.20 Photograph of Gomco clamp
Step 1. After cleaning, draping anaesthesia, and marking the
line of the circumcision over the corona, retract the foreskin
and separate the adhesions to expose the corona, as
described above.
Step 2. It is usually necessary to make a small dorsal slit to
allow the clamp to be placed on the glans (Fig 6.21). It is
important not to make the dorsal slit too long. Otherwise, it will
extend beyond the ring of crushed tissue produced by the
Gomco clamp and may produce an untidy result with increased
risk of bleeding. The dorsal slit should be long enough to allow
all adhesions to be divided and the bell of the Gomco clamp to
be placed over the glans.
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Fig. 6.21 Making a small dorsal slit in preparation for placing
the Gomco clamp.
Step 3. Choose the correct size of Gomco clamp bell to fit the
glans. For neonatal circumcision, a bell size of 1.1 cm is
usually appropriate. Introduce the bell through the aperture in
the foreskin and place over the glans. Then pull the foreskin
over the bell (Fig 6.22).
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Fig. 6.22 Placing the bell and base plate of the Gomco clamp.
Step 4. Place the base plate of the Gomco clamp over the bell,
keeping the foreskin pulled over the bell (Figs 6.22 and 6.23).
Put the rocker arm of the clamp in position, taking care to place
the crossbar at the top of the bell correctly in the yoke. The
clamp is now ready for tightening.
Before tightening the clamp, make sure that the foreskin is
symmetrical over the bell. The apex of the dorsal slit should be
visible. Finally, the crossbar at the top of the bell should sit
Infant and paediatric circumcision Chapter 6 - 21