Manual for Male Circumcision under Local Anaesthesia

Male circumcision under local anaesthesia
Version 3.1 (Dec09)
A
B
Fig 5.2 Picking up a blood vessel with forceps (tweezers) (A) to
facilitate accurate placing of the artery forceps (B)
Tying and under-running. Either tie the vessel or under-run and tie it.
The simplest procedure is to tie the vessel below the artery forceps
(Fig. 5.3). The basic tie consists of two throws (Fig. 5.3A), but many
surgeons make a third throw (Fig. 5.3B) to give the knot extra security.
A B C
Fig. 5.3 Simple tie. A: the knot with two throws. B: the knot with three
throws. C: the finished knot pulled tight.
It is important to ensure that the tie is securely placed and not liable to
slip off, particularly in the first few days following the operation during a
penile erection. If there is any doubt about the security of the tie, it is
better to use the under-running technique (Fig. 5.4). Secure the
bleeding vessel with an artery forceps. Pass the suture needle just
beneath the artery (not too deep!) and pull through, leaving enough
suture material for the tie. Then pass the suture beneath the vessel a
second time, pull gently to occlude it, and tie a knot, as above.
.
Surgical procedures for adults and adolescents Chapter 5-3