Circumcision is the surgical excision of all or part of the prepuce (foreskin). There are different techniques and instrument is used for Circumcision. This article will list down each of the Instruments used for Circumcision. 

What Instrument is Used for Circumcision?

Clamp and shield

The Mogen clamp is the prototype shield and clamp method. The prepuce is pulled out distal to the glans and a metal shield is slid over it directly distal to the glans in this manner. The superfluous prepuce distal to the shield is removed using a scalpel. The shield protects the glans, and the frenulum is not affected by the excision. After that, the inner preputial layer can be split back beyond the glans and removed, ensuring that the glans are fully exposed after healing. The wound is merely bandaged to achieve hemostasis and no stitches are used. The glans and frenulum are protected from the knife and thus do not come into contact with it. The glans and urethrocutaneous fistula are rarely injured; however, bleeding is a serious risk with this approach.

Also Read: Circumcision Surgery in Bangalore | ZSR Circumcision Surgery

Plastibell

A plastic bell with a groove on the back is slipped between the glans and the prepuce; a dorsal incision is usually required to position the bell. The prepuce is pushed forward slightly, and suture material is wrapped around and secured tightly in the groove. The suture severs the blood supply to the prepuce distal to the groove, causing it to wither and fall off after 7-10 days. The two main problems of this method are glans necrosis and the failure of the prepuce to fall off. The main cause of these issues is an incorrect bell size and insufficient sutures across the prepuce. Its key benefit is that it has a reduced risk of bleeding.

Gomco

After the prepuce is entirely retracted, a metal bell is put over the glans. The prepuce is then restored over it, with the dorsal slit assisting the process. Over the bell is a metal plate with a machined undersurface on which the rim of the bell sits. As a result, the prepuce is sandwiched between the plate and the bell. The foreskin is trapped in place by a tensioning rod looped under a T-shaped component on the top of the bell and clamped down securely to the metal plate. After proper strangling, a scalpel is run over the upper side of the plate to remove the prepuce. One of the consequences is hemorrhage, which is why hemostatic stitches are used. When this surgery is performed with diathermy, a catastrophe can ensue, leading to complete penile loss. Its main advantage, like those of other shield methods, is that it protects the glans and frenulum.

Zhenxi Rings

The prepuce is removed from the glans and retracted. The glans are covered with a grooved sleeve that sits immediately behind the corona. After that, the prepuce is replaced over the sleeve. To hold the prepuce in place, a hinged plastic clamping ring is placed over the sleeve, the location of the prepuce is adjusted, and the nut is tightened. The prepuce is then compressed into the groove of the sleeve below it by an elastic cord wrapped securely around the phallus. The prepuce is constricted distally as a result of this. The frenulum is preserved by protecting the glans and frenulum. A sleeve that is too tight can cause glans necrosis, while one that is too loose can result in bad cosmetic results.

Tara Klamp

It’s a Malaysian invention that works similarly to the plastic bell, however instead of tying suture material around a groove in the bell, plastic arms lock into place to push two surfaces into tight contact, trapping the prepuce between them. It has similar advantages and disadvantages to plastibell.

SmartKlamp

This functions similarly to the Tara Klamp. The device cuts off the prepuce’s blood supply by trapping it between an outer ring and an inner tube. The Tara Klamp is made out of a single piece with locking arms at the top. The inner tube and outside locking component of the SmartKlamp are distinct, with the locking arms on the side. The excess foreskin is removed using the inside of the baseplate as a guide once the clamp is in place. As a result, the glans and frenulum are protected.

Shang Ring

This is a novel Chinese creation that consists of two concentric rings that fit into each other and sandwich the prepuce in the middle. It is considered to be a successful disposable device used in HIV prevention mass circumcision campaigns. The process is simple to learn and does not require any special skills. The lack of a shield for glans protection is a key flaw of the Shang Ring, which raises the danger of glans amputation.

PrePex

This instrument is unique in that it can be used to circumcise adult males without the use of an anesthetic. A placement ring, an inner ring, and an elastic ring make up this set. The elastic ring is carried by the placement ring to make its application easier during the procedure. The inner ring features a groove for the elastic ring to be inserted into. The prepuce is sandwiched between the inner ring and the elastic ring when the device is deployed. Ischemic necrosis of the “trapped” prepuce is the outcome. About a week after implantation, the PrePex device is disassembled, and the withered prepuce is bloodlessly cut from the penis. It is said to be both safe and successful in the mass implementation of adult male circumcision for HIV prevention.

Forceps Guided

The prepuce is released from the glans and dragged out in front of the glans in this technique. A pair of strong locking forceps are clamped over it, parallel to the corona and just in front of the glans. The prepuce is removed flush to the forceps with the knife. The forceps shield the glans, which is analogous to the guillotine approach. The frenulum is not cut during this procedure, however, it can be removed before or after circumcision if needed.

Dorsal Slit

Many procedures involve the dorsal slit, which is sometimes used alone, especially in the presence of acute inflammation. Both phimosis and paraphimosis are prevented by the dorsal slit. The prepuce is released from adhesion glans, and a 12 o’clock slitting of both layers of the prepuce is done to a few millimeters of the corona with the help of artery forceps inserted at 10 and 1 o’clock.  Many other circumcision techniques necessitate a dorsal slice to enlarge the outer preputial ring first. Performing a dorsal slit without excising the prepuce is usually unattractive from a cosmetic standpoint.

Excision Sleeve Resection

The prepuce is retracted over the glans penis, and a circumferential incision is made around the shaft, usually distal to the corona, as far back as the scar line is to be placed. The prepuce is replaced to cover the glans, and a second circular incision around the shaft is performed in the same location as the first. The strip of skin is removed after a longitudinal cut is made between the two circumferential ones. After that, the free raw edges are sutured. The frenulum can be cut as part of the main incision or separately if desired. The glans and frenulum are not protected in any way and must be avoided at all costs.

Also Read: ZSR Stapler Circumcision Surgery in India

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