Named procedure for circumcision
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named procedures circumcision surgical techniques eponymous
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https://pmc.ncbi.nlm.nih.gov/articles/PMC3888996
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Named Procedures (Eponymous Techniques) for Circumcision
Circumcision methods are broadly classified into three types: dorsal slit, shield and clamp, and excision (sleeve resection). Many named/eponymous procedures fall under these categories.
1. Gomco Clamp Technique
The Gomco (Goldstein Medical Company) clamp is the most commonly used instrument for circumcision in the United States. It works by crushing the foreskin against a bell-shaped metal device, providing hemostasis before excision.
Steps:
- A metal bell is placed over the glans under the foreskin
- The clamp plate is lowered over the bell, crushing the foreskin circumferentially
- The foreskin is excised flush with the clamp plate
- The clamp is removed - hemostasis is already achieved by crushing
Key point: Electrocautery must NEVER be used with the Gomco clamp (risk of current passing to the glans).
- Pfenninger and Fowler's Procedures for Primary Care, 3rd Ed.
2. Mogen Clamp Technique
The Mogen clamp (named after the Hebrew word for "shield") is a flat, angled clamp with a narrow slot. It is faster than the Gomco (approximately half the time) and follows the angle of the corona to avoid removing excess ventral tissue.
Key point: The Mogen clamp is NOT a guillotine - it is a crushing device. The narrow slot prevents entry of the glans if used properly.
Advantage: Studies (Kurtis et al. 1999; Kaufman et al. 2002) showed less operative time and less discomfort compared with Gomco.
- Pfenninger and Fowler's Procedures for Primary Care, 3rd Ed.
3. Plastibell Technique
The Plastibell is a plastic ring device (available in sizes 1.1x to 1.7x cm). It is an "in situ" device - the foreskin is not cut during the procedure; it falls off later with the device.
Steps:
- A plastic bell is placed over the glans
- A ligature is tied tightly around the foreskin in the groove of the Plastibell
- The handle is broken off; the ring and foreskin fall off naturally within 7-10 days as the crushed tissue necrotizes
Key point: Electrocautery must NEVER be used with the Plastibell. Parents must be instructed to return if the ring migrates proximally.
- Pfenninger and Fowler's Procedures for Primary Care, 3rd Ed.; Hinman's Atlas of Urologic Surgery
4. Dorsal Slit Procedure
Not a complete circumcision but a named emergency/temporizing procedure used for paraphimosis or severe phimosis.
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A single longitudinal incision is made in the dorsal foreskin, releasing the constriction
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Creates a "beagle ears" appearance
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Definitive elective circumcision is recommended after the acute episode settles
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Roberts and Hedges' Clinical Procedures in Emergency Medicine; Bailey and Love's Short Practice of Surgery, 28th Ed.
5. Sleeve Resection (Two-Incision / Freehand) Technique
The classic open surgical technique used predominantly in adults and older children:
- Two circumferential incisions are marked - one on the outer skin at the corona, one on the inner mucosal layer leaving ~0.5 cm of inner prepuce
- The prepuce is slit dorsally to the corona to create two flaps
- The inner and outer flap tissue is excised
- Vessels are secured with bipolar diathermy or absorbable sutures
- Cut edges are approximated with interrupted absorbable sutures, ensuring frenular vessels are ligated
- Excised skin is sent for histology when indicated (e.g., lichen sclerosus)
- Bailey and Love's Short Practice of Surgery, 28th Ed.
6. Other Named Devices / Methods
| Device/Method | Type | Notes |
|---|---|---|
| Unicirc | Surgical instrument | Used in adult circumcision programs, particularly WHO HIV prevention campaigns in Africa |
| ShangRing | In situ plastic ring | Used in adult/adolescent mass circumcision programs |
| Prepex | Non-surgical device | Elastic ring device; used in WHO programs for adult circumcision without anesthesia |
| Pollock Technique | Mogen-based | Rapid technique using Mogen clamp with modifications for speed in neonates |
Summary Table
| Procedure | Age Group | Mechanism | Key Feature |
|---|---|---|---|
| Gomco clamp | Neonates (all ages) | Crush + excise | Most used in USA |
| Mogen clamp | Neonates | Crush + excise | Fastest; follows corona angle |
| Plastibell | Neonates/infants | Ligature + necrosis | Ring falls off in 7-10 days |
| Sleeve resection | Adults/older children | Two-incision excision | Standard surgical technique |
| Dorsal slit | Any (emergency) | Single incision | Temporizing; not complete circumcision |
| ShangRing/Unicirc | Adults | Clamp/ring | Used in WHO HIV programs |
Absolute contraindications for all circumcision techniques: hypospadias, epispadias, megaurethra, ambiguous genitalia - as the foreskin is needed for later reconstructive repair.
- Campbell-Walsh-Wein Urology; Pfenninger and Fowler's Procedures for Primary Care
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