Circumcision

Considerations

Benefits

Contraindications

Complications

Neonatal circumcision

Gomco

  1. Place on circumcision board
  2. Inject ~5mL 1% lidocaine as dorsal penile block, sit for 5 minutes
  3. Dilate phimotic ring with hemostat
  4. Crush foreskin at 12 o'clock position then cut to expose glans
  5. Remove all smegma and adhesions to fully expose glans
  6. Place hemostat x2 on the corners of the cut foreskin and place bell within foreskin on top of glans
  7. Place outer device over foreskin, grasp corners with new hemostat to bring the foreskin up and through device
  8. Confirm adequate and even position of Gomco device prior to tightening
  9. Leave for 5 minutes after tightening, can cut off foreskin at any time
  10. After 5 minutes, remove device and gently push edges off bell to expose penis
  11. Apply bacitracin and dressing

Circumcision under general anesthesia

Pediatric technique #1

  1. Supine positioning
  2. Take down adhesions with a snap and sponge, sterilize with betadyne
  3. Demarcate proximal border, make incision w/ #15 scalpel
  4. Demarcate distal border, make incision w/ #15 scalpel
  5. Use 4 snaps to grap foreskin at dorsal aspect
  6. Spread with tenotomy scissors, cut at dorsal aspect
  7. Remove foreskin with cautery, discard unless abnormal appearing
  8. Obtain hemostasis of any active or potential bleeding
  9. Place two 5-0 stitches at ventral portion
  10. Reapproximate frenulum if necessary with simple interrupted
  11. Suture subcutaneous at 12 o’clock with 6-0, then perform running subcuticular dorsal to ventral, perform on either side
  12. At ventral portion, put stitch through skin, then go back through skin again and tie to loop
  13. Place mastisol, telfa strip, and tegaderm with cut on ventral then dorsal portion
  14. Cover with bacitracin
  15. Send home with tylenol, ibuprofen, and bacitracin

Pediatric technique #2

  1. Supine positioning Take down adhesions, sterilize with betadyne Demarcate proximal border, make incision w/ #15 scalpel Demarcate distal border, make incision w/ #15 scalpel Use 4 snaps to grap foreskin at dorsal aspect Spread with tenotomy scissors, cut at dorsal aspect Remove foreskin with cautery, discard unless abnormal appearing Obtain hemostasis of any active or potential bleeding Place 12 6-0 chromic stitches simple interrupted Place mastisol, telfa strip, and tegaderm with cut on ventral then dorsal portion Send home with tylenol and ibuprofen

Pediatric technique #3

  1. Supine positioning Take down adhesions, no betadyne Place 5-0 prolene stitch in glans for positioning Demarcate borders, incise with electrocautery on cut (or coag) Use 4 snaps to grap foreskin at dorsal aspect, spread with tenotomy scissors, cut at dorsal aspect Can also just cut through foreskin and take down in parts Remove foreskin with cautery, discard unless abnormal appearing Obtain hemostasis of any active or potential bleeding Place 12 o’clock stitch and 6 o’clock stitch and hold on with snaps (5-0 fast gut) Place 8 stitches total with 5-0 fast gut Place dermabond Send home with tylenol and ibuprofen

Adult technique