Circumcision procedure
(Gomco Clamp method)

Fig. 1 (63 Kb)
PATIENT CARE MAGAZINE, March 15, 1978, pp. 82-85.

       The following directions are provided for conduct of
circumcision operations with the GOMCO clamp:

                   The Gomco Technique.

 1.  Stretch the preputial opening

 2.  Break preputial adhesions [synechial membrane] so that
     the foreskin is completely retractile. [Fig. A above.]

 3.  Retract the foreskin until you can see the corona.
     Check the glans for any hidden adhesions.

 4.  Apply a small amount of lubricant such as K-Y Jelly to
     the glans so it won't stick to the inside of the bell.

 5.  Apply the bell-shaped plunger over the glans. [Fig. B above.]
     The bell should fit easily over the glans so they cover the
     corona.  Too small a bell may injure the glans and fail
     to protect the corona.  If stretching the preputial
     opening does not allow the bell to be inserted in the
     preputial space and entirely cover the glans, a dorsal
     slit may be necessary.

 6.  Pull the prepuce over the bell. [Fig. C above.] The foreskin
     should not be stretched or pulled too snugly over the bell.
     If it's pulled up too tightly, it's possible to remove
     too much shaft skin or to pull the urethra up so you
     get a tangential cut through the urethra as well as the

 7.  Judge the amount of the shaft skin left below the
     corona;  the skin should be relaxed and supple.

 8.  After you're sure of the dimensions, apply the plate of
     the clamp at the level of the corona. [Fig. D above]

 9.  With everything in proper alignment, tighten the clamp.
     This squeezes the prepuce between the bell and the
     clamp to make it blood-free.  Be sure the weight of the
     clamp doesn't distort the anatomy so there isn't a
     proper amount of skin in the clamp.

10.  Make a circumferential incision with a cold knife, not
     an electrosurgical instrument. [Fig. E above]

11.  Leave the clamp in place at least five minutes to allow
     clotting and coagulation to occur.

12.  Remove the clamp and apply antiseptic ointment
     (Betadine) to the crush line.  Apply a light dressing
     or loin cloth arrangement to keep the ointment from
     rubbing off.

13.  If you remove the clamp prematurely, the crushed edges
     may separate and bleeding will occur.  When this
     occurs, suture the mucocutaneous margin, being careful
     to avoid deep sutures that might penetrate the urethra.
     If the whole edge separates, treat as a freehand
     circumcision, placing quadrant sutures and sewing
     between them with fine stitches.

14.  Have the baby watched overnight for any signs of

15.  If late separation occurs, it's best to keep the wound
     clean and let it heal secondarily rather than try to
     suture it and risk development of stricture or fistula.
     Skin of this area tends to re-epethelialize rapidly.

PATIENT CARE MAGAZINE, March 15, 1978, pp. 82-85.

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