The choice between the two devices is a matter of personal preference for circumcision doctors. A study evaluating the differences between the outcomes of using the Gomco clamp versus the Plastibell device was conducted on over one thousand patients at the Nationwide Children’s Hospital, Columbus, Ohio, USA. The conclusion was that there was very little difference between the methods regarding complications and required interventions. There are, however, differences in each technique that could affect a doctor’s choice.
Gomco clamp
The Gomco clamp was invented in 1935 taking its name from the original manufacturing company – Goldstein Manufacturing Company. Inventor Aaron Goldstein and obstetrician Dr Hiram Yeller put their skill sets together to develop the device used for over 85 years. It is still preferred by many circumcision doctors.
The plate and bell of the clamp need to fit together tightly to clamp the skin for around 90 seconds to minimise bleeding before proceeding with the cut. The circumcision doctor also needs to ensure that he chooses the right size of the bell and clamp for the patient. Generally, if the penile shaft of an infant is less than 1cm, the Gomco clamp is not used for circumcision. Also, if babies are ill or premature, the parents should wait until the circumcision doctor gives the go-ahead.
With the Gomco clamp, the circumcision doctor first administers a dorsal nerve block, most often lidocaine. The urethral meatus must be avoided as the surgeon ensures that the foreskin is separate from the penis, down to the corona level, tenting it away from the glans. The surgeon will make a dorsal slit after pulling the prepuce forward. Then it is retracted before placing the metal bell of the Gomco device over the glans. Once this is done, the surgeon replaces the prepuce over the bell of the device.
A metal plate is placed over the bell and prepuce, fitting tightly into the rim. The prepuce is isolated between the bell and plate, enabling the doctor to tension a bar that keeps the foreskin in place, cutting off the blood supply to minimise bleeding. The doctor will then use a scalpel around the edge of the plate, removing the foreskin. As with the Plastibell device, the glans and frenulum are protected from accidental injury. A Gomco circumcision takes around 10 minutes, making it faster than the Plastibell method.
Plastibell device
The 1950s saw the introduction of the bell-shaped device to circumcision clinics. It is made of plastic and constructed with a groove at the device’s rear. It is placed between the prepuce and the glans. The Plastibell device is worn after the procedure, while the Gomco clamp is removed immediately. The Plastibell is used once and discarded, while the Gomco clamp is sterilised and used again.
The medical professional carrying out the procedure will administer dorsal nerve blocks before starting the procedure. The circumcision doctor will then ensure there are no adhesions, using a probe to separate the foreskin from the penis before using the Plastibell. A dorsal slit is usually made before the Plastibell is placed in position. Pulling the prepuce slightly forward allows the doctor to place suture material into the groove, ensuring it is in the correct position and symmetrical before it is tied tightly. The blood supply to the prepuce above the groove is cut off by the tight suture material resulting in the prepuce withering and dropping off within a week to ten days.
Circumcision doctors who favour this method say it is straightforward as the parent does not have to do anything other than keeping the area clean and watching for any signs of infection. The advantage of this method is a low risk of bleeding.
The Plastibell device seems to be favoured for infants, with approximately 60% of the circumcisions in the US carried out using this device. What appeals is the fact that the foreskin is not removed with a scalpel, minimising blood loss. The procedure takes about 20 minutes.
According to the Columbus Study, the statistics did not vary significantly between the two devices concerning complications and interventions for procedures carried out in the circumcision doctor’s office.
To find out more about circumcision techniques, contact Small Surgery Courses today.