What Happens During Circumcision? (PlastiBell)

This is a Circumstraint. It has Velcro straps to restrain the baby's arms and legs so that he cannot move.

The area is prepared with Betadine, an antiseptic.

A surgical drape is placed over the baby. (In this illustration, the normal infant penis can be seen, with its foreskin covering.)

The foreskin opening in a newborn is normally very small, to prevent the entry of foreign matter (eg. fecal matter). The first stage of circumcision is to grasp the foreskin with forceps, and widen the opening.

The foreskin is normally attached to the glans by a membrane called the synechia. The glans and inner lining of the foreskin are still developing in the young child. During circumcision, the synechia must be torn apart. Naturally, this is painful.

The foreskin is clamped. A slit is made in the dorsal side of the foreskin.

The slit is separated and the foreskin is laid back, exposing the raw and bleeding glans.

A PlastiBell of appropriate size is slipped over the glans, and the foreskin is laid over it.

A ligature is tied in the ridge of the bell, as tightly as possible around the foreskin. Oozing will occur if the ligature is loose.

After one or two minutes to allow for crush, the foreskin is sliced off at the distal edge of the ligature using a knife or scissors. The surgeon trims as much tissue as possible to reduce the amount of necrotic tissue and the possibility of infection. The handle of the bell is snapped off at this time.

The rim of tissue will become necrotic (dead) and separate with the bell in 5 to 10 days. Occasionally, edema (swelling) will trap the plastic ring on the shaft of the penis. In this case it's usually necessary to cut off the ring, using a guide and ring cutter, although application of ice will sometimes reduce edema enough to remove the ring.