Operative note 15 Core
Circumcision
What it does: remove the foreskin.
- Foreskin in its natural position. Flaccid penis. No stretch. Mark the outer skin line with a marker pen.
- 2 clips on the distal foreskin, either side of midline. They hold and retract it.
- Cut the outer line. Skin only.
- Dorsal slit in 2 layers. See the meatus before every cut. Never cut blind.
- Outer (superficial) layer first: all the way back to the outer cut.
- Inner (deep) layer next: stop 0.5 cm short of the outer cut.
- Evert the foreskin.
- Mark a 0.5 cm mucosal collar. Cut along it.
- Scissors join the inner and outer cuts. The sleeve comes off. Foreskin to histology.
- Frenulum, ventral at 6 o'clock: bipolar forceps to the frenular artery, then a box stitch at 6 o'clock. The frenular artery is the bleeder.
- Close all the way round: interrupted Vicryl Rapide.
- Dressing: Jelonet (paraffin gauze), then gauze. Crepe bandage optional.
- Watch: Penile block: 9 mL a side. Bupivacaine + lidocaine. Through Buck's fascia, just under the pubis. NEVER adrenaline. It can kill penile skin.
- Watch: Late issues: meatal stenosis, skin bridges.
From the UroRef Operative Quick Guide.