Newborn Circumcision Methods: Gomco, Mogen & Plastibell

• There are several ways that doctors can perform a newborn circumcision, they are typically described by the specific tools that are used. The techniques that our parents tend to ask about include the use of either a Gomco, or a Mogen clamp, or use of a Plastibell ring. These three techniques are the most commonly used techniques for elective bedside newborn circumcision in North America.
• If performed appropriately, by an experienced medical practitioner, all of these techniques should result in the same outcome. That is to say, once the circumcision wound is fully healed, there is no difference in how the penis looks whether the child was circumcised with a particular clamp or a ring.
• Some circumcision clinics or circumcision doctors will promote one technique as being quicker, safer or providing a better cosmetic result. It is the opinion of The Circumcision Clinic that this is a marketing tactic and not necessarily the truth, nor the most important considerations when choosing a surgical technique.
• Based on the experience of our clinical team, we believe most physicians practice using the technique in which they were trained in, or the technique that they gained the most experience with. Their choice of a specific tool is typically less informed by the specifications of the tool, and more informed by their comfort using the tool safely and effectively in their own hands — and we think this is the correct way to decide! We believe it is more important for doctors to use the tools and techniques they are the most proficient with. The ‘better’ tool in less experienced hands is more likely to result in a complication than a ‘worse’ tool used by an experienced and competent provider.
• There are reports of various complications with all the different techniques used for newborn circumcision. The medical literature consistently reports that complication rates are lowest with experienced providers.
• Most of our doctors use a Mogen clamp; this is not something The Circumcision Clinic has mandated. It just so happens that this is the tool that our current doctors have used throughout their career and are very good with. The Clinic would be happy to support a doctor using another technique if they had a proven track record of excellence with that technique, as well as the same track record of excellence in bedside manner and commitment to post-procedure care.
• As important as meticulous surgical technique, we believe the bundle of care, which includes pain control, thorough parent education about aftercare, and appropriate and expedient access to follow up is what leads to excellent outcomes.

All of the doctors at The Circumcision Clinic use a tool called a Mogen Clamp to perform the circumcision procedure. Below is a description of the surgical technique, followed by a video of one of our doctors performing the procedure.

Once 10-15 minutes had passed following the penile nerve ring block injection (after the block has had an appropriate time to have the full effect) the child returns to the procedure room for the circumcision. The foreskin, shaft, and base of penis are prepped with chlorhexidine (an antiseptic solution used to disinfect the skin prior to the surgery). The surgeon puts on sterile surgical gloves and drapes the penis with a sterile drape.

The foreskin is retracted, and the mucosa (inner foreskin which is often stuck or adherent against the head) is separated from the glans (head) using sterile gauze and a blunt dissecting probe. The foreskin is returned to neutral position before the incision line is measured and marked with a sterile skin marker.

A mosquito snap (surgical tool) is placed on the dorsal aspect (top) of the foreskin before a Mogen clamp is applied. Prior to closing the clamp, the site is carefully inspected to ensure that the appropriate amount of foreskin is going to be removed, and that the glans (head of the penis) is safely below the clamp (rather than trapped in the opening).

The clamp is closed, protecting the head from injury and ensuring a cut that aligns with the markings, even if the child is wriggling or moving in the restraints. A scalpel blade is used to cut away the foreskin above the clamp. The clamp is then opened, at which point the shaft skin edges are press-sealed in front of the head. At this point the head is concealed momentarily, before the shaft is gently pulled down, which allows the head to come out, revealing the final result.

Below is a video of one of our doctors performing a newborn circumcision in our clinic: