Steps of infant male circumcision by Circumplast device

• Match consent to patient name and DOB and ask for medical history

• Obtain informed consent from both parents

• Restrain the infant appropriately with the surgical assistant

• Put on non-sterile gloves

• Inspect the anatomy of the penis for any abnormalities like hypospadias, buried penis, web, rotation, deviation

• Draw up 0.25 ml of 2% lignocaine and 0.75% ml Chirocaine 0.5%

• Use antiseptic to cleanse skin before injection

• Have a pacifier with sugar available as needed

• Apply a 25-gauge needle for injection

• For Ring Block anaesthesia, make a subcutaneous bleb of Local Anaesthesia at the base of the penis

• Beginning laterally, inject superficially in a ring circumferentially around the base of the penis

• Inject anaesthetic subcutaneously in a superficial ring circumferentially around the base of the penis

• Ask mum to feed the infant for 5 minutes  

• Set up circumcision tray and select Circumplast device size if glans is already exposed

• Put on Personal Protection Kit of sterile gloves & cover gown as needed

• Sterilely prep patient using expanding ring technique with antiseptic solution two times

• Drape the baby sterilely

• Apply two haemostats to the foreskin at 10 and 2 o'clock positions and check the external meatal opening

• Separate the adhesions between the previously placed haemostats with another probe remaining  superficially

• Crush the foreskin with a straight haemostat placed at 12 o’clock to a length approximately the same  length as the width of the glans

• Wait at least 10-15 seconds after clamping before cutting the slit

• Use tissue scissors to make the dorsal slit on the crushed line

• Manually retract the foreskin

• Free remaining adhesions, completely exposing the sulcus by probe or artery forceps tip and diathermised  the frenulum

• Check the Circumplast device bell size

• Untie ligature and place ligature underneath at the base of the penis

• Pull the foreskin forward and put the bell inside the foreskin over the Circumplast device

• Place the bell so that the groove of the bell is just distal to the sulcus

• Make sure that the apex of the dorsal slit is distal to the bell’s groove and check inner mucosa should not  be seen inside the device 

• Position the ligature around the bell's groove and draw over it lightly 

• ligature very strongly

• Finish the surgeon's knot squarely with 2 and 3 ties as a square knot

• Diathermy the edges of the cut skin and Snip off excess ligature

• Trim off the foreskin using the outer ridge of the bell as a cutting guide to complete the circumcision

• Break off bell handle

• Clean off excess blood with the gauze

• Check again for any signs of bleeding or swelling before discharging the infant 

Note: Practice may be slightly different for different doctors