The procedure of circumcision includes separating the foreskin from the head of the penis, retracting and fixing the foreskin, cutting the dorsal and ventral foreskin for circumcision, ligating to stop bleeding, and suturing the wound.
1. Local anesthesia is administered using an anesthetic drug such as lidocaine.
2. Separate the adhesion: If the patient has narrowing of the circumcision opening or adhesion between the foreskin and the head of the penis, the circumcision opening can be enlarged with a hemostat first, and then the dorsal margin can be separated by clamping up the middle part of the dorsal margin with two hemostats.
3. Creation of incision: The distal end of the foreskin is lifted up and then cut down from the distal end of the foreskin to the level of the coronal sulcus by means of surgical scissors.
4. Excision of the foreskin: align the inner and outer plates of the foreskin, pull the hemostat at the dorsal side of the foreskin and at the tethered ligament outward, and then review the outer plate of the foreskin for proper incision, and then excise the foreskin in a circular fashion from the dorsal incision toward the ventral tethered ligament.
5. Suture: Use fine silk thread to close one suture each in the dorsal, ventral, left and right of the circumferential incision, but be careful to avoid ligating too tightly, so as not to damage the skin in case of tissue edema. The suture is not cut short, left for fixing the dressing, then sutured between each two stitches, the suture needle should be close to the cutting edge.
6. Dressing: use a piece of gauze to encircle the circumcision, fix the gauze with sutures, and then use several layers of gauze to wrap it.
The circumcision procedure may vary slightly in different hospitals, and patients are advised to consult the hospital for the detailed procedure.