Plastibell
Encyclopedia
The Plastibell Circumcision Device is a clear plastic ring with a deep groove running circumferentially designed for circumcising
infant
male
s. The Plastibell is placed onto the head of the penis during a 10 minute surgical procedure, and the device will fall off within 3 to 7 days. The Plastibell was invented by Hollister Inc
in 1950, and first reported on in 1953.
The Plastibell Circumcision Device is a clear plastic ring with handle designed for male neonatal circumcision
that has a deep groove running circumferentially. The elective
minimally invasive surgical procedure
to install the Plastibell device may be performed by an OB/GYN
, a pediatrician, a urologist, a family physician or a pediatric surgeon
. The important issue is that the medical practitioner is trained in the procedure.
The adhesions between glans and foreskin are divided with a probe. Then the foreskin
is cut longitudinally to allow it to be retracted and the glans
(the head of penis) to be exposed. The Plastibell comes in 6 sizes. The appropriate one is chosen and applied to the head (the circumcision pictured at right is in this stage). The ring is then covered over by the foreskin. A ligature is tied firmly around the foreskin, crushing the skin against the groove in the Plastibell. Then the excess skin protruding beyond the ring is trimmed off. Finally, the handle is broken off at the end of the procedure. The entire procedure takes five to ten minutes, depending on the experience and skill of the surgeon.
As with all circumcisions, the procedure should involve adequate anaesthesia, using either EMLA cream, dorsal penile nerve block, penile ring block, or a combination of these prior to operation. The ring falls off in 3 to 7 days leaving a circumferential wound that will heal over the following week. Typically, the glans will appear red or yellow until it has cornified.
No bandage is required, allowing easy monitoring for infection.
Healing occurs while the edges of the prepuce are secured in the ring, making skin bridge
s (where the foreskin's end heals to the glans' corona) unlikely.
Cosmetically, there will be little to no circumcision scar
, though as usual with any circumcision, there will be a color change where the (formerly) inner and outer layers of foreskin meet.
One study of 2000 Plastibell circumcisions found a complication rate of 1.8%.
The foreskin must be slit and forced from the glans to allow entry for the plastic dome.
Furthermore, because convalescence depends on a (temporarily) affixed medical device, risks of infection or hemorrhage due to the bell slipping or otherwise failing are greater than a Gomco clamp
or similar entirely-supervised circumcision.
There are several reports in the literature of urinary retention after circumcision with the Plastibell device. One case resulted in death.
There also is a report of impetigo
caused by Staphylococcus aureus
when using the Plastibell.
Circumcision
Male circumcision is the surgical removal of some or all of the foreskin from the penis. The word "circumcision" comes from Latin and ....
infant
Infant
A newborn or baby is the very young offspring of a human or other mammal. A newborn is an infant who is within hours, days, or up to a few weeks from birth. In medical contexts, newborn or neonate refers to an infant in the first 28 days after birth...
male
Male
Male refers to the biological sex of an organism, or part of an organism, which produces small mobile gametes, called spermatozoa. Each spermatozoon can fuse with a larger female gamete or ovum, in the process of fertilization...
s. The Plastibell is placed onto the head of the penis during a 10 minute surgical procedure, and the device will fall off within 3 to 7 days. The Plastibell was invented by Hollister Inc
Hollister Inc
Hollister Incorporated is a medical supplies company founded in Chicago, Illinois, United States by John Dickinson Schneider in 1921 and now headquartered in Libertyville, Illinois since 1981....
in 1950, and first reported on in 1953.
Surgical description
A video of the Plastibell circumcision procedure done with EMLA, Lignocaine block is available at circumcision videoThe Plastibell Circumcision Device is a clear plastic ring with handle designed for male neonatal circumcision
Circumcision
Male circumcision is the surgical removal of some or all of the foreskin from the penis. The word "circumcision" comes from Latin and ....
that has a deep groove running circumferentially. The elective
Elective surgery
Elective surgery is surgery that is scheduled in advance because it does not involve a medical emergency...
minimally invasive surgical procedure
Minimally invasive procedure
There are three main categories which describe the invasiveness of surgical procedures. These are: non-invasive procedures, minimally invasive procedures, and invasive procedures ....
to install the Plastibell device may be performed by an OB/GYN
Obstetrics and gynaecology
Obstetrics and gynaecology are the two surgical–medical specialties dealing with the female reproductive organs in their pregnant and non-pregnant state, respectively, and as such are often combined to form a single medical specialty and postgraduate training programme...
, a pediatrician, a urologist, a family physician or a pediatric surgeon
Pediatric surgery
Pediatric surgery or paediatric surgery is a subspecialty of surgery involving the surgery of fetuses, infants, children, adolescents, and young adults...
. The important issue is that the medical practitioner is trained in the procedure.
The adhesions between glans and foreskin are divided with a probe. Then the foreskin
Foreskin
In male human anatomy, the foreskin is a generally retractable double-layered fold of skin and mucous membrane that covers the glans penis and protects the urinary meatus when the penis is not erect...
is cut longitudinally to allow it to be retracted and the glans
Glans penis
The glans penis is the sensitive bulbous structure at the distal end of the penis. The glans penis is anatomically homologous to the clitoral glans of the female...
(the head of penis) to be exposed. The Plastibell comes in 6 sizes. The appropriate one is chosen and applied to the head (the circumcision pictured at right is in this stage). The ring is then covered over by the foreskin. A ligature is tied firmly around the foreskin, crushing the skin against the groove in the Plastibell. Then the excess skin protruding beyond the ring is trimmed off. Finally, the handle is broken off at the end of the procedure. The entire procedure takes five to ten minutes, depending on the experience and skill of the surgeon.
As with all circumcisions, the procedure should involve adequate anaesthesia, using either EMLA cream, dorsal penile nerve block, penile ring block, or a combination of these prior to operation. The ring falls off in 3 to 7 days leaving a circumferential wound that will heal over the following week. Typically, the glans will appear red or yellow until it has cornified.
Advantages
The glans is protected during the procedure by the ring. Hemostasis (control of bleeding) is effective due to the ligature tie. Cosmetically, a predictable result is obtained due to the straight line of the ligature that causes the wound. It is a quick procedure once mastered - taking a few minutes to perform, and hopefully, relatively compared to 'normal' circumcision, causing less discomfort for the baby.No bandage is required, allowing easy monitoring for infection.
Healing occurs while the edges of the prepuce are secured in the ring, making skin bridge
Skin bridge
A skin bridge is a penile skin adhesion. It most commonly occurs as a consequence of an improperly healed circumcision, being formed when the inner lining of the remaining foreskin attaches to another part of the penis as the cut heals. While less common, skin bridges can also occur in...
s (where the foreskin's end heals to the glans' corona) unlikely.
Cosmetically, there will be little to no circumcision scar
Circumcision scar
In males who have been circumcised, the circumcision scar refers to the scar after a circumcision has healed. In some cases, the scar can be darker-colored, and, in all cases, it will encircle the shaft of the penis.-Appearance:...
, though as usual with any circumcision, there will be a color change where the (formerly) inner and outer layers of foreskin meet.
Disadvantages
The ring must fall off before final healing can occur. Rarely, the tip of the glans may protrude through the ring and become swollen, trapping the ring in place. Blood transfusion risk 1 in 30,000 procedures (Wiswell).One study of 2000 Plastibell circumcisions found a complication rate of 1.8%.
The foreskin must be slit and forced from the glans to allow entry for the plastic dome.
Furthermore, because convalescence depends on a (temporarily) affixed medical device, risks of infection or hemorrhage due to the bell slipping or otherwise failing are greater than a Gomco clamp
Gomco clamp
A Gomco clamp, otherwise known as a Yellen clamp, is a specialized clamp for performing circumcisions. It was invented by Hiram S. Yellen and Aaron Goldstein in 1934-1935. Gomco stands for the GOldstein Medical COmpany, the original manufacturer of the clamp...
or similar entirely-supervised circumcision.
There are several reports in the literature of urinary retention after circumcision with the Plastibell device. One case resulted in death.
There also is a report of impetigo
Impetigo
Impetigo is a highly contagious bacterial skin infection most common among pre-school children. People who play close contact sports such as rugby, American football and wrestling are also susceptible, regardless of age. Impetigo is not as common in adults. The name derives from the Latin impetere...
caused by Staphylococcus aureus
Staphylococcus aureus
Staphylococcus aureus is a facultative anaerobic Gram-positive coccal bacterium. It is frequently found as part of the normal skin flora on the skin and nasal passages. It is estimated that 20% of the human population are long-term carriers of S. aureus. S. aureus is the most common species of...
when using the Plastibell.
Prevalence
At least 50% of American non-therapeutic infant circumcisions since 1980 have been performed with a Plastibell.External links
- http://www.circlist.com/instrstechs/plastibell.html
- A video of dorsal penile and ring block and the Plastibell Circumcision