Plastibell 5531108 226113127 2008-07-16T21:43:27Z Azoreg 5650240 Added citations [[Image:Plastibell_Circumcision_Device.jpg|right|thumb|A 6 day old Plastibell Circumcision Device on a one month old infant.]] The '''Plastibell Circumcision Device''' is a clear plastic ring with a deep groove running circumferentially designed for [[circumcision|circumcising]] [[infant]] [[male|males]]. The Plastibell is placed onto the head of the penis during a 10 minute [[Elective surgery|elective]] [[Minimally invasive procedure|minimally invasive surgical procedure]], and the device will fall off within 3 to 7 days. The Plastibell was invented by [[Hollister Inc | Hollister Inc]] in 1950, and first reported on in 1953.<ref name=Miller1953>{{cite journal | author = Miller, R.L. | coauthors = Snyder, D.C. | year = 1953 | title = Immediate circumcision of the newborn male. | journal = Am J Obstet Gynecol | volume = 65 | issue = 1 | pages = 1-11 | url = http://www.ncbi.nlm.nih.gov/pubmed/13016660 | accessdate = 2008-07-16 }}</ref><ref name=Kariher1956>{{cite journal | author = Kariher, D.H. | coauthors = Smith, T.W. | year = 1956 | title = Immediate circumcision of the newborn. | journal = Obstet Gynecol | volume = 7 | issue = 1 | pages = 50-3 | url = http://scholar.google.com/scholar?hl=en&lr=&ie=UTF-8&sa=G&oi=qs&q=immediate+circumcision+of+the+new+born+author:d-kariher | accessdate = 2008-07-16 }}</ref> ==Surgical Description== [[Image:Plastibell1.jpg|right|thumb|A baby midway through a Plastibell circumcision.]] 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 surgery|elective]] [[Minimally invasive procedure|minimally invasive surgical procedure]] to install the Plastibell device may be performed by an [[Obstetrics and gynaecology|OB/GYN]], a [[pediatrician]], a [[urologist]], or a [[Pediatric surgery|pediatric surgeon]] 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 penis|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.<ref>{{cite journal | last = Herbert | first = Barrie | coauthors = ''et al'' | title = The Plastibell Technique for Circumcison | journal = Br Med J | volume = 2 | issue = 5456 | pages = 273–275 | date = 1965 | url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1845746}}</ref> As with all circumcisions, the procedure should involve adequate anaesthesia, using either EMLA cream,<ref>Russell, T: Topical anaesthesia in neonatal circumcision: a study of 208 consecutive cases. Aust Fam Physician Jan 1996:S30-4</ref> 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 [[Keratin#Cornification|cornified]]. ==Advantages== The glans is protected during the procedure by the ring. Haemostasis (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 causing minimal 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 bridges (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. ==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). 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<ref>{{cite news | first = Mark | last = Brennae | title = Ontario boy dies after complications from circumcision | url = http://www.canada.com/vancouversun/story.html?id=cb3b8281-4134-46ba-85d3-b076072bda75&k=25810 | work = The Vancouver Sun | publisher = CanWest News Service | date = June 13, 2007 | accessdate = July 16, 2008 }}</ref> than a [[Gomco clamp]] or similar entirely-supervised circumcision. There are several reports in the medical literature of urinary retention after circumcision with the Plastibell device.<ref>[http://www.cmaj.ca/cgi/content/full/169/3/216 Acute venous stasis and swelling of the lower abdomen and extremities in an infant after circumcision - Ly and Sankaran 169 (3): 216 - Canadian Medical Association Journal<!-- Bot generated title -->]</ref> One case resulted in death.<ref>[http://www.pulsus.com/Paeds/12_04/Pdf/zwol_ed.pdf Paediatrics & Child Health, Home<!-- Bot generated title -->]</ref> There also is a report of [[impetigo]] caused by [[Staphylococcus aureus]] when using the Plastibell.<ref>[http://www.cirp.org/library/complications/stranko1/ Impetigo in Newborn Male Infants Associated with a Plastic Bell Circumcision<!-- Bot generated title -->]</ref> ==Prevalence== At least 50% of American non-therapeutic infant circumcisions since 1980 have been performed with a Plastibell. ==Notes and references== <references /> ==See also== *[[Circumcision]] *[[Gomco clamp]] ==External links== *http://www.circlist.com/instrstechs/plastibell.html [[Category:Medical clamps]] [[Category:Circumcision]]