Forceps Guided circumcision
The inner foreskin is freed from the head of the penis (glans) and pulled out in front of the glans. A pair of straight forceps is clamped across it parallel to the coronal sulcus immediately in front of the glans or with more oblique at the foreskin if short ventral skin is present and the scalpel blade is used to remove the foreskin flush above the forceps. The forceps protect the glans, like the bone cutter's guillotine method. This method does not cut the frenulum; however, it is safer to do the frenuloplasty before the forceps-guided procedure to protect the glans from getting injured Advantage of this method is a clean and straight cut. Still, the left inner foreskin is longer compared to the sleeve method Incision line may be away from the glans, so it gives the appearance of low-cut circumcision.
Dorsal slit
The dorsal slit is to cut a crushing clamp at the front part of the foreskin and familiar to many methods and infrequently is used alone, especially in the presence of acute inflammation (balanitis), tight foreskin (phimosis), and BXO (lichen Sclerosis) Dorsal slit or German cut (commonly called in Philippines) prevents both phimosis and paraphimosis In this procedure, the foreskin is freed from the glans of adhesions and with the aid of artery forceps placed at 10 and 1 o’clock, a noon cutting of the foreskin is done to a few millimetres of the coronal sulcus Many of other methods of circumcisions requires dorsal slit to be performed first to broaden the foreskin opening to gain access to the glans It is usually not acceptable to carry out dorsal slit alone aesthetically without doing full circumcision.
Sleeve Resection
The foreskin is withdrawn over the glans penis with or without a dorsal slit. A circumferential incision is made around the shaft at the mucosa near the coronal sulcus at the level of the scar line. The foreskin is restored to cover the glans back, and another all-around incision is made around the outer foreskin at the same level as the first one. A vertical cut is made between the two incisions at one side, and the band of skin is removed. Diathermy is used to coagulate the blood vessels at this stage before putting the suture and glue to the free edges. The frenuloplasty can be done before the procedure or separately afterwards if required. The glans and frenulum must be protected during the operation.
There are several alterations of the sleeve circumcision bipolar diathermy that can be used for bloodless circumcision. A few surgeons use gauze rolls between the head of the penis and the inner layer of the foreskin both for tightness and to stop the bleeding. Others described the use of artery forceps to crush the layers before the excision of the foreskin. Many modifications by surgeons are intended to reduce complications of this technique.
Laser circumcision
For meticulousness and sealing of skin edges, laser circumcision can be done. Laser circumcision is reported in patients with bleeding disorders, although rare. As far as we know, no clinic or hospital does laser circumcision in the UK. Some clinics pretend the laser circumcision with circumcision using bipolar diathermy.
Khan Circumcision technique
By anecdotal evidence, our results with the “Khan technique of circumcision” were superior to all other methods, and many patients’ feedback endorses these results. Khan's technique of circumcision is a combination of forceps and sleeve methods with Glue circumcision with or without a dorsal slit.
