Medically reviewed by Mr A. R. Khan, MBBS, FRCS, FRCS (paed), Paediatric Surgeon/Urologist
Quick answer: There is no single “best” method of circumcision for everyone. The most suitable surgical technique depends on the patient’s age, the medical reason for circumcision (such as phimosis or BXO), the anatomy of the foreskin and frenulum, and the surgeon’s expertise. The most commonly used surgical methods are forceps-guided circumcision, sleeve resection, dorsal slit, stapler (ZSR/CircCurer) circumcision, ring devices such as the Shang Ring, and glue closure techniques. At London Circumcision Centre, we most often use the Khan technique, which combines the forceps-guided and sleeve methods with tissue glue, and we also offer stapler circumcision for adults who prefer a device-based method.
Forceps-Guided Circumcision
Forceps-guided circumcision is one of the most widely used methods in many countries, particularly under local anaesthetic.
The inner foreskin is freed from the head of the penis (glans) and drawn forward in front of the glans. A pair of straight forceps is clamped across the foreskin, parallel to the coronal sulcus, immediately in front of the glans. If the ventral (undersurface) skin is short, more oblique forceps can be applied instead. The scalpel blade then removes the foreskin flush along the top of the forceps. The forceps protect the glans throughout — similar in principle to the traditional “guillotine” bone-cutter method.
This method does not divide the frenulum. If a frenuloplasty is needed, it is safer to perform it before the forceps-guided step, so the glans remains protected from injury.
Advantages: a clean, straight cut and a well-protected glans. Limitations: the remaining inner foreskin is longer than with the sleeve method, and the scar line may sit further from the glans, giving the appearance of a low-cut circumcision.
Dorsal Slit
A dorsal slit involves crushing and then cutting the front (dorsal) part of the foreskin. It is familiar to most surgeons but is rarely used on its own. It is most useful for a temporary procedure when there is acute inflammation (balanitis), a very tight foreskin (phimosis), or scarring from BXO (lichen sclerosus).
The foreskin is first freed from any adhesions to the glans. Artery forceps are placed at the 10 and 2 o’clock positions, and a 12 o’clock cut is made through the foreskin to within a few millimetres of the coronal sulcus. The dorsal slit — sometimes called the “German cut” in the Philippines — relieves both phimosis and paraphimosis.
Many circumcision methods begin with a dorsal slit to widen the foreskin in phimosis and access the glans. On its own, however, a dorsal slit is generally not cosmetically acceptable without completing a full circumcision.
Sleeve Resection
Sleeve resection is favoured by many urologists for its precise, tailored result.
The foreskin is retracted over the glans, with or without a dorsal slit. A circumferential incision is made through the inner mucosa near the coronal sulcus, at the level of the natural scar line. The foreskin is then returned to cover the glans, and a second circumferential incision is made around the outer foreskin at the matching level. A vertical cut joins the two incisions on one side, and the sleeve (band) of skin between them is removed.
Bipolar diathermy is used to seal blood vessels before the skin edges are closed with fine sutures and tissue glue. A frenuloplasty can be performed before the procedure or separately afterwards if required. The glans and frenulum must be protected throughout the operation.
Several variations exist: bipolar diathermy can achieve a virtually bloodless circumcision, some surgeons place a gauze roll between the glans and inner foreskin for tension and haemostasis, and others crush the tissue layers with artery forceps before excision. All these modifications aim to reduce complications.
Stapler Circumcision (ZSR / CircCurer)
Stapler circumcision is a modern, device-based method that has become increasingly popular with adult patients in the UK. It uses a single-use, disposable circular stapler device — commonly known as ZSR or CircCurer — sized to the individual patient.
An inner steel bell is placed over the glans to completely protect it. The foreskin is drawn over the bell, and the outer ring of the device is closed. In one action, the device cuts the foreskin in a perfect circle and simultaneously places a ring of tiny sterile staples along the wound edge, sealing the skin and controlling bleeding at the same moment.
Advantages: very quick, minimal bleeding, a symmetrical circular scar with the glans fully protected, and no stitches in most cases. Points to consider: the silicone with staples falls away naturally over 2–4 weeks (occasionally, a few retained staples need removal at follow-up), correct device sizing and surgeon experience are essential, and the frenulum is not treated by the device, so a frenuloplasty with stitches can be added at the same visit if needed.
At London Circumcision Centre, we are increasingly offering stapler circumcision as a first-line option for adults with a healthy foreskin, where the device sits well and gives an excellent symmetrical result. Where the foreskin is scarred, thickened or affected by BXO, a conventional technique such as the Khan method is usually more suitable.
Shang Ring Circumcision
The Shang Ring is another device-based method, best known internationally: it is WHO-prequalified and has been used in millions of adult circumcisions, particularly in large-scale programmes in Africa.
The device consists of two concentric plastic rings. The inner ring is placed over the glans under the foreskin, the foreskin is everted (folded back) over it, and the outer ring is locked in place, sandwiching the foreskin between the two. The excess foreskin is trimmed away above the ring. No sutures are needed; the compressed skin edges seal together while the ring remains in place, and the ring is removed at a follow-up visit around 7 days later.
Advantages: a very fast procedure, minimal bleeding, no stitches, and a uniform scar line. Points to consider: the ring must be worn for about a week, which some patients find uncomfortable or inconvenient; a second visit is required for removal; sizing must be accurate; and delayed removal can cause wound dehiscence and a 2-3 mm scar line after delayed healing (secondary healing). The Shang Ring is not widely available in the UK, where stapler and conventional glue techniques are generally preferred.
Laser Circumcision
Laser circumcision offers meticulous cutting and sealing of the skin edges, and it has been reported in patients with bleeding disorders, although this is rare.
Important for UK patients: to the best of our knowledge, no clinic or hospital in the UK performs true laser circumcision. Some clinics advertise “laser circumcision” when they are in fact using bipolar diathermy — an electrical device, not a laser. Always ask exactly which instrument will be used before booking.
Khan Circumcision Technique
The Khan technique of circumcision is our preferred approach at London Circumcision Centre. It combines the strengths of the forceps-guided and sleeve methods with glue closure and can be performed with or without a dorsal slit.
In our experience, as reflected in many patients’ feedback, results with the Khan technique have been excellent — combining the glans protection of the forceps method, the neat symmetrical inner mucosal scar line of the sleeve method, and the comfort and cosmetic benefits of tissue glue.
Comparison of Circumcision Methods at a Glance
| Method | Glans Protection | Cosmetic Result | Best Suited For |
| Forceps-guided | Excellent (forceps shield glans) | Clean, straight cut; low-cut appearance | Adults under local anaesthetic |
| Dorsal slit | Good | Not acceptable alone | Acute balanitis, severe phimosis, paraphimosis, BXO |
| Sleeve resection | Requires careful protection | Precise, tailored scar line | Patients wanting a defined scar position |
| Stapler (ZSR/CircCurer) | Excellent (bell shields glans) | Symmetrical circular scar | Adults wanting a quick, low-bleeding method |
| Shang Ring | Excellent (inner ring shields glans) | Uniform scar; ring needs to be removed in 7 days | Adults; mainly used internationally, rare in the UK |
| Laser | Good (where genuinely available) | Neat edges | Rare bleeding disorders; not available in the UK |
| Khan technique | Excellent | Neat, symmetrical, glue-sealed | Most adults and older boys at our clinics |
How Do We Choose the Right Method for You?
At consultation, the surgeon assesses:
- Age and anaesthetic suitability — local or general anaesthetic
- The underlying condition — phimosis, BXO/lichen sclerosus, balanitis, frenulum breve, or elective/religious circumcision
- The frenulum — whether frenuloplasty is needed
- Preferred cosmetic outcome — high or low cut, loose or tight style
- Closure method — glue, dissolvable stitches, or stapler (CircCurer), Khan technique
Frequently Asked Questions
Which circumcision method is the best?
No single method suits every patient — it depends on your age, the condition being treated, your anatomy, and your surgeon’s expertise. At London Circumcision Centre, the Khan technique is our preferred approach for most adults, and we are increasingly using stapler circumcision where the foreskin is healthy and the stapler is suitable.
What is stapler circumcision (ZSR)?
Stapler circumcision uses a disposable circular device (ZSR or CircCurer) that cuts the foreskin and closes the wound with tiny silicone staples in a single action. It is quick, causes minimal bleeding, and gives a symmetrical scar. The staples fall off naturally within 2–4 weeks.
What is Shang Ring circumcision?
The Shang Ring is a two-ring plastic device that clamps the foreskin without stitches. The ring stays on for about 7 days and is removed at a follow-up visit. It is WHO-prequalified and widely used internationally, but rarely available in the UK.
Is stapler circumcision better than traditional circumcision?
The stapler is faster with less bleeding, while conventional glue or stitch methods give the surgeon more control over scar position and skin tension. Both give excellent results in experienced hands.
Is laser circumcision available in the UK?
To our knowledge, no UK clinic or hospital performs genuine laser circumcision. Clinics advertising it are usually using bipolar diathermy, an electrosurgical device, not a laser.
Does circumcision remove the frenulum?
The forceps-guided, stapler, and ring methods do not cut the frenulum. If the frenulum is short or tight, a frenuloplasty can be performed before or at the same time as circumcision.
Which method of circumcision heals fastest?
Most methods heal within 4–6 weeks. Glue closure and stapler circumcision are often more comfortable in the first week, but overall healing depends more on aftercare, age, and general health.
How much does adult circumcision cost in the UK?
At London Circumcision Centre, adult circumcision starts from £650 with stitches or glue, and from £780 with the stapler (CircCurer) device. Frenuloplasty can often be combined at the same visit — exact fees are confirmed at consultation.
Book a Consultation
Our consultant urologist at London Circumcision Centre (London and Cambridge) will examine you, recommend the most suitable technique for your anatomy, and answer your questions. Call +44 7527 314081 or book online today.
Medical disclaimer: This information is general guidance only and does not replace a professional assessment by a qualified surgeon or urologist. If you have urgent symptoms, seek urgent medical advice.