The Plastibell circumcision device is a clear, lightweight plastic in the shape of a bell with an attached handle (see photograph). It comes in various sizes to fit newborns, infants, and toddlers. The bell portion is designed to cover the glans while the foreskin is pulled over it and secured with a string (ligature). The ligature sits in a groove at the top of the bell so that when tied, the ligature will compress the excess foreskin, cutting off its circulation. The unwanted foreskin can now be removed by cutting around the bell while it protects the glans from injury.
The key is choosing the correct size device since too large a bell will cause excessive tension on the remaining foreskin and pull the bell over the glans onto the penile shaft. On the other hand, if the bell size chosen is too small, an inadequate amount of foreskin could be removed and/or excessive pressure on the glans could result in a visible deformity. An experienced provider will choose the appropriate size device and perform the procedure in 5-10 minutes. Healing time is approximately 10-14 days.
Pain Management for Newborns
Performing a circumcision produces significant discomfort if done without the use of an anesthetic. Infants under 1 year of age should receive an injectable anesthetic to numb the small nerves that control pain to the foreskin of the penis. The injection is much like the vaccines your child receives during routine office visits. Common pharmaceutical names include Lidocaine® and Marcan®. Some practitioners may use EMLA cream®, a numbing agent that can be applied to the foreskin before performing the procedure. Oral medications such as Tylenol® infant drops or infant Motrin® drops may be given. Sucrose (sugar) water has been shown to lessen discomfort especially in combination with injectable lidocaine.