Khitan dengan Alisklamp
Diposting tanggal: 04 Desember 2014

 

circumcision with
While starting the process of circumcision with  you are requested to draw a line over the bubble on the prepuce of glans penis with an acetate pen. This is also recommended with the aim to prevent the spoiling of the circumcision operator’s orientation in the cases where the locally applied anesthetic medicine is risen up to the prepuce.
It is always advised that the dotted lines are drawn in order to designate the middle line from upper and lower parts of the penis.
The process of cleaning and sterlizing the surgical area is performed according to classical surgical procedures after completion of the line drawing process.
The circumcision operator applies the local anesthesia process to the penis after he has finished the cleaning and covering process. Optionallly it is advised to use  5cc syringe and insulin or dental syringe tip. It may be done in the form of Local Anesthesia Dorsal penile block or of Ring block.
After it has been waited for a while, the Local anesthesia controllin process is done. Following the realization of anesthesia, the prepuce is pulled back. By cleaning the penis head completely, any adhesion and simegma are prevented.

It should be paid attention to the fully opening of any adhersions in the coronal area in particular. The area is cleaned and dried with an antiseptical solution once again.
In the cases where the prepisium is narrow (phimosis), it is recommended to carry out the expanding process to the prepisium by a flat forceps. The fırceps is opened in line with the glans and pulled back without closing. This process can, when and if desired, be applied for attaching the tube easily in all cases.
A suitable long tube is placed over the penis head. Since the inclination of the tube is the same with that of the glans penis, the tube will be put over the glans penis like a hat.
The puled back prepuce is brought to its old condition over the transparent tube. In the meantime, for not causing to be any wrinkledness in the internal mucosa, the prepisium is pulled toward outside throughly.
It should be controlled by looking to inside from the tube’s upper hole, whether or not there is mucosal folding; and that the glans is in the neutral position.

 
The white colored pinching apparatus is placed onto the tube by one hand, provided that its circulary end is first placed. In the meantime, the prepuce and the tube is held tightly by the other hand. And then, the quanrangular hole of the white colored apparatus is put over the tube. On the upper part of the white colored pinching ring are available round and triangular bulges which are in harmony with the upper part of the tube. The pinching ring is turned a quarter tour after it has been attached onto the tube. It is provided that the round indent in the tube and the round bulge in the clamp are interlocked completely.
While the exterior skin is being made, it should be paid attention that the lower skin of the penis should not be uptight. In order to check this, the penis is brought to the position of erection. The lower skin’s uptightness is conrolled. If it is uptight, it must be absolutely loosened.
The second phase of adjusting the exterior skin is to check the upper part of the penis.  And the upper skin of the penis should not be uptight as well in the neutral position of the penis. It is important for a good circumcision that the lower part of the apparatus should be in a perpendicular position to the long axis of the penis, and that the legs of the apparatus should have been drawn beforehand and be at the same level with the upper and lower lines of the penis.
After adjustment of the exterior skin, the interior skin (mucosa) should be adjusted. A good circumcision is the circumcision in that the mucosa is left at the same length throughout the glans penis. Ideal mucos length is around 3-5 mm. By drawing the clamp upward slightly from the observation hole at the upper part of the tube, the position of the mucosa is evaluated through circulary movements.
The lower part of the penis where a frenulum is available is controlled prior to the adjustment of the interior skin. When ir is looked from upside, the frenulum should be seen clearly. If its mucosa is short, it is pushed with a flat forceps on the end of which there is a small aceptic gauze in such a way that the the mucosa will be seen. If the mucose is long, the internal leaf of the prepisium skin between the tube and the clamp is drawn upward with an artery forceps. Thanks to this, the mucosa is shortened. In the second phase of the interior skin adjustment, the upper part of the penis is checked. In order to obtain the desired length of mucosa, the above mentioned processes can be repeated in the same way.
After the exterior and interior skins have been adjusted accordingly, the keys of the apparatus are locked by presing strongly. Thaks to this, the prepisium is pinched between the white colored pinching apparatus and the transparent tube.
After completion of the pinching process, the adjustment of interior and exterior skins is checked fort he last time. The prepuce is removed by cutting in circulary form from 1-2 mm above of the edge of the pinching ring with a bistoury no. 11 or 15 preferably. (Never cut the same from the lower side of the pinching ring’s edge!!)
The process of circumcision has been just finished. The area is locally cleaned. The circumcised person can easily wear his underwears and trousers.