The Gomco® Circumcision Clamp



Last updated: 08 March 2014, 18:48 UTC



Originally made by the Gomco Surgical Manufacturing Corporation of Buffalo NY, USA, this design of circumcision clamp remains in common use and has seen off many later variants. The precise date of product launch is uncertain, but the US Patent and Trademark Office has on file an advertisement published 25.April.1935. The theoretical principle of operation relies on the work of H.S. Yellen, in particular on a paper “Bloodless Circumcision of the Newborn” he read to the Buffalo Academy of Medicine on 23.Jan.1935. Realisation of the first practical design to implement the general concept is frequently attributed to A.A. Goldstein, but there is some suggestion that the Winkelmann Clamp may have pre-dated the Gomco design. This would account for the fact that the patent in Goldstein’s name is a Design Patent (D119180) and not a Utility Patent.

Although the original patent has long expired the name Gomco is still a Registered Trade Mark, currently the intellectual property of Allied Healthcare Products. Thus, whilst look-alike devices can now be produced without infringement of design rights, the name Gomco can only lawfully be used to describe the commercial product of the Trademark holder or their licencee.

The Gomco circumcision clamp comes in a wide variety of sizes for use on infants, boys and men of all ages and sizes. By careful adjustment it can be used to achieve a variety of styles of circumcision. It is especially suited to performing tight circumcisions pre-puberty; because the bell has a closed end there is no danger of it slipping past the glans as can happen with a Plastibell. However, it is possible for the coronal rim of the glans to be trapped in the clamp. Extreme care is needed to avoid this possibility.

The clamp naturally produces a relatively ‘low’ style, especially compared with the forceps-guided technique. To choice it also has the ability to deliver very tight circumcisions, much tighter than can be achieved with a Plastibell.



Description of the device

The clamp is made up of 4 parts: a plate, a stud (bell), an arm (yoke), and a nut (to tighten the clamp). As illustrated below (left), the nut and the yoke can be common to several sizes. Only the bell and the plate need to be selected to fit the glans of the patient. Careful pairing of these is required. A USFDA Caution exists in respect of worn or incorrectly matched components.

Gomco Clamp set, Youth’s sizes Gomco parts, adult size
A set of Gomco Clamps, sizes 13mm, 16mm and 21mm Parts in adult size

The bell is introduced into the preputial cavity (over the glans and under the foreskin) and the prepuce is drawn over it. The plate is then placed over the bell so that the prepuce is sandwiched between them. The arm is fitted into its proper place and when the nut is screwed on tightly, it exerts a crushing force on the prepuce at the junction of the bell and plate. The clamp is left on for 5 minutes to achieve hemostasis and the prepuce is then excised with a scalpel. Due to the metallic construction of the clamp, electrosurgical techniques cannot be used.

Note:  This device should not be used to do a self-circumcision. Circumcision should always be performed by a trained and skilled healthcare provider.


Illustration of procedure


Sketch : Gomco Procedure (22,685 bytes) Sketch : Bandaged (73,270 bytes)
Artist’s impression : Gomco circumcision of a young boy



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Wound closure in adults and older boys : Sutures or glue?

In infants, the crushing action of the Gomco clamp is normally sufficient to bring about wound closure without further intervention. However, in older children and adults some form of reinforcement is necessary in order to prevent the wound edges from separating during erections. Traditionally this is done by suturing, normally using absorbable suture material. This complicates matters, increasing both the skill requirements and the duration of the whole procedure.

Doctors in Beira, Mozambique, are using the Gomco clamp followed by Dermabond® to seal the wound. Such cyanoacrylate tissue adhesives (essentially specially-formulated super glues) are used extensively in medicine and have been shown to provide excellent results in circumcisions. The objective is to de-skill the surgery such that Gomco circumcisions can, in the context of anti-HIV mass circumcision campaigns, be performed by general medical practitioners and surgical assistants. This allows circumcisions to be done under local anesthesia using standard instruments in primary care clinics, thus allowing fully trained surgeons to attend to other, more complex duties.

Unlike circumcisions done with clip-&-wear clamps (which induce healing by Secondary Intention), this procedure results in healing by Primary Intention. The proponents of Primary Intention claim that the wound is more secure against infection in the period before it is fully healed. Supposedly there is, in consequence, a lower risk of HIV acquisition if sexual activity is resumed prematurely.

The procedure is illustrated here:


Gomco + Wound Glue as being used in Mozambique (2011).
Explicit photo

1.  Assembly of the Gomco Clamp
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2.  Gomco in place
Explicit photo

3.  Removing the foreskin
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4.  Foreskin cut
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5.  Gomco clamp removed (1)
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6.  Gomco clamp removed (2)
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7.  Applying glue
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8.  One week after surgery (Dorsal)
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9.  One week after surgery (Ventral)
Download: 9 kB

10.  Three weeks after surgery
Mozambique flag   Icon   Watch a video of the whole procedure on YouTube.

A full report of this method is expected to be published shortly in Tropical Doctor.



Related reading

The Gomco Circumcision: Common Problems and Solutions
http://www.aafp.org/afp/980915ap/peleg.html

True, day-by-day experience of a 24 year old Canadian man’s circumcision with the Gomco clamp. Includes pictures taken during the procedure.



Sales outlet of the current Trademark owner:
USA flag Allied Healthcare Products



Known manufacturers of look-alike products:
USA flag Generic Medical Devices Inc.
Pakistan flag Lister Surgical logo Lister Surgical Co.
Other manufacturers and wholesale distributors wishing to have their names added to this list are invited to contact the Editor.



Incremental improvements

A number of attempts have been made to introduce incremental improvements to the original Gomco design. Notable are the Circumstat and Baumgarten’s Modification (United States Patent number 3874389, which the inventor assigned to the Gomco Surgical Manufacturing Corporation in 1974).



Acknowledgements

The following addditional resources were used in the preparation of this web page:
USA flag USPTO logo US Trademark Electronic Search System (TESS), accessed 16.Jan.2011.
USA flag (316 bytes) Free Patents Online logo (1687 bytes) http://www.freepatentsonline.com/ record for US Design Patent number D119180.
USA flag USFDA logo US Food and Drug Administration safety alert, updated 18.Nov.2010.




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