Gomco Clamp


The introduction of the Gomco clamp and the development of the bloodless technique by Yellen in 1935 and Brodie in 1939 have encouraged the practice of routine circumcision. These factors have made the operation safer, reduced the chances of infection, and practically eliminated hemorrhage. This has been corroborated by the studies of Speert and Hovsepian.

The Gomco clamp is made up of 4 parts: a plate, a stud (bell), an arm (yoke), and a nut (to tighten the clamp). The bell is introduced into the preputial cavity (over the glans and under the foreskin) and the prepuce is drawn over it. T he 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 excised.

As this clamp is the most widely used circumcision instrument worldwide (second only to the Plastibell in the U.S. which is often used on newborns), it is well known by physicians. However, recent evidence suggests the Mogen clamp, frequently used by Jewish Mohels, causes the infant less discomfort. (Jump to article.)

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

The Gomco clamp comes in a wide variety of sizes for use on infants, boys and men of all ages and sizes. The following shows a standard youth set.

1.3 cm - 1/2" Newborn; 1.6 cm - 5/8" Child; 2.1 cm - 13/16" Youth

This is a combination set. It contains 3 base Plates - 3 Bells - 1 Rocker - 1 Screw Down Wheel and can be put together to accommodate all three of the above sizes.


The following directions are provided to perform circumcision operations with the GOMCO clamp. See below for sketch of procedure.

1. Stretch the preputial opening if required

2. Break any preputial adhesions [synechial membrane] so that the foreskin is completely retractile.

3. Retract the foreskin until you can see the corona. Check the glans for any hidden adhesions.

4. Apply a small amount of lubricant such as K-Y Jelly to the glans so it won't stick to the inside of the bell.

5. Apply the bell-shaped plunger over the glans. The bell should fit easily over the glans so it covers the corona. Too small a bell may injure the glans and fail to protect the corona. If stretching the preputial opening does not allow the bell to be inserted in the preputial space and entirely cover the glans, a dorsal slit may be necessary.

6. Pull the prepuce over the bell. The foreskin should not be stretched or pulled too snugly over the bell. If it's pulled up too tightly, it's possible to remove too much shaft skin or to pull the urethra up so you get a tangential cut through the urethra as well as the skin.

7. Judge the amount of the shaft skin left below the corona; the skin should be relaxed and supple.

8. After you're sure of the dimensions, apply the plate of the clamp at the level of the corona.

9. With everything in proper alignment, tighten the clamp. This squeezes the prepuce between the bell and the clamp to make it blood-free. Be sure the weight of the clamp doesn't distort the anatomy so there isn't a proper amount of skin in the clamp.

10. Make a circumferential incision with a cold knife, not an electrosurgical instrument.

11. Leave the clamp in place at least five minutes to allow clotting and coagulation to occur.

12. Remove the clamp and apply antiseptic ointment (Betadine) to the crush line. Apply a light dressing or loin cloth arrangement to keep the ointment from rubbing off. In teen and adult circumcision, suture the incision line to prevent separation during erections.

13. If you remove the infant clamp prematurely, the crushed edges may separate and bleeding will occur. When this occurs, suture the mucocutaneous margin, being careful to avoid deep sutures that might penetrate the urethra. If the whole edge separates, treat as a freehand circumcision, placing quadrant sutures and sewing between them with fine stitches.

14. If late separation occurs, it's best to keep the wound clean and let it heal secondarily rather than try to suture it and risk development of stricture or fistula. Skin of this area tends to re-epethelialize rapidly.

RICGomco.jpg (73270 bytes)

Shown with light dressing applied.


The Gomco Clamp, by its very design, removes a larger portion of the inner foreskin (similar to the Plastibell) than does the forceps guided or freehand techniques. However, a skilled operator can manage to fit more of the outer skin into the clamp, than inner skin thereby preserving more inner foreskin lining, if desired.



Related reading:

The Gomco Circumcision: Common Problems and Solutions

http://www.aafp.org/afp/980915ap/peleg.html


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


GMD Universal Circumcision Clamp

Device Marks First 510(k) Clearance for a Significantly Equivalent Surgical Product to be Marketed at Generic Price

GIG HARBOR, Wash.--(BUSINESS WIRE)--Generic Medical Devices, Inc. (GMD), the first company to design, develop, manufacture and supply quality surgical products marketed at generic prices, today announced that the U.S. Food and Drug Administration (FDA) has cleared the GMD Universal Circumcision Clamp for market. This marks the companys first 510(k) clearance by the FDA for a medical device that will be sold as a generic alternative to existing, standard-of-care surgical products. GMD will now deliver the benefits of branded devices at costs that help reduce strains on the healthcare system.

The FDAs review and clearance of the GMD Universal Circumcision Clamp is evidence that generic devices are as safe and effective as the original, brand name products (in this case the Gomco circumcision clamp shown above). As a company, we are now able to go to market with widely-used and clinically-proven alternatives to high-priced medical products at costs that are attractive to healthcare organizations and third-party payors alike. The Circumcision Clamp is the first of what we hope will be many generic medical devices brought to market over the next few months.

The GMD Circumcision Clamp is a Class II medical device intended for use in circumcision procedures generally performed on newborns and less frequently on older males. Clearance of the GMD Universal Circumcision Clamp is based on the device being substantially equivalent having the same or equivalent materials, design specifications, technological characteristics, operation, intended use and performance to pre-amendment devices and a product currently on the market. Additionally, because this type of technology and procedure have a long history of efficacy and clinical use, no additional clinical research was required to establish equivalence.

In addition to opening the door for GMD to market low-cost generic devices for healthcare organizations in the United States, clearance also gives us the chance to begin exploring opportunities with organizations in Third World nations where there is an immediate need for proven and affordable devices that could help stem infection rates for such diseases as HIV, continued Kuntz. The potential humanitarian benefits could be enormous and far reaching.

About Generic Medical Devices

Generic Medical Devices, Inc. is the worlds first designer, developer, manufacturer and supplier of quality medical products marketed at generic prices that allow healthcare providers to meet the standard of care for patients. Recognizing the need for healthcare reform and the ever-increasing burden that Americas aging population is placing on the healthcare system, GMD set out to develop lower-priced products with proven outcomes and better-than product features. These generic devices, based on products that are becoming a commodity in the marketplace, allow the healthcare system to provide more patients access to innovative and often expensive treatments while helping to stem the tide of rising healthcare costs. Generic Medical Devices, Inc.[TM] (GMD[TM]), announced May 2007 that it has opened for global business with the establishment of its European headquarters in Brussels, Belgium. In addition, J.P. Allar has been named GMD's Vice President, International Sales and Managing Director, GMD Europe, and Daniel Verstappen, R.N. will join GMD as Senior Director, Clinical and Regulatory, GMD Europe.

 




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