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readjusted spelling of Plastibell
One of the most widely used clamps in the USA is the Gomco clamp. First, a cut is placed into the [[foreskin]], then the metal bell is placed over the [[Glans penis|glans]]. After that, the bell, together with the [[foreskin]], is pulled through the opening in the base plate and hung into the lever. By fastening the screw the lever pulls the bell upwards, jamming the [[foreskin]] between bell and base plate. After several minutes of clamping, the skin is cut off with a scalpel along the upper side of the base plate and the clamp removed.
[[File:Circumpendium-6-2-2-plastibell.jpg|center|thumb|plastibell Plastibell method]]In the [[PlastiBellPlastibell]] method, the skin is first cut lengthwise, then a plastic ring is placed over the [[Glans penis|glans]] and the [[foreskin]] pulled over it. A tightly tied string is used to fix the [[foreskin]] to a rim in the ring, thereby strangulating it.
The tissue beyond the string is cut off and the bell's handle cracked off. The strangulated tissue dies off in the following days, and the ring falls off on its own. Since this form of circumcision means part of the process goes on without medical supervision, it may not be possible to intervene promptly in the event of swelling; also there is a risk of the ring being removed prematurely due to external influence. This may cause the healing wound to burst open, necessitating additional suturing.
[[File:Circumpendium-6-2-2-Smartclamp.jpg|center|thumb|Smartclamp]]
The Smartclamp and a couple of similar designs are one way clamps, representing a mixture of the [[Gomco]] and [[PlastiBellPlastibell]] methods. The [[Glans penis|glans]] is inserted into the plastic tube, the [[foreskin]] pulled over it. The base plate of the outer clamping mechanism is pushed over the [[foreskin]] and cocked shut, jamming the [[foreskin]] between the bulging lower rim of the tube and the lower base plate. The [[foreskin]] is now cut off along the upper side of the base plate. The entire clamping mechanism remains on the [[penis]], until it - like the [[PlastiBellPlastibell]] - falls off by itself after the clamped skin dies off in the following days.
All of these methods have in common that the [[foreskin]] has to be separated from the [[Glans penis|glans]] first. In case of the circumcision of a child, it is in most cases (see chart above) necessary to forcibly tear apart the [[synechia| balanopreputial membrane]], which fuses the [[foreskin]] to the [[Glans penis|glans]], either by violently retracting the [[foreskin]] or separating it by pushing a blunt instrument underneath the [[foreskin]], both of which can result in injuries and inflammations of the [[Glans penis|glans]].