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Gomco

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[[Image:Gomco_clamp.jpg|right|thumb|A medical instrument used in circumcision ]]
A '''Gomco clamp''', otherwise known as a '''Yellen clamp''',<ref> {{cite journalREFjournal |authorlast=Warner E, Strashin E | first= | coauthors= | pubyear=1981, November |title=Benefits and risks of circumcision |journal=Can Med Assoc J |volume=125 |issue=9 |pages=967–76, 992 |yearurl= | quote=1981 |monthaccessdate=November |pmid=7037142 |pmc=1862490 |doi= |url= |postscript=}} </ref><ref name="gelbaum">{{cite journalREFjournal |authorlast=Gelbaum | first=I. | coauthors= | pubyear=1993 |title=Circumcision. Refining a traditional surgical technique |journal=J Nurse Midwifery |volume=38 |issue=2 Suppl |pages=18S–30S |yearurl= | quote= | accessdate=1993 |pmid=8387102 |doi= 10.1016/0091-2182(93)90093-V |url= |postscript=}}</ref> is a specialized clamp for performing circumcisions. It was invented by Hiram S. Yellen and Aaron Goldstein in 1934-1935.<ref>{{Cite bookREFbook | last=Hodges | first=Frederick | year=1997 | title = Sexual mutilations: a human tragedy | contribution url= A Short History of the Institutionalization of Involuntary Sexual Mutilation in the United States | last editor= HodgesGeorge C. Denniston, Marilyn Fayre Milos | first edition= Frederick | editor1-last volume= Denniston | editor1-first chapter= George C.A Short History of the Institutionalization of Involuntary Sexual Mutilation in the United States | editor2-last pages= Milos26 | editor2-first location= Marilyn Fayre | publisher = Springer | date =1997 | isbn = 9780306455896 | pages note= 26 | postscript accessdate=}}</ref><ref>{{cite journalREFjournal |authorlast=Alanis MC, Lucidi RS | first= | coauthors= | pubyear=2004, May |title=Neonatal circumcision: a review of the world's oldest and most controversial operation |journal=Obstet Gynecol Surv |volume=59 |issue=5 |pages=379–95379-95 | url= |yearquote=2004 |monthaccessdate=May |pmid=15097799 |doi= 10.1097/00006254-200405000-00026 |url= |postscript=}}</ref> Gomco stands for the <u>Go</u>ldstein <u>M</u>edical <u>Co</u>mpany, the original manufacturer of the clamp.<ref name="gelbaum"/> In a 1998 study, it was the preferred circumcision technique of 67% of US physicians.<ref>{{cite journalREFjournal | author last= Stang HJ, Snellman LW | first= | coauthors= | pubyear=1998, June | title = Circumcision practice patterns in the United States | journal = Pediatrics | volume = 101 | issue = 6 | pages = E5 | year url=http://pediatrics.aappublications.org/cgi/content/full/101/6/e5 | quote= 1998 | month accessdate= June
| pmid = 9606247
| doi = 10.1542/peds.101.6.e5
| url = http://pediatrics.aappublications.org/cgi/content/full/101/6/e5 | postscript =}}</ref>
==Method==
[[Image:Gomco.gif|Circumcision with Gomco clamp]]
 The technique is as follows:<ref>{{cite journal REFjournal |first1last=David Peleg |last1first=Peleg David |first2coauthors=Ann Steiner |last2pubyear=Steiner 1998 |title=The Gomco Circumcision: Common Problems and Solutions |journal=American Family Physician | volume=58 | issue=4 |pmidpages=9767725 891-8 |url=http://www.aafp.org/link_out?pmid=9767725 |yearquote=1998 |volumeaccessdate=58 |issuepmid=4 |pages=891–89767725}}</ref>
# Anesthetic should be applied (though it is a historically recent addition, dating only to approximately the early 1990s).
# The foreskin is gripped with two hemostats (tissue holders) and a tool is inserted between his foreskin and glans.<ref name="children.webmd"/>
# Once separated, a hemostat is used to pull his foreskin lengthwise in order to reduce bleeding.<ref name="children.webmd"> HealthWise Medical Reference, Available online at: http://children.webmd.com/tc/circumcision-what-happens-during-a-circumcision Last Updated: February 19, 2008.</ref>
# Next, the foreskin is cut lengthwise through the stretched tissue (dorsal slit) to allow space to insert the circumcision device.<ref name="children.webmd" />
# The bell of the Gomco clamp is placed over the glans, and the foreskin is pulled over the bell.
== Description ==
From a 1935 article <ref>{{REFjournal | last=Hiram | first=Yellen | coauthors= | pubyear=1935 | title=Bloodless circumcision of the newborn | journal=American Journal of Obstetrics and Gynecology | volume=30 | issue= | pages=146-7 | url=http://www.historyofcircumcision.net/index.php?option=content&task=view&id=43#yel | quote= | accessdate=2015-08-13}}</ref> by Dr. Hiram Yellen, one of the two inventors (with Aaron Goldstein) of the Gomco Clamp. 
<blockquote>
''...the dorsal aspect of the prepuce (A) is put on a stretch by grasping it on either side of the median line with a pair of haemostats. A flat probe, anointed with Vaseline, is then inserted between the prepuce and the glans to separate adherent mucous membrane. The prepuce is then gently drawn backward, exposing the entire glans penis. This is again cleaned. In case where the prepuce is drawn tightly over the glans, a partial dorsal slit will facilitate applying the cone of draw stud over the glans [?? sic]. (Note: If too long a slit is made, the cone has a tendency to slip of the glans. The slit should, therefore, be made only sufficiently long to enable the cone to be easily applied.)
''On children older than twelve months, we find it advisable to insert a few sutures.
</blockquote>
<ref>{{cite journal | title = Bloodless circumcision of the newborn | journal = American Journal of Obstetrics and Gynecology | date = 1935 | first The pin = Yellen | last = Hiram | coauthors = | volume = 30 | issue = | pages = 146-7 | id = | format = | accessdate = 8/13/2015 | url = http://www.historyofcircumcision.net/index.php?option=content&task=view&id=43#yel}}</ref>
A small safety pin may be used to bring the edges of the dorsal slit together over the flare of the bell before bringing the draw stud through the base plate. The safety pin should be inserted through both the foreskin and the mucosa so that care is taken not to omit the mucosal layer. In addition, the clinician must take special care to make sure that the sharp end of the safety pin does not cause inadvertent injury to the clinician or the infant.<ref>{{REFweb
| last=David Peleg, M.D., and Ann Steiner, M.D
| first=
| year=1998-09-15
| title=The Gomco Circumcision: Common Problems and Solutions
| url=http://www.aafp.org/afp/1998/0915/p891.html
| publisher=
| accessdate=
}}</ref>
[[Image:safetypin.jpg]]
== Advantages ==
=== The pin ===
A small safety pin may be used to bring the edges of the dorsal slit together over the flare of the bell before bringing the draw stud through the base plate. The safety pin should be inserted through both the foreskin and the mucosa so that care is taken not to omit the mucosal layer. In addition, the clinician must take special care to make sure that the sharp end of the safety pin does not cause inadvertent injury to the clinician or the infant.<ref>
{{cite web
| author = DAVID PELEG, M.D., and ANN STEINER, M.D
| title = The Gomco Circumcision: Common Problems and Solutions
| date=1998-09-15
| url = http://www.aafp.org/afp/1998/0915/p891.html
}}
</ref>
 
[[Image:safetypin.jpg]]
 
==Advantages==
* The circumcision scar is straight.
* The circumcision is relatively quick compared to the more recent Plastibell.
== Disadvantages ==
 
* Involves several small parts, all of which must be sterile so as to ensure the safety of the patient and minimize the risk of infection.
* Special care needs to be taken to match the correct size bell and clamp to prevent injuries to the glans.
[[Image:Gomco Image gallery.jpg|Gomco clamp crushing a foreskin]]
== External links =={{LINKS}}* [http://www.danheller.com/circumcision.html Photos of a circumcision, by Dan Heller] * [http://www.pediatricsconsultantlive.com/display/article/1803329/1601590?pageNumber=4 The Gomco Method]
==<small>References</small>==<div class='references-small'><references/></div>{{REF}}
[[Category:Circumcision Products]]
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