2. circumcision with smartklamp

'Ring Block' technique is commonly used in older child. Injection of about 1-2cc LA given through subdermal space at 11 ' and 1 ' o'clock position at base of penis. Then the LA is injected laterally and toward the ventral surface of penis. Injection through ventral site is also commonly practiced.
The foreskin needed to be stretched wide to allow the tube to be inserted. Apply some lubricants like petroleum jelly over the tube so the insertion is less friction.

Once the tube is secured inside the foreskin, release the forceps. If necessary catch and pull the edge of foreskin with forceps.
Outer clamp then inserted. It needed to be angled about 30 degree before passing through the rectangular part of the inner tube. The clamp is inserted over the tube and pushed as far as possible until it reaches the end of the cylinder tube. This is where the skin is tightly gripped between the tube and the clamp.

The clamp then is turned 90 degree clockwise or anticlockwise to allow the rectangular part of the tube fixed onto the clamp outer rectangular ring. When enough foreskins have been pulled and urethral meatus is properly aligned in the center, press the lock once.

When the side arms pressed in further, the second lock activated and the smartklamp is fully locked. If there are complications, the lock can still be released, but a bit harder.

Use either scalpel or fine scissors to cut the unwanted skin.

At day 5 of post circumcision, use a cutter to cut through the outer ring of the external clamp. Smartklamp is easily removed with minimal pain.
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