Safe Paediatric Male Circumcision Simulator/Module 3: Plastibell circumcision

The simulator video below outlines the steps for a Plastibell circumcision:

Plastibell Circumcision Simulator video

Selecting Plastibell size

This video demonstrates how to select appropriate Plastibell size to avoid strangulation of the glans or Plastibell retention.

After practicing with the simulator, use the self-assessment checklist below to assess your level of proficiency. You must score Done or 1 in all steps to confirm proper completion of the procedure. If you score Not done or 0, or you are not sure whether to score Done or Not done, then repeat that step until you can confidently score Done or 1.

Self-assessment checklist/framework for safe paediatric male circumcision

PLASTIBELL TECHNIQUE

Step	Description	Completion Status
	Preparation
1.	Examines both the tip and shaft of the penis to ensure there are no abnormalities.	☐ Done ☐ Not Done
2.	Opens sterile instrument pack for circumcision without touching enclosed contents.	☐ Done ☐ Not Done
3.	Places dextrose pacifier in baby’s mouth.	☐ Done ☐ Not Done
4.	Ensures appropriate position of apparatus; feeding bottle nipple and base placed over groin of image on board projection of conical plasticine tip through cut end of nipple two glove fingers projecting around nipple.	☐ Done ☐ Not Done
5.	Scrubs and wears sterile gloves for procedure.	☐ Done ☐ Not Done
6.	Prepares appropriate dilution of preferred local anesthetic using appropriate doses (see dosages below**) and using aseptic technique.	☐ Done ☐ Not Done
7.	Uses warm antiseptic solution (cetrimide or chlorhexidine) to cleanse the baby’s perineum.	☐ Done ☐ Not Done
8.	Applies a sterile drape around the surgical area.	☐ Done ☐ Not Done
	Analgesia
9.	Administers local anesthetic* at 2 and 10 O’clock positions deep to the pubic symphysis after palpating to determine position. Does not puncture skin more than twice.	☐ Done ☐ Not Done
10.	Adds additional ring block at base of phallus, raising a subcutaneous weal circumferentially.	☐ Done ☐ Not Done
11.	Allows 5-7 minutes for anesthesia to take effect.	☐ Done ☐ Not Done
12.	Uses toothed dissecting forceps to gently pinch prepuce to confirm that anesthesia has taken effect before proceeding.	☐ Done ☐ Not Done
	Procedure
13.	Applies two hemostats to the lateral edges of the prepuce.	☐ Done ☐ Not Done
14.	Gently pulls the prepuce forward with the haemostats.	☐ Done ☐ Not Done
15.	Inserts a well-lubricated (dipped briefly in the antiseptic solution) curved haemostat into the preputial opening, directing the tip upwards and away from the urethra.	☐ Done ☐ Not Done
16.	Gently sweeps around the inner prepuce to lyse adhesions without causing tears or bleeding.	☐ Done ☐ Not Done
17.	Gradually opens the forceps to widen the preputial opening without causing tears or bleeding.	☐ Done ☐ Not Done
18.	Removes hemostat on the lateral edges of the prepuce.	☐ Done ☐ Not Done
19.	Retracts the prepuce from the glans and wipes away smegma until the corona is clearly visible circumferentially.	☐ Done ☐ Not Done
20.	Inspects the glans for abnormalities and estimates the appropriate plastibell size.	☐ Done ☐ Not Done
21.	Repositions the prepuce over the glans.	☐ Done ☐ Not Done
22.	Reapplies the hemostats on the lateral edges of the prepuce	☐ Done ☐ Not Done
23.	Applies a straight hemostat to the dorsal midline of the prepuce to create a crush line.	☐ Done ☐ Not Done
24.	Uses blunt-tipped dissecting scissors to make a dorsal slit along the crush line up to two-thirds of the prepuce, exposing only the tip of the glans.	☐ Done ☐ Not Done
25.	Applies the selected plastibell over the glans.	☐ Done ☐ Not Done
26.	Changes to bigger sized plastibell if the selected plastibell is noted to be too tight over glans.	☐ Done ☐ Not Done
27.	Stretches the prepuce over the plastibell and cross clamps with a hemostat to hold in place.	☐ Done ☐ Not Done
28.	Secures plastibell lightly with a ligature, placing ligature only on groove of plastibell.	☐ Done ☐ Not Done
29.	Checks circumferentially to confirm that ligature is placed only on groove of plastibell before securing knot more tightly.	☐ Done ☐ Not Done
30.	Makes at least 4 knots with the ligature.	☐ Done ☐ Not Done
31.	Inspects penis to see that tip of glans is centrally positioned and no part of the penis has been caught in ligature except prepuce.	☐ Done ☐ Not Done
32.	Trims the ligature. Then trims the prepuce circumferentially distal to the ligature.	☐ Done ☐ Not Done
31	Breaks the handle of the plastibell by bending gently forward and backward while holding the ring.	☐ Done ☐ Not Done
32.	Cleanses the wound using antiseptic lotion or normal saline.	☐ Done ☐ Not Done
33.	Observes to confirm there is no residual bleeding before handing the baby back to mother or caregiver.	☐ Done ☐ Not Done
	Total score

*Scoring

Not done - 0

Done - 1

**Dosages

Local anesthetic - to include one of the following as available in the locality:

1. 1% or 2% Plain lidocaine 3mg/kg in 1:1 dilution.

2. 0.25% or 0.5% Bupivacaine 2mg/kg made up to 2ml or 3ml volume.

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Authors	SAFE PAEDIATRIC MALE CIRCUMCISION SIMULATOR
License	CC-BY-SA-4.0
Language	English (en)
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Created	March 18, 2025 by SAFE PAEDIATRIC MALE CIRCUMCISION SIMULATOR
Last edit	December 30, 2025 by StandardWikitext bot
Cite as	SAFE PAEDIATRIC MALE CIRCUMCISION SIMULATOR (2025). "Safe Paediatric Male Circumcision Simulator/Module 3: Plastibell circumcision". Appropedia. Retrieved May 30, 2026.
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