Safe Paediatric Male Circumcision Simulator/Module 4: Sleeve circumcision

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

Sleeve Circumcision Simulator video

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

Sleeve technique

Step	Description	Completion Status
	Preparation
1.	Examines both the tip and shaft 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 cut-end 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 position 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.	Allow 5-7 minutes for anesthesia to take effect.	☐ Done ☐ Not Done
12.	Uses toothed dissecting forceps to gently pinch on penile skin 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 prepuce 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.	☐ Done ☐ Not Done
21.	Makes a circumferential mark on inner prepuce about 0.5-1 cm distal to the corona.	☐ Done ☐ Not Done
22.	Repositions the prepuce over the glans.	☐ Done ☐ Not Done
23.	Makes a circumferential mark on outer prepuce at the level of the corona.	☐ Done ☐ Not Done
24.	Ensures marking allows for tension-free apposition of shaft skin with preputial collar.	☐ Done ☐ Not Done
25.	Carefully makes circumferential incisions based on preputial markings.	☐ Done ☐ Not Done
26.	Uses curved dissecting scissors to excise the prepuce distal to the marking by sharp dissection.	☐ Done ☐ Not Done
27.	Picks bleeding points within dartos tissue and secures hemostasis with suture ligation.	☐ Done ☐ Not Done
28.	Apposes the preputial collar and penile shaft skin using fine absorbable sutures*** or tissue adhesive.	☐ Done ☐ Not Done
29.	Makes at least 4 knots with each suture tie.	☐ Done ☐ Not Done
30.	Inspects wound circumferentially to confirm no residual areas of bleeding.	☐ Done ☐ Not Done
31.	Cleanses wound with normal saline or antiseptic solution.	☐ Done ☐ Not Done
32.	Applies a sterile non-adherent dressing to be left in place for 24 hours.	☐ 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.

*** Suture size

Absorbable sutures available in the local environment should be used. Appropriate sizes range from 4/0 to 6/0 dependent on child’s weight and age.

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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/Module 4: Sleeve circumcision". Appropedia. 2025. Retrieved June 4, 2026.
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