Sleeve circumcision technique

After local anesthesia and skin asepsis are performed, the two incision sites are marked circumferentially, the first one on the mucosal side of the foreskin with the prepuce in a retracted position, leaving a 5 to 10 mm cuff around the base of the corona, and following the natural V shape of the frenulum on the ventral side. The second skin marking is then made on the outer aspect of the foreskin around the base of the corona while it is reduced back to its normal position. It is important not to remove too much preputial skin, as penile shortening and tethering may occur postoperatively. Both incisions are made with a scalpel blade and carried through the Dartos fascia (A). Extreme caution is necessary when performing the ventral incision with the foreskin reduced as the urethra may be injured if the incision is too deep. The foreskin is then incised in a longitudinal fashion, adjoining both circumferential incisions, and is resected circumferentially using either scissors or electrocautery (B). Hemostasis is performed using electrocautery. The skin edges are then approximated using interrupted 4-0 or 5-0 resorbable sutures (C). The frenulum can be elongated by closing its V-shaped edges longitudinally.