Dorsal-slit circumcision technique

The dorsal-slit technique is useful for patients with very tight phimosis. After local penile anesthesia and skin asepsis, hemostatic clamps are placed at 3 and 9 o'clock on the distal edge of the foreskin. The foreskin is then "crushed" at the dorsal midline with a straight hemostatic clamp for hemostasis and held for a few seconds. Then a dorsal midline incision using scissors is performed along the crush line until the foreskin can be adequately retracted (A). The glans penis is then cleaned and prepped adequately with antiseptics. Two circumferential skin markings are then drawn in a similar fashion to the sleeve technique. The two incisions may then be performed simultaneously with scissors while following the lines and keeping the foreskin on traction with hemostatic clamps (B). Alternatively, the sleeve technique may be used to finish the procedure now that the foreskin can be reduced. Hemostasis and skin closure are performed identically to the sleeve technique (C).