Circumcision is performed using one of several specialized tools, depending on the patient’s age and the clinical setting. For newborns in the United States, three devices dominate: the Gomco clamp, the Mogen clamp, and the Plastibell. For older children and adults, surgeons typically use a scalpel-based technique with electrocautery, or newer single-use devices like the ZSR stapler or the ShangRing. Each tool works differently, carries its own complication profile, and shapes the recovery experience in distinct ways.
The Three Standard Newborn Devices
Nearly all infant circumcisions in the U.S. rely on one of three tools. All three protect the head of the penis while the foreskin is removed, but they differ in speed, complexity, and the training required to use them safely. Overall complication rates for infant circumcision are low, ranging from 0.2% to 0.6%, with bleeding occurring in roughly 0.08% to 0.18% of cases and infection in about 0.06%.
Gomco Clamp
The Gomco clamp is a multi-part metal device. A small bell is placed over the head of the penis and beneath the foreskin. The foreskin is then pulled up and over the bell, and a flat base plate is fitted around it. A top plate (called a rocker arm) connects to the bell and is tightened against the base plate, crushing the foreskin between the two surfaces. This compression stays in place for about five minutes, cutting off blood flow. The crushed tissue is then trimmed away and the device is disassembled.
The Gomco requires more training to use correctly and takes longer than the other options. It is associated with slightly more bleeding and a higher overall complication rate compared to the Mogen clamp.
Mogen Clamp
The Mogen clamp is the simplest and fastest of the three. It looks like a pair of pliers with a narrow slit, only about 3 mm wide. The foreskin is pulled forward and slid into the slit, and the clamp is closed for 60 to 90 seconds. The compressed tissue above the clamp is then removed with a scalpel, and the clamp is released.
Because the procedure is straightforward, the Mogen requires the least training and the shortest procedure time. It also produces less bleeding and fewer complications than the Gomco or Plastibell. A randomized trial found that infants experienced less pain with the Mogen clamp compared to the Gomco.
Plastibell
The Plastibell works on a different principle. Instead of crushing and immediately cutting, a plastic ring is placed over the head of the penis beneath the foreskin. A string ligature is tied tightly around the foreskin over the ring, which cuts off blood supply to the tissue. The excess foreskin above the string is trimmed, and the ring stays in place. Over the next week or so, the remaining tissue dies and the ring falls off on its own.
Parents sometimes prefer the Plastibell because there is no open wound at the time of the procedure. However, it requires a similar level of training to the Gomco, takes longer, and carries a comparable complication profile. The ring occasionally fails to detach on schedule, which can require a follow-up visit.
Devices for Adults and Older Children
Older patients have different anatomy and thicker tissue, so the clamps designed for newborns are not used. Adult circumcision has traditionally been a scalpel-and-suture procedure, but newer devices have shortened the process considerably.
Conventional Surgical Tools
In a traditional “open” circumcision, the surgeon uses a scalpel or surgical scissors to remove the foreskin, then seals blood vessels and closes the wound with sutures. To control bleeding, many surgeons use bipolar electrocautery, a tool that passes a small electrical current between the tips of a pair of forceps to seal individual blood vessels. Bipolar electrocautery is preferred over other electrical options because the current stays localized between the two tips, reducing the risk of unintended burns to surrounding tissue. The entire procedure typically takes 30 minutes or more.
ZSR Stapler
The ZSR is a disposable, single-use device that looks something like a small staple gun. It simultaneously cuts the foreskin and places a ring of tiny silicone-coated staples along the wound edge, sealing it shut without any hand-sewn stitches. The staples fall off naturally within about two weeks.
The biggest practical advantage is speed. A ZSR procedure typically takes 3 to 5 minutes, compared to over 30 minutes for conventional surgery. Recovery tends to be faster, the wound edges are more uniform, and patients generally need fewer follow-up visits. Pain after the procedure is reported as minimal, with mild discomfort lasting about 15 minutes.
ShangRing
The ShangRing is a two-ring clamp system designed for use in both adults and older boys. An inner ring is placed around the head of the penis, and an outer ring snaps over it, trapping and compressing the foreskin between the two. The excess tissue is trimmed, and the rings are left in place. The device is typically removed at a follow-up visit about seven days later, though in some cases it detaches on its own. The World Health Organization has prequalified the ShangRing for use in voluntary medical circumcision programs, making it a key tool in large-scale public health campaigns, particularly in sub-Saharan Africa.
Pain Management Tools
The circumcision device itself is only part of the picture. Effective pain control requires its own set of tools. For newborns, the standard approach is a dorsal penile nerve block: a small syringe with a fine 27-gauge needle is used to inject a local anesthetic (typically 1% lidocaine without epinephrine) at the base of the penis, numbing the nerves that supply the foreskin. Some providers also use a topical numbing cream applied 60 to 90 minutes before the procedure, or a subcutaneous ring block around the shaft.
For adults, the nerve block technique is similar but uses larger volumes of anesthetic. When the procedure is done with a stapler or ring device, the short duration means less total anesthesia time, which is one reason these newer tools have become popular in outpatient settings.
How the Tool Affects Recovery
The choice of device shapes what recovery looks like. With clamp-based newborn procedures (Gomco and Mogen), the wound is fully exposed immediately after the procedure. Parents typically apply petroleum jelly and gauze to prevent the healing tissue from sticking to the diaper. Healing takes about 7 to 10 days.
With the Plastibell and ShangRing, a piece of the device stays on the body during the early healing phase. This can be reassuring because the wound is partially protected, but it also means watching for signs that the device is not detaching properly. For the ZSR stapler, the small staples along the wound edge eliminate the need for stitch removal, and the wound itself tends to look neater as it heals.
In adults, conventional sutured circumcisions often involve noticeable swelling for 2 to 3 weeks and require stitch removal or dissolution. Stapler-based procedures generally produce less swelling and a faster return to normal activity, though mild bruising around the staple line is common in the first few days.