Mogen clamp

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The Mogen clamp, one of the three most common circumcision devices, was invented by Rabbi Harry Bronstein in 1954.[1] It has two flat blades that open approximately 3 mm.[2] The name "Mogen clamp" is a general term for a style of clamp; there are several different manufacturers of specific models.[citation needed]

History and prevalence[edit]

Rabbi Harry Bronstein, a mohel from Brooklyn, invented the Mogen clamp in 1954. The name "Mogen" was derived from the Hebrew word מגן (magen), which means shield. Bronstein hoped to standardize circumcision equipment for mohels and doctors.[1] Medical literature reports that the Mogen clamp is (probably) the third most popular circumcision clamp (after Plastibell and Gomco) used by medical practitioners in hospitals.[3]

Procedure[edit]

The hospital circumcision procedure with the Mogen clamp is as follows:

  1. Apply local anesthetic
  2. Use hemostats to draw the foreskin forward
  3. Break any adhesions from the foreskin to the glans penis
  4. Place the Mogen clamp over the foreskin following the angle of the corona, ensuring the glans is not trapped
  5. Use the Mogen clamp arm to close the clamp, crushing the foreskin along a line that is 1mm wide
  6. Excise the foreskin distal to the clamp
  7. Release the clamp arm and remove the clamp
  8. Liberate the glans by pulling the crush line apart
  9. Bandage[4][5]

The hospital procedure usually takes three to four minutes and is virtually bloodless.[5]

Newborn post-procedure care[edit]

  • Remove the bandage 48 hours after the procedure
  • Clean the penis by washing gently with water several times per day[6]

Advantages[edit]

  • Fastest:[3] Procedure with Mogen clamp has been found to be from 2.5 times[7] to over ten times[8] faster than with Gomco clamp and almost two times faster than with the PlastiBell technique[9]
  • Preferred by hospital residents and interns vs. PlastiBell in one institution in San Francisco [9]
  • Does not leave a foreign body at the circumcision site vs. Plastibell [5]
  • Least likely to lead to infection[10]
  • Allows full visualization of exactly how much foreskin to remove[3]

Disadvantages[edit]

  • It is not possible to remove as much inner foreskin as with the Gomco clamp
  • Scar might be crooked if the device isn't perfectly angled and lined up
  • Device does not directly protect the glans during the procedure[5]
  • The glans is not visualized before removal of the foreskin[3]

Complications specific to the Mogen clamp[edit]

A 1984 study of 313 circumcisions using the Mogen clamp states "Circumcision using the Mogen clamp is a simple quick, and safe procedure." The study showed that the "complication rate was low (1.6%)."[11]

If the Mogen clamp is placed inappropriately,[12] or is otherwise used in a way outside the manufacturer's specifications,[13] injury to or removal of a portion of the glans penis is possible; several cases of this occurring have been reported.[3][12][14]

Lawsuits[edit]

A Massachusetts lawsuit regarding a circumcision performed using Mogen Circumcision Instruments' clamp resulted in a $7.5 million judgement against Mogen Circumcision Instruments of New York in 2007. This judgment caused Mogen to go into default.[15]

In a case in which 85% of a child's glans penis was accidentally amputated, and could not be reattached, a lawsuit was filed against Miltex Inc., Miltex Inc.'s parent company Integra Life Sciences Holding Corp., and the doctor who performed the circumcision. Miltex Inc. and Integra Life Sciences Holding Corp. were ordered to pay the child and his mother $4.6 million. The lawsuit against the doctor was dismissed.[1][16][17]

See also[edit]

References[edit]

  1. ^ a b c Molly Hennessy-Fiske (2011-09-26). "Injuries linked to circumcision clamps". Los Angeles Times. 
  2. ^ Ellsworth, Pamela et al. (2012-02-08). "Circumcision Devices". eMedicine. 
  3. ^ a b c d e Strimling, BS (1996). "Partial amputation of glans penis during Mogen clamp circumcision". Pediatrics 97 (6 Pt 1): 906–7. PMID 8657537. 
  4. ^ Reynolds, RD (1996). "Use of the Mogen clamp for neonatal circumcision". American family physician 54 (1): 177–82. PMID 8677833. 
  5. ^ a b c d Dr. Brendan Duterte, performing physician; Janelle Aby, MD, producer. Circumcision -- Mogen Technique. Stanford School of Medicine. 
  6. ^ "Newborn Circumcision Information". Kaiser Permanente. p. 2. Retrieved April 30, 2012. 
  7. ^ Kurtis, P. S.; Desilva, H. N.; Bernstein, B. A.; Malakh, L.; Schechter, N. L. (1999). "A Comparison of the Mogen and Gomco Clamps in Combination with Dorsal Penile Nerve Block in Minimizing the Pain of Neonatal Circumcision". Pediatrics 103 (2): e23. doi:10.1542/peds.103.2.e23. PMID 9925869. 
  8. ^ "Less Painful Newborn Circumcision". Harvard Medical School Family Health Guide. June 2000. Retrieved April 30, 2012. 
  9. ^ a b Taeusch, H William; Martinez, Alma M; Partridge, J Colin; Sniderman, Susan; Armstrong-Wells, Jennifer; Fuentes-Afflick, Elena (2002). "Pain During Mogen or PlastiBell Circumcision". Journal of Perinatology 22 (3): 214–8. doi:10.1038/sj.jp.7210653. PMID 11948384. 
  10. ^ By Healthwise Staff, reviewed by Adam Husney, MD and Peter Anderson, MD, FRCS(C) - Pediatric Urology (January 29, 2010). "Mogen clamp for circumcision". WebMD. Retrieved April 30, 2012. 
  11. ^ Kaweblum, YA; Press, S; Kogan, L; Levine, M; Kaweblum, M (1984). "Circumcision using the Mogen clamp". Clinical pediatrics 23 (12): 679–82. doi:10.1177/000992288402301204. PMID 6499347. 
  12. ^ a b "Complications of Circumcision". Stanford School of Medicine -- Department of Pediatrics. Retrieved April 30, 2012. 
  13. ^ David W. Feigal, Jr., MD, MPH (August 29, 2000). "Potential for Injury from Circumcision Clamps". FDA. Retrieved April 30, 2012. 
  14. ^ Patel, HI; Moriarty, KP; Brisson, PA; Feins, NR (2001). "Genitourinary injuries in the newborn". Journal of pediatric surgery 36 (1): 235–9. doi:10.1053/jpsu.2001.20062. PMID 11150473. 
  15. ^ Molly Hennessy-Fiske (September 26, 2011). "Injuries linked to circumcision clamps". Retrieved Jul 30, 2012. 
  16. ^ "$4.6M Settlement in Botched Circumcision Lawsuit My Fox LA, Published July 18, 2011
  17. ^ Boy's Family To Receive $4.6M For Botched Circumcision CBS Los Angeles, Published July 18, 2011

External links[edit]