Lysis of "Adhesions"

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Use your non-dominant hand to hold both hemostats, separating them slightly.

In this image: The physician holds both hemostats in their non-dominant hand while separating them slightly.

Take another straight hemostat (closed) in your dominant hand and enter the midline dorsal space between the prepuce and glans, keeping the tip of the hemostat up to prevent damage to the glans.

In this image: The clinician keeps the tip of the hemostat up to prevent damage to the glans.

In this image: The physician pushes the closed hemostat down the plane to the corona.

Push the closed hemostat down this plane to the corona and open it widely, breaking the "adhesions."

In this image: The physician withdraws the hemostat.

Reintroduce the closed hemostat and reopen it in a similar manner, but at approximately 2 o'clock, 4 o'clock, 10 o'clock, and 8 o'clock to systematically remove the adhesions.

Remember to keep the tip of the hemostat up and visible on the prepuce to ensure no damage or abrasions to the glans. Avoid crossing the ventral midline (6 o'clock) where the frenulum lies. Damage to the frenulum can lead to significant bleeding and may be hard to control.

Checking for near-complete lysis of "adhesions"

• You may use the hemostat, introducing it again dorsally into the space you created between the glans and prepuce, opening the hemostat and rotating it, checking for any residual "adhesions."

• Alternatively, you may use the blunt probe for this. In either method, remember not to cross the ventral midline and risk damage to the frenulum.

In this image: The physician avoids crossing the ventral midline to minimize the risk of damage to the frenulum.

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