circumcisionMale Sexual HealthPhimosisIs Circumcision for Everyone? Who should get circumcised?

Stapler Circumcision (ZSR Circumcision or Anstomat Circumcision)

By now, we don’t think you need any introduction about what circumcision is, what are the benefits of circumcision or who should get circumcised etc. Typically, circumcision takes the first spot in the list that counts the number of surgeries performed by our popular urologists at our hospital.

Let us directly get into the subject – Stapler Circumcision also called ZSR Circumcision or Anstomat Circumcision.

In this article, lets touch some of the aspects of stapler (ZSR) circumcision such as:

  1. What is Stapler (ZSR) circumcision?
  2. How is Stapler Circumcision performed?
  3. Is Stapler Circumcision safe? How does it compare it with other techniques?
  4. Benefits of Stapler Circumcision?
  5. Cost of Stapler Circumcision?
Stapler Circumcision in Chennai

What is Stapler (ZSR) Circumcision?

In simple terms, a device called ‘Stapler or Anstomat’ is used by the doctor / surgeon to perform Circumcision (in babies or men), such a process is called ‘Stapler Circumcision’.

This stapler device (that you can see in the above picture) has been developed by medical specialists in China. It includes two parts – inner bell & outer bell.  The inner bell is designed to protect the inner glans and the outer bell consists of a blade to cut the foreskin and staples to close the wound for simultaneous hemostasis.

How is Stapler Circumcision Performed?

As the very first step in Stapler Circumcision, the size of the penis just below the glans is measured by the urologist. Penis is then surgically disinfected with iodine or other equivalent disinfecting liquids before performing the circumcision procedure.

Steps for Stapler Circumcision

Referring to the image above, here are the steps performed in Stapler Circumcision:

  1. The size of the penis, just below the glans is measured (as mentioned earlier).
  2. After disinfecting the penis with iodine or equivalent, the dorsal nerve block and circumferential block are done with 1% lidocaine.
  3. Then, the inner bell is placed inside the foreskin of the penis to cover the glans; the edge of the bell is brought to the level of coronal sulcus. In cases where the patient is suffering from Phimosis, a dorsal slit has to be made to correctly the position the inner bell of the stapler.
  4. The safety shield is then removed from the outer bell.
  5. The outer bell is placed over the inner bell while the frenulum is kept intact. The safety bolt of the stapler is then removed.
  6. The screw on top of the stapler is then rotated clockwise to sandwich the foreskin tightly; the handles / prongs of the stapler are triggered/ pressed to cut the foreskin and the wound is closed by staples at the same time.
  7. The device is then unscrewed and removed
  8. The wound on the foreskin is checked and pressed with gauze for a minute or two to stop any bleeding that might occur.
  9. Hemostasis is achieved with a compression bandage that is put over the penis as shown in the picture #9

Is Stapler Circumcision safe? How does it compare with other techniques of circumcision?

Just like other techniques of circumcision including laser, stapler circumcision is a safer process. However, it has got it’s own benefits when compared to other methods of circumcision that are mentioned below:

  1. The time taken for the operation / surgery is less than 10 minutes.
  2. Blood loss is 5 times lesser than other methods of surgery.
  3. The pain experienced by the patient is way less than the other methods.
  4. Healing time is quicker but barely by a day or two.
  5. Possibility for complications is less than half compared to other circumcision techniques.
    1. Less bleeding
    2. Near 0 chances of wound (caused by surgery) re-opening
    3. Less Edema
    4. Lower chances of infection.

Medical problems addressed with circumcision

  1. Phimosis – A condition when the foreskin on the penis head can’t be pulled back
  2. Paraphimosis – A condition when the foreskin can’t be pulled back onto the penis head. (Opposite of Phimosis)
  3. Balanitis – Inflammation of the foreskin and the head of the penis
  4. Reducing risk of Sexually Transmitted Infections Transmission

Benefits/Advantages of stapler (zsr) circumcision

  1. Minimal injury to the tissue and lower blood loss (by volume)
  2. Shorter operation time
  3. Fewer post-op complications
  4. Faster recovery compared to conventional circumcision
  5. Procedure can be safely performed on children and adults.

The main disadvantage of this stapler circumcision is the need to remove the residual staples after surgery. Most of the times, a surgeon will be required to remove the staples after or during recovery. Research to overcome this disadvantage is being performed by some medical teams who are trying to use a plastic gasket underneath the staples or by improving the material of the staples.

What is the cost of stapler (zsr) circumcision in Chennai?

Typical cost of stapler circumcision in our Chennai clinics range between Rs.45,000 to Rs.90,000/-. Cost of any medical procedure varies depending on the patient’s condition.

After you consult our sexologist, you can then check with the billing department or front desk to know the exact cost for you to get staple (zsr) circumcision procedure done.

Video on Stapler Circumcision


  1. Hi I would like to know how much is the cost for this procedures doctor . My friend is in chennai he wants to go for this ops.

    • Dear Kumaran, please call us at
      +91 90928 49786

      You can ask all the questions you have.
      Thank you,
      Dr. Karthik Gunasekaran.

  2. Hi Sir,
    I need to clarify a think regarding some sudden problem in my penis and due to this lockdown I can’t able to reach hospitals frequently. My age is 21 and I have tight foreskin and for the last 3 days I can see my penis head is little bit whiter in color (something like infection or balantis). Usually even though i have toght foreskin i can able to retract it little bit but for the last 3 days i cant even pull the foreskin back it’s somewhat like stick in the tip of the penis at the same time i can see some white layers in the penis head and today morning I can find some small cut wonds here and there in the head of the forekin. Is it a serious problem?

    • Yes, it is going to get serious. Please see me as soon as possible.
      Thank you,
      Dr. Karthik Gunasekaran

  3. Gud evening sir,I have phimosis condition sir..I’m native of erode..due to this lockdown I can’t able to come to Chennai sir..could you suggest better clinics for stapler surgery near coimbatore ,thank you sir

    • Hello Praveen, Sorry, as per my knowledge, CBE doesn’t have good sexologists who can do stapler.

    • Please call up our staff and you can ask your questions on the costing. If your foreskin is tight, i will need to check on that and see if medication will work.
      if not, only then i would recommend circumcision.


  4. Hello Doctor , I don’t have Foreskin tightness prblm are any other issues, but I’m willing to do circumcision due to My sexual Hygienic is this Good Idea ?

  5. Hello doctor, your videos are too good and it’s giving proper information and solutions for some doubts. Thanks for that.

    From the birth, I having tight foreskin. I didn’t do circumcision till now. In erecting moment I’m not able to get penis out because of tight foreskin. if I try to get out, it creates more pain at skin. So is it curable by medicines or should I do circumcision??

    • Rajesh, how tight is it is the question. In some cases, some creams will help but in many cases circumcision is the only solution.
      If you can, please see me in person, I can help you.

      Thank you,
      Dr. Karthik Gunasekaran

  6. Hi Sir,

    I having a penile vitiligo in my foreskin. 2 spots sports are there. It’s has grown for 1 inches from 3 years. Is circumcision is the efficient way diagnose the vitiligo affected skin? If I go with surgery then any chances of getting affected by any other parts?

  7. Hello Doctor,

    I’m 40 yrs old.
    The frenulum in my penis is quite tight. Instead of Frenuloplasty, i would like to go for circumcision.
    Is it advisable to go for stapler circumcision at this age. Kindly advise me on this. Thank you

  8. Hello Doctor,

    Thanks for your reply
    During Stapler Circumcision, will the frenulum tightness can be removed? Not sure about the complete process.

      • Sir ,I have phimosis , short frenulum and there is also adhesion between the foreskin and glans penis. Last year after seeing your videos I tried to do stretch exercises. when floppy, I could even retract the skin. After doing the exercise for almost 3 to 4months , I could able to retract the skin , at that time I noticed that foreskin and glans are attached together and could see smegma accumulating. first time i cleaned all those .But during erection I couldn’t retract. So, what’s is treatment for adhesion sir? Will it be paining while releasing the adhesion? Thank you in advance.

  9. Dr. Karthik Gunasekaran,

    I would like to do circumcision for my son due to religious reasons, he is 8 years old. I know there are few methods, conventional surgery, laser, stapler, and ‘Gomco’ method (mostly not practiced in India as far as I know). What kind of Circumcision method do you suggest? also, does the child (8 years) need any anasthesia?

    let me know your opinion and how soon we can get an appointment for the circumcision procedure if we decide on 30.07.2021?


  10. Good Morning sir, I am Dr.Ragavan from Pondicherry. I completed my MBBS and working as Junior resident. Sir , There is adhesion of foreskin with glans at the end, so It is very diffcult for me to retract the foreskin. If I retract , my glans bends downwards. How to proceed sir. ?

  11. Hello sir, I want to go with circumcision due to religious reasons. I am 24 years old. I dont have any medical conditions. Which method is effective? Kindly let me know the painless and quick recovery way. Coz, I have a situation that I need to resume with my work within a week. Kindly reply back .

  12. Hello doctor thank for clearing basics doubt. Now feeling some good.

    My penis normall time size is around 5 cm at the stretch time it will going to 15 cm diameter also look same and I am foreskin problem whether it can come our through ZSR process or we need to any other process and small size normally time can affect any sex life

  13. Hi doctor..My age is 32 and i am working in UAE.. my pennis size is very small, skin completely covered my pennis head.. it is not flexible also and last one year too much skin developed before pennis head..During sex time, skin very tight and i feel too much pain.. i cannot able to do intercourse normally.. is it foreskin problem?? How i will recover from this issue and will lead a normal sex life.. if you advise i will come and meet you at chennai

    • It sounds like you need circumcision to be done.
      Sure, please do see me when you come to Chennai. I can take a look and help you with your issue.
      We also offer PRP treatment to improve the size of penis, you can learn about it and try it if you want to.

  14. Hi Sir,

    I would like to go for circumcision, but I’m kind of confused to go for Laser or Stapler Method. My age is 29 and I have my foreskin has got Phimosis…

    Please suggest to me which one I need to go for.

    • Simply putting, in laser circumcision, the skin removal is done by cutting it with laser which is better than a normal scalpel cut. There will be lesser blood loss.
      Stapler is more popular method and gives better results wrt the skin removal. Go for stapler.

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