A dorsal slit is necessary to slit the foreskin open to open the preputial cavity. After the foreskin has been cut open the bell can be inserted and placed on the glans.In order to apply the clamp the foreskin is grabbed with hemostats as the the bell and the glans have to be maneuvered through the bevel hole.The arms of the bell are here maneuvered through the bottom of the bevel hole in the base plate. As soon as the bell arms are through the base plate is worked down over the secured foreskin and the plate is seated onto the bell. The top plate is swung around so that it sits over the base plate and the arms of the bell are lifted onto the yoke.Now the nut is tightened down as far as possible, thereby crushing the foreskin between the bell (cone) and base plate. Tightening the clamp forces the rim of the bell down against the frenulum, which responds by either stretching or by tearing or bleeding.With the scalpel blade the crushed foreskin is excised against the bell at the base plate and bell junction. All remaining shreds of foreskin above the plate are removed.Now the nut can be loosened releasing the bell arms from the yoke. Removal of the clamp allows the bell arms to drop back down through the plate. Now the penis is circumcised.