Three adjustments were needed to position the device prior to excising the foreskin with a conventional scalpel. The procedure started with the C-Frame and the outer knurled knob (here tinted magenta) set aside. With the two cones collapsed together, the foreskin was draped over the cones. Once positioned, the jaws of the grippers (tinted yellow) were closed by turning the knurled knob tinted blue. This held the foreskin firmly in position on the upper cone. The next stage involved turning the separate, green-tinted knurled knob. With the shaft prevented from rotating by a keyway, this increased the gap between the two cones, drawing shaft skin forwards so that shaft skin as well as foreskin would later be severed. Given the fine pitch of the thread a considerable number of turns were needed and it is likely that this stretching process took several minutes, but the mechanical advantage thereby gained enabled huge tension to be applied very evenly and a radically tight final result obtained.
Finally, the C-Frame and outer knob were assembled, a process carried out without disturbing the spacing of the cones (and thus the tightness of the circumcision) determined earlier.