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Electrocautery circumcision
ELECTROCAUTERY -4. BARRY
BELMAN,
CIRCUMCISION 1I.D.
From the Department of Urology and Child Health and Development, Children’s Hospital National Medical Center and the School for Health Sciences, George Washington University, \Vashington, D. C.
For the past eighteen months those children who have had elective non-newborn cicumcision under my supen-ision have had the procedure performed exclusively by electrocautery. Over 100 circumcisions have been done in the following manner. Procedure After anesthetic induction and the usual skin preparation, the foreskin is grasped with hemostats, and a straight clamp is inserted beneath the dorsal foreskin and the glans (Fig. 1A). Applying a blended cutting current by means of the needle cautery tip, dorsal (Fig. 1B) and then \.entral slits are made (Fig. 1C). The apical skin edges are approximated with 5-O Polyglycolic sutures. First one and then the other lateral foreskin wings are held over a folded gauze sponge while the glans is retracted
away (Fig. 1D). Both superficial and deep foreskin layers are cut simultaneously. The skin edges are approximated in the usual manner (Fig. 1E). At the completion of the procedure 1 per cent lidocaine hydrochloride (Xylocaine) is infiltrated at the base of the penis. Of the circumcisions done by this method to date, none has required reoperation or return to the operating room for bleeding. Although postoperative edema is of rapid onset and may be severe, the final cosmetic result is equally as satisfactory as the other methods employed for circumcision with no excessive scar formation. Healing is not protracted. Commellt
Although there would appear to be little reason to change one’s method of performing
circun~cisioll. the rapidity with which this prouxlurt~ c’an he done as well as the abilit? to prevent bleeding makes it advantageous. There is little need for additional pinpoint caqulation or ligature of multiple vessels. The procvdl~re herein described is A freehand techniqlle in which the tissue being cut is clearl) visible. The primary theoretical risk is to the glans which may be injured if’ the straight clamp under the prepuce is not fully protecti\-c. One might elect performing the initial dorsal slit with ;I scissors and withhold carltery f’o~ excision of‘ the skin itself.
Additionally, on the ad\,ice of Dr. Au-on I have begun infiltrating the lwe of Jackson. the penis with local anesthetic on completion of the operati\-e procedure. The Ilecessity for use narcotic is thvn olxiated. and of a postoperative .B!, the time the patient awakens in comfort. pain lwconies severe an oral agent can l>
50;
BELMAN,
CIRCUMCISION 1I.D.
From the Department of Urology and Child Health and Development, Children’s Hospital National Medical Center and the School for Health Sciences, George Washington University, \Vashington, D. C.
For the past eighteen months those children who have had elective non-newborn cicumcision under my supen-ision have had the procedure performed exclusively by electrocautery. Over 100 circumcisions have been done in the following manner. Procedure After anesthetic induction and the usual skin preparation, the foreskin is grasped with hemostats, and a straight clamp is inserted beneath the dorsal foreskin and the glans (Fig. 1A). Applying a blended cutting current by means of the needle cautery tip, dorsal (Fig. 1B) and then \.entral slits are made (Fig. 1C). The apical skin edges are approximated with 5-O Polyglycolic sutures. First one and then the other lateral foreskin wings are held over a folded gauze sponge while the glans is retracted
away (Fig. 1D). Both superficial and deep foreskin layers are cut simultaneously. The skin edges are approximated in the usual manner (Fig. 1E). At the completion of the procedure 1 per cent lidocaine hydrochloride (Xylocaine) is infiltrated at the base of the penis. Of the circumcisions done by this method to date, none has required reoperation or return to the operating room for bleeding. Although postoperative edema is of rapid onset and may be severe, the final cosmetic result is equally as satisfactory as the other methods employed for circumcision with no excessive scar formation. Healing is not protracted. Commellt
Although there would appear to be little reason to change one’s method of performing
circun~cisioll. the rapidity with which this prouxlurt~ c’an he done as well as the abilit? to prevent bleeding makes it advantageous. There is little need for additional pinpoint caqulation or ligature of multiple vessels. The procvdl~re herein described is A freehand techniqlle in which the tissue being cut is clearl) visible. The primary theoretical risk is to the glans which may be injured if’ the straight clamp under the prepuce is not fully protecti\-c. One might elect performing the initial dorsal slit with ;I scissors and withhold carltery f’o~ excision of‘ the skin itself.
Additionally, on the ad\,ice of Dr. Au-on I have begun infiltrating the lwe of Jackson. the penis with local anesthetic on completion of the operati\-e procedure. The Ilecessity for use narcotic is thvn olxiated. and of a postoperative .B!, the time the patient awakens in comfort. pain lwconies severe an oral agent can l>
50;