All about Stapler Circumcision
Most decisions about circumcision are based on cultural, religious or personal reasons. Though circumcision is not a medical mandatory, the benefits of circumcision in men outweighs the risks of indicative medical conditions.Male circumcision (MC) was one of the earliest operations performed by humans. This procedure gained practice worldwide for the reason that circumcision has the potential to decrease the risk of sexually transmitted diseases such as human papillary, genital ulcer disease and human immunodeficiency virus (HIV) infection. Circumcision is also known to improve penile topical hygiene.
During male circumcision, the redundant foreskin is removed and the glans is exposed.Common indications for male circumcision are:
Phimosis – a condition where the foreskin is not easily retracted (pulled back) from around the tip of the penis.
Paraphimosis – This occurs when the foreskin can be retracted, but cannot be moved back into its normal position. This may require emergency medical attention.
Balanitis –An inflammation of the glans penis is a common condition affecting an estimated 3-11% of all men at any age.
Penile yeast infections – The area under the penile foreskin may get repeated fungal infections.
UTI – Repeated infections of the urinary system due to abnormal urinary tracts or unhygienic conditions.
Trauma – Isolated injuries to the foreskin such as Zipper injuries and foreskin tearing may require a circumcision to prevent scarring and adhesion formation.
Prevention of sexually transmitted infections and penile cancer are also reasons for considering circumcision in men.
Conventional circumcision is the most frequently performed procedure by urologists to overcome the above listed penile conditions.There are three different techniques of conventional circumcision as recommended by WHO. They are the dorsal slit, the forceps-guided method and sleeve resection. However, complications such as bleeding, oedema, prolonged recovery time and unsatisfactory cosmetic results with either of the techniques are still common in men who undergo conventional circumcision.
The urgent situation of HIV infection in Africa demanded a new operative method that at least needed to meet 4 criteria: safe, effective, quick and finally easy to learn and easy to perform even by those with less surgical training.Chinese Shang Ring MC emerged as a newer method. This device uses metal clips and silicone rings.No surgical stitches are used.By using this specially designed device – Chinese Shang Ring, adult MC could be performed quickly, safely, and effectively even by those with less surgical expertise but with its own drawbacks.
Stapler circumcision is an alternative device technique that was initially developed by ZSR Biomedicals, a Chinese company and is now being applied universally. ZSR Circumcision is a specialized circumcision technology which uses a surgical stapler to cut and seal the cut skin edges instead of traditional sutures. In conventional circumcision, the surgeon has to first cut the skin with a knife and then stitch it. In ZSR circumcision technology, the stitching with staples and the cutting are done by the device.
The circumcision stapler is a single-use device. The disposable circumcision stapler is a sterile, hand-held, manual surgical instrument preloaded with non-bioabsorbable skin staples intended to be used to perform a circumcision. It is designed to cut the foreskin and apply a circular row(s) of staples proximal to the cut line. The stapler portion typically consists of a dome intended to be inserted under the foreskin over the glans penis and a circular cutting stapler mechanism with a manual lever intended to connect over the outside of the foreskin.
Based on literatures and clinical experience, it is believed that the stapler has some advantages over the Shang Ring.
- First, the foreskin is cut completely with the stapler, causing less pain after the procedure. In contrast, patients who undergo circumcision with the Shang Ring experience pain for 7 to 16 days until the ring is removed. Based on patient self-reports, this postoperative pain can be very severe during spontaneous or nocturnal erections.
- Second, patients who undergo stapler circumcision have shorter healing time. In patients treated with the Shang Ring, removal of the foreskin is obtained by necrosis which leads to a relatively ischemic edge. After ring removal, more time is required to reconstruct the local blood circulation for wound healing.
- Third, patients who undergo stapler circumcision have less wound dehiscence. Patients treated with the Shang Ring have a greater possibility of wound dissidence which usually develops when spontaneous or nocturnal erection occurs.
The usual procedural steps of stapler circumcision involve the following :-
- Anaesthesia – ZSR Circumcision is done either under local, regional or general anesthesia depending on the age and medical fitness of the male.
- ZSR Surgery Duration – The surgery duration is 30 minutes. The surgery is performed in daycare. The patient can go home same day.
- ZSR Surgery stitches – No stitches are used.
Expected recovery from stapler circumcision:-
- The patient requires 3 weeks to completely recover from stapler Circumcision.
- After the surgery the patient can go home the same day.
- minimal rest is required for initial 24 hours.
- The bandage (dressing) is changed after 48 hours. The dressing change is simple and can be done at home.
- There is minimal pain after ZSR Circumcision.
- There is no restriction on office work unless there is strenuous physical activity involved.
- Patients are advised to avoid masturbation and sexual intercourse for 3 weeks from stapler Circumcision.
In comparison with other circumcision techniques, the advantages of stapler circumcision are:-
- Minimal tissue injury.
- Fewer postoperative complications.
- Shorter operative time
- Lower blood loss volume.
- Time-efficient and safe male circumcision technique.
- Faster recovery time as less as 12 hrs.
- Nice cutting edge that facilitates cosmetic appeal.
- Applied both on children and adults.
Thus, stapler circumcision is reported to be associated with fewer complications than conventional or Shang Ring circumcision, especially with respect to severe oedema and wound dehiscence. These advantages of stapler circumcision may be due to the short operative time, minimal tissue injury and lack of electrocautery. It is associated with a shorter operative time, lower blood loss volume, and fewer postoperative complications than other methods of circumcision. Stapler circumcision is an easy and patient friendly device for performing male circumcision. The approximate cost of stapler circumcision falls between Rs.50,000 and Rs.90,000 at some of the finest Urological centres.