Medicine Hospital Department of Urology, Biruni University, İstanbul, Turkey.
Medicine Hospital Department of Urology, Biruni University, İstanbul, Turkey.
J Pediatr Urol. 2019 Apr;15(2):186.e1-186.e8. doi: 10.1016/j.jpurol.2019.01.003. Epub 2019 Jan 19.
Circumcision is one of the most frequently applied surgical procedures all over the world and a number of techniques and devices have been described concerning its method. Especially in developing countries where circumcision has been performed intensively under local anaesthesia, the thermocautery device developed to perform circumcisions in a short time and safely has found a widespread application.
We aim to share our experiences concerning application principles of the thermocautery device so as to be able to achieve better cosmetic results with lower complication rates.
Between the years 2009 and 2016, a total of 12,355 children between the ages of 40 days and 16 years (mean: 5.1 ± 2.0 years) were circumcised at our hospital. All circumcisions were performed by urologists under local anaesthesia using a thermocautery device (Thermo-Med TM 802B device; Thermo Medikal, Adana, Turkey).
Bleeding that required surgical intervention did not occur in any patient. Compressive dressing was applied to 62 patients who had moderate degrees of bleeding, for haemostasis purposes. Twelve syncopes and four epileptic seizures developed secondary to local anaesthesia were managed in consultation with the Department of Children Health and Diseases. The most serious complication, trapped penis, was seen in 48 patients. All these complications were resolved using surgical interventions. Infection developed in 15 patients, and it was relieved with the administration of oral antibiotherapy. Penile adhesions were relieved in 25 cases, and anti-inflammatory treatment was organised. Meatal stenosis occurred in three cases, and two cases of inclusion cysts were treated with surgical intervention.
In countries where circumcision is routinely applied, developing swift and safer methods are of the utmost importance. To this end, we prefer thermocautery, which can satisfy patient demands swiftly and safely.
To reduce the complications after circumcision using thermocautery, we think that it is appropriate to pay attention to the following issues during circumcision: The cautery should be turned in a serial manner and both sides of the blade should be used for cutting, and temperature of the thermocauter should be adjusted according to the skin thickness. The cutting process should be achieved in two steps, and another method should be preferred for buried penis. If these rules are followed, we think that the thermocautery-supported method can be a very safe and fast circumcision method.
包皮环切术是全世界应用最广泛的手术之一，已经描述了许多关于其方法的技术和设备。特别是在发展中国家，在局部麻醉下广泛开展包皮环切术，为了能够安全、快速地进行包皮环切术，开发了热刀设备。
我们旨在分享热刀设备应用原则的经验，以实现更好的美容效果和更低的并发症发生率。
在 2009 年至 2016 年期间，我们医院共对 12355 名年龄在 40 天至 16 岁之间的儿童（平均年龄：5.1±2.0 岁）进行了包皮环切术。所有包皮环切术均由泌尿科医生在局部麻醉下使用热刀设备（Thermo-MedTM802B 设备；Thermo Medikal，Adana，土耳其）进行。
没有患者出现需要手术干预的出血。对 62 名中度出血的患者应用压迫性敷料进行止血。12 例因局部麻醉引起的晕厥和 4 例癫痫发作与儿科疾病科会诊后进行了处理。最严重的并发症是 48 例包茎，所有这些并发症均通过手术干预得到解决。15 例患者发生感染，经口服抗生素治疗缓解。25 例阴茎粘连得到缓解，并进行抗炎治疗。3 例尿道口狭窄，2 例包涵囊肿行手术干预。
在常规开展包皮环切术的国家，开发快速、安全的方法至关重要。为此，我们更喜欢热刀，它可以快速、安全地满足患者的需求。
为了减少使用热刀进行包皮环切术后的并发症，我们认为在包皮环切术过程中应注意以下几点：电刀应逐个转动，刀的两侧应用于切割，电刀的温度应根据皮肤厚度进行调整。切割过程应分两步进行，对于埋藏式阴茎应采用另一种方法。如果遵循这些规则，我们认为热刀支持的方法可以是一种非常安全和快速的包皮环切术方法。
