Bipolar diathermy haemostasis during circumcision

Abstract

The use of diathermy in circumcision is traditionally frowned upon. The risk of arterial damage caused by the passage of a current along the shaft of the penis with monopolar diathermy is considered too great to permit its routine use'. This objection is overcome with bipolar diathermy, in which there is very little collateral current spread and the risk of vascular damage is negligible. A retrospective review was undertaken to determine the complication rate of the diathermy technique compared to the standard procedure using ties. Patients and methodsThe notes of all patients undergoing circumcision between February 1991 and December 1993 were reviewed. One surgeon and his team used bipolar diathermy only for haemostasis in all patients and the remaining teams used ligation for haemostasis. ResultsCircumcision was performed using bipolar diathermy in 93 patients aged from 16 months to 77 years (median 11 years). Of these, 87 (94 per cent) were admitted as day cases, although six subsequently stayed overnight; six were inpatients. Two patients developed minor bleeding which required haemostatic sutures. In the same period, 355Paper accepted 15 August 1994 circumcisions were performed using ligation for haemostasis in patients aged from 7 months to 95 years (median 35 years). Of these, 216 (61 per cent) were admitted as day cases and seven patients ( 2 per cent) had minor bleeding. DiscussionThe theoretical risk of arterial damage when using monopolar diathermy1 is removed with bipolar diathermy. Frequent use of diathermy, as is required in circumcision, results in rapid crusting of the forceps, rendering them inefficient and necessitating frequent cleaning. This problem can be overcome by dipping the forceps regularly in an aqueous solution, so preventing crusting while producing a more satisfactory escar.The age range in this series was from 7 months to 95 years and raises the question of the indications for circumcision. The differing day case rates reflect the different practice of the consultant surgeons, and these aspects are now the subject of a prospective audit.Complications of circumcision are well described2, and in this series there were no additional complications associated with the use of bipolar diathermy. This method gives satisfactory haemostasis and does not leave subcutaneous nodules, which may occur with ties.The exclusive use of bipolar diathermy is as good as other methods of haemostasis during circumcision. The use of the 'dip' represents an improvement in the diathermy technique, and its routine use is recommended3. References1 Azmy A, Boddy SA, Ransley PG. Successful reconstruction following circumcision with diathermy.

Complications of traditional male circumcision

“…This can be avoided by careful attention to detail and the use of bipolar diathermy. 10 The boys who presented with bleeding had a reduced haematocrit and prolonged bleeding and clotting times. We do not routinely test bleeding and clotting times in all children presenting for circumcision, as recommended by some, 7 but FIG.…”

Bipolar scissors circumcision is a safe, fast, and bloodless procedure in children

“…The advantages of this type of scissors are gentle tissue dissection with fast subcutaneous hemostasis, avoiding risks of bleeding reported with the use of scalpel or burning usually described with the monopolar electrocautery. Bipolar forceps diathermy is also used by many surgeons for hemostasis, minimizing bleeding with less edema but increasing surgical time [6]. Bipolar diathermy scissors is a modified 7-in Metzembaum scissors with 2 blades insulated by a ceramic coat (PowerStar Ethicon bipolar scissors).…”

“…Circumcision using bipolar scissors is a relative new technique. First reported by Marshs and Archer in 1995 [6], very few studies about the use of bipolar diathermy scissors for circumcision have been described [7][8][9]. To our knowledge, clinical comparative studies between bipolar scissors circumcision and conventional scalpel procedure in boys with true phimosis have not yet been reported.…”

Rapid Way of Circumcision: Bipolar Diathermic Knife

“…In 1995 for the first time Marshs and Archer published the first data on circumcision using bipolar electrocautery. 5 Later Peters and Kass reported that after circumcision, circumcision revision and excision of skin bridges of 346 patients between the ages of 14 to 38 months, bipolar electrocautery could be safely used for penile surgery procedures in children. 6 In the literature there are many papers on the reliability of circumcision with bipolar electrocautery.…”