Thermocautery for infantile circumcision in high-volume hospitals: a retrospective analysis of over 1,500 cases.

INTRODUCTION: We share our experience with thermocautery (TC) used in over 1500 cases. There is a lack of data regarding this technique, and the recent WHO manual for infantile circumcision (IC) has only mentioned three devices: Mogen, Gomco, and Plastibell, with a few publications on other techniques. METHODS: This retrospective study was carried out in a setting where IC was a standard procedure. The primary reasons for patient cancellations included buried penis, excessive suprapubic fat, and obesity. No standard preoperative assessment was conducted. The technique adhered to the fundamental surgical principles of IC, with the skin incision made using a digital thermocautery device along a long surgical clamp. Two sutures were placed at the 6 and 12 o’clock positions using 4/0 absorbable sutures. RESULTS: A total of 1650 patients underwent the procedure during the study period. The average age was 130 ± 15 days. The entire procedure lasted 6 ± 0.5 min. No significant perioperative surgical or anesthetic complications were noted. Eleven patients experienced early postoperative bleeding (7/1000), with only 3 needing re-suturing under local anesthesia. Five patients required redo-circumcision, and 3 developed meatal stenosis, which was addressed with meatoplasty. CONCLUSION: For hospitals that frequently perform IC, the thermocautery technique provides a straightforward, convenient, and time-efficient method. It can be executed outside the main operating room and is cost-effective. This approach is nearly bloodless and has the lowest bleeding incidence compared to other methods. The rate of other complications is consistent with those seen in alternative surgical techniques.