title: Sutureless and scalpel-free circumcision--more rapid, less expensive and better?
abstract: OBJECTIVE
  We previously reported our success with sutureless circumcision using 2-octyl cyanoacrylate in 267 patients. We have since modified our technique by making incisions with electrocautery. We report our results with this novel technique. We also performed a cost analysis.
  
  
  METHODS
  We compiled data on all patients 6 months to 12 years old who underwent primary circumcision and circumcision revision in a 39-month period, as done by 3 surgeons. Study exclusion criteria were complexity beyond phimosis and Gomco clamp use. The technique included 1) a circumferential inner incision using electrocautery on cutting current, 2) a circumferential outer incision using electrocautery, 3) foreskin removal, 4) hemostasis with electrocautery, 5) skin edge approximation with 2-octyl cyanoacrylate or 6-zero suture and 6) antibiotic ointment application. We also determined the cost of all procedures based on anesthesia and operating room facility fees, and material costs.
  
  
  RESULTS
  Between July 1, 2006 and October 1, 2009 we performed 493 primary circumcisions and 248 revisions using 2-octyl cyanoacrylate, and 152 primary circumcisions and 115 revisions using 6-zero sutures. Mean operative time for primary circumcision and revision using 2-octyl cyanoacrylate was 8 minutes (range 6 to 18), and for sutured primary circumcision and revision it was 27 minutes (range 18 to 48). At a mean 18-month followup (range 1 to 39) 3 patients treated with 2-octyl cyanoacrylate and 2 treated with sutures were rehospitalized for bleeding. When done with electrocautery, the cost of the 2-octyl cyanoacrylate technique was $743.55 less than the sutured technique as long as the 2-octyl cyanoacrylate procedures required less than 15 minutes and the sutured procedures required more than 15 minutes.
  
  
  CONCLUSIONS
  Combined electrocautery and 2-octyl cyanoacrylate for circumcision is a safe, efficient, financially beneficial, cosmetically appealing alternative to traditional circumcision done with scalpel and sutures.
authors: Department of Pediatric Urology, Emory University School of Medicine, Atlanta, Georgia, USA.
authors: Jonathan D
authors: JD
authors: Kaye
authors: Jonathan F
authors: JF
authors: Kalisvaart
authors: Scott P
authors: SP
authors: Cuda
authors: James M
authors: JM
authors: Elmore
authors: Wolfgang H
authors: WH
authors: Cerwinka
authors: Andrew J
authors: AJ
authors: Kirsch
mesh_terms: D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male / Q000191:economics* / Q000379:methods* / Q000592:standards; D003365:Costs and Cost Analysis; D003487:Cyanoacrylates; D004564:Electrocoagulation; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D014014:Tissue Adhesives
chemical_list: D003487:Cyanoacrylates; D014014:Tissue Adhesives; C100832:octyl 2-cyanoacrylate