title: Adult bipolar diathermy circumcision and related procedures in adults - a safe and efficient technique.
abstract: OBJECTIVE
  To present our novel technique and step-by-step approach to bipolar diathermy circumcision and related procedures in adult males.
  
  
  METHODS
  We reviewed our technique of bipolar circumcision and related procedures in 54 cases over a 22-month period at our day procedure center. Bipolar diathermy cutting and hemostasis was performed using bipolar forceps with a Valleylab machine set at 15. Sleeve circumcision was used. A dorsal slit was made, followed by frenulum release and ventral slit, and was completed with bilateral circumferential cutting. Frenuloplasties released the frenulum. Preputioplasties used multiple 2-3 mm longitudinal cuts to release the constriction, with frenulum left intact. All wounds were closed with interrupted 4/0 Vicryl Rapide™.
  
  
  RESULTS
  A total of 54 nonemergency bipolar circumcision procedures were carried out from November 2010-August 2012 (42 circumcisions, eight frenuloplasties, and four preputioplasties). Patients were aged 18-72 years (mean, 34 years). There was minimal to no intraoperative bleeding in all cases, allowing for precise dissection. All patients were requested to attend outpatient reviews; three frenuloplasty and two circumcision patients failed to return. Of the remaining 49, mean interval to review was 49 days, with a range of 9-121 days. Two circumcision patients reported mild bleeding with nocturnal erections within a week postoperatively, but they did not require medical attention. Two others presented to family practitioners with possible wound infections which resolved with oral antibiotics. All 49 patients had well-healed wounds.
  
  
  CONCLUSIONS
  The bipolar diathermy technique is a simple procedure, easily taught, and reproducible. It is associated with minimal bleeding, is safe and efficient, uses routine operating equipment and is universally applicable to circumcision/frenuloplasty/preputioplasty. In addition, it has minimal postoperative complications, and has associated excellent cosmesis.
authors.affiliation: Department of Urology, Eastern Health, Box Hill Hospital, Box Hill, VIC, Australia.
authors.forename: Sunny
authors.initials: S
authors.lastname: Nalavenkata
authors.affiliation: Department of Urology, Eastern Health, Box Hill Hospital, Box Hill, VIC, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Winter
authors.affiliation: Department of Urology, Eastern Health, Box Hill Hospital, Box Hill, VIC, Australia.
authors.forename: Rachel
authors.initials: R
authors.lastname: Kour
authors.affiliation: Department of Urology, Eastern Health, Box Hill Hospital, Box Hill, VIC, Australia.
authors.forename: Nam-Wee
authors.initials: NW
authors.lastname: Kour
authors.affiliation: Department of Urology, Eastern Health, Box Hill Hospital, Box Hill, VIC, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Ruljancich
keywords: bipolar; circumcision; diathermy; frenuloplasty; preputioplasty