"Superglue” Circumcision Cost Effective and Cosmetically Appealing

A scalpel-free circumcision technique uses electrocautery and 2-octyl cyanoacrylate (2-OCA) glue instead of scalpels and sutures.

Researchers at Emory University School of Medicine (Atlanta, GA, USA) compiled data on 1,008 boys aged 6 months to 12 years (mean 1.8 years) who had either primary circumcision or circumcision revision between 2006 and 2009. The technique used included a circumferential inner incision using electrocautery on cutting current, followed by a circumferential outer incision using electrocautery. After foreskin removal, hemostasis was achieved with electrocautery, skin edge approximation with 2-octyl cyanoacrylate or 6-zero sutures, followed by antibiotic ointment application.

The results showed that 493 primary circumcisions and 248 revisions were performed using 2-OCA, compared to 152 primary circumcisions and 115 revisions using 6-zero sutures. Mean operative time for primary circumcision and revision using 2-OCA was 8 minutes, and for sutured primary circumcision and revision, it was 27 minutes. At a mean 18-month follow-up, three patients treated with 2-OCA and two treated with sutures were rehospitalized for bleeding. When done with electrocautery, the cost of the 2-OCA technique was significantly less than the sutured technique, as long as the 2-OCA procedures required less than 15 minutes and the sutured procedures required more than 15 minutes. The study was published early online on August 24, 2010, in the Journal of Urology.

"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,” concluded lead author Andrew Kirsch, M.D., and colleagues of the department of pediatric urology. "Patient satisfaction was equally high in all groups, but surgeon satisfaction was higher in the 2-OCA groups due to absent suture tracks and suture sinuses.”

In the 2-OCA procedure, the surgeons pinch the shaft skin at the base of the penis after removing the foreskin, pushing it distally toward the preputial collar, and then apply a thin layer of 2-OCA dorsal and intermittently in circumferential fashion. After 30 seconds' drying time, they applied 2-OCA continuously around the apposed skin edges. The antibiotic ointment was spread over the entire penis, scrotum, and mons pubis, partly to keep the 2-OCA from sticking.

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Emory University School of Medicine