Manual for Male Circumcision under Local Anaesthesia

Male circumcision under local anaesthesia
Version 3.1 (Dec09)
A
B
Fig. 5.4 Under-running a bleeding vessel. A: the knot with two throws.
B: the knot with three throws.
Diathermy
In surgical diathermy coagulation is achieved by creating heat with an
electrical current passing through the tissue. The techniques
described in this manual can all be undertaken safely without
diathermy equipment and any surgeon undertaking male circumcision
should be adept at stopping bleeding without diathermy. Diathermy
has the advantage of decreasing haemostasis time thereby reducing
the total procedure time.
Monopolar and bipolar diathermy: There are two diathermy
electrical circuits in common use − monopolar and bipolar. With
monopolar diathermy the current runs from the machine through the
diathermy forceps, through the tissue held by the forceps, through the
patient’s body to a grounding plate, and then back to the machine. In
bipolar diathermy the current runs from the machine to one of the two
prongs of the diathermy forceps, through the tissue grasped between
the prongs and then back through the other prong to the machine.
With both types care must be taken to ensure that the patient is not in
contact with any metal or conducting material as there is a risk of earth
leakage and burns at the point of contact. This risk is greatest with
monopolar diathermy. Whenever diathermy is used, care must be
taken in positioning on the operating table, the choice of operating
table and clinic construction to prevent current leakage to earth. Some
monopolar diathermy machines include automatic safety switch off in
case of earth leakage, disconnected grounding plate, or poor contact
between the grounding plate and skin. The grounding plate should be
placed to ensure the whole surface is in contact with the patient’s skin,
usually on the thigh or buttocks. It may be necessary to shave hairs to
ensure good contact.
Surgical procedures for adults and adolescents Chapter 5-4