Sunathrone Clamp


New in 2006 was a plastic disposable circumcision clamp called “Sunathrone”.  Developed by Sunathrone BioMedical in Malaysia (http://www.sunathrone.com/), the makers claim a number of significant advantages over previous designs of disposable clamps.  The principal advantage appears to be the size of the device remaining on the penis for the duration of the healing period, which is considerably smaller than the Tara KLamp and other similar clamps.  In most cases the Sunathrone clamp will fall off in the bath, in a manner similar to a Plastibell circumcision.  The clamp comes in various sizes for use on males of all ages, from newborn to adults.

How does the Sunathrone™ work?  (see photo examples below)

  1. Measure the diameter of the glans at the level of the corona, using the Sunameter™ device provided.
    This ensures that the right size of Sunathrone™ is being used.  (See photo at right)
  1. Administer / apply your chosen local anesthesia at the base of the penis. A combination of Xylocaine 2% (2mg/dl) and Bupivacaine 5% (5mg/dl) injected as a ring block at the penile root is recommended.
  1. Mark with a sterile marker the amount of prepuce you want to remove.
  1. Free all adhesions and then clean the Glans Penis thoroughly.
  1. If the frenulum is to be removed as well as the foreskin, it should be severed at this stage by means of a single cut with surgical scissors as close to the glans as possible. The remaining frenular tissue will then be removed by the rest of the Sunathrone™  procedure.
  1. Insert the grooved end of the tube between the prepuce and the glans, up to the level of the glans corona. You may lubricate the inner tube surface with 2% Xylocaine Gel to facilitate smooth tube insertion.
  1. Adjust the tube to the required level. Make sure the urinary meatus is visible and centrally located.
  1. Loosely apply the cuff locking mechanism, aligning it with the groove of the inner ring.
  1. Adjust the position of the whole Sunathrone™  clamp so that the distal face of the cuff aligns with the marked position for the cut.
  1. Make sure that the foreskin is evenly trapped right around the circumference of the ring.  [Note: This has to be done before closing it tight!].
  1. Press the two ends of the cuff together until the mechanism clicks at least twice and locks satisfactorily.
  1. Again make sure that make sure that the foreskin is evenly trapped right around the circumference of the ring.
  1. Double check that the cuff is correctly located in the groove of the tube before proceeding.
  1. Cut through both layers of the prepuce / foreskin using a scalpel or scissors, placing the cut close against the distal face of the cuff, and remove the separated tissue from the tube.
  1. Break off the distal end of the tube by applying a light twisting force.
  1. This will leave 1/5 of the original inner part clamping the wound, which is secured by the cuff's locking mechanism.
  1. Leave the Sunathrone™ attached to the penis until the circumcision wound fully heals.
  1. If the glans is raw as a result of recent freeing of adhesions, apply a proprietary antiseptic barrier cream (for example one containing Chlorhexidine Gluconate 0.1% w/w and Cetrimide 0.5% w/w).  We recommend that you do not use petroleum jelly.
  1. The Sunathrone™ device will drop off by itself once satisfactory healing is achieved.
  1. A small ring of necrotic tissue will remain, and disappear by itself in a few days.
  1. If excessive swelling of the penis or scrotum occurs, free the Sunathrone™ cuff locking mechanism by cutting it at one end of the lock using a surgical cutter.  Be prepared for the possible need to suture the wound if bleeding occurs following premature removal of the Sunathrone™  device.

Medical Personnel Caution : Early examples of this product, shipped in packaging marked STERILE-R, were subject to a production process not approved to CE or FDA standards. Users are recommended to destroy any examples bearing a STERILE-R label and use only the more recent production marked EO (indicating sterilization by the Ethylene Oxide method) along with a valid Lot Number and Expiration Date.

Photos of Procedure

 

 

Our Review:  This design provides a convenient and relatively simple method of circumcision, and will be particularly useful in countries where circumcision is routinely performed on all boys.  The prototype clamp we reviewed had a minor design flaw that could expose the glans penis to damage in the hands of an untrained circumciser.  However, we are informed by the manufacturer that changes in design have been made to eliminate even this slight possibility.  Users are therefore recommended to accept only the 'Mk.2' design with a bayonet joint connecting the two parts of the transparent tube. Product with a break-off joint should be destroyed, even if sterilized EO.

The Sunathrone clamp is made of hypoallergenic food grade plastic which is completely transparent.  This assists in positioning for the proper central location of the urinary meatus.  When properly performed, the circumcision is nearly bloodless and totally sutureless, and is thus easy to perform even in less than desirable conditions. Under normal conditions, it does not require any other special surgical activity or equipment.

Healed Results on Another Boy
Note Style Difference Between Patient Above

Further, as the design does not require a return visit to the circumciser (as the clamp generally falls off by itself), it simplifies the overall circumcision process.  If necessary the mechanism can be removed after 8-12 days and if the wound has not sealed, the physician must perform a delayed secondary suturing of the circumcision under local anesthesia.

Manual Removal of the Clamp

From the standpoint of the boy or adult being circumcised, the clamp is small and light to wear during the short healing period, and is not painful to remove.  Additionally, several styles of circumcision can be achieved when applied by an experienced operator, resulting in circumcision styles from moderately low/loose to high/tight.  The device does not remove or damage the frenulum, which may upon the parents/patients choosing, be done either before the clamp is applied or after it is removed.

Additional Photo Set

Finally, it should be noted the clamp is designed to be used by a skilled physician or other trained healthcare provider.  This is not a 'do it yourself' device.  The majority of photos on this page were provided by, and are the property of the manufacturer and posted here with their generous permission.



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