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)_small.jpg)
- 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)
- 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.
- Mark with a
sterile marker the amount of prepuce you want to remove.
- Free all
adhesions and then clean the Glans Penis thoroughly.
- 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.
- 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.
- Adjust the
tube to the required level. Make sure the urinary meatus is visible
and centrally located.
-
Loosely apply the cuff locking mechanism,
aligning it with the groove of the inner ring.
- Adjust the
position of the whole Sunathrone™ clamp so that the distal face of the cuff
aligns with the marked position for the cut.
- 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!].
- Press the
two ends of the cuff together until the mechanism clicks at least twice and
locks satisfactorily.
-
Again
make sure that make sure that the foreskin is evenly trapped right around
the circumference of the ring.
- Double
check that the cuff is correctly located in the groove of the tube before
proceeding.
- 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.
- Break off
the distal end of the tube by applying a light twisting force.
- This will
leave 1/5 of the original inner part clamping the wound, which is secured by
the cuff's locking mechanism.
- Leave the
Sunathrone™ attached to the penis until the circumcision wound fully heals.
- 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.
- The
Sunathrone™ device will drop off by itself once satisfactory healing is
achieved.
- A small
ring of necrotic tissue will remain, and disappear by itself in a few days.
- 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.
Copyright 1992 - 2008, All Rights Reserved CIRCLIST
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