This is a Malaysian invention which works in a very similar fashion to the Plastibell except that instead of having to tie suture material around a groove in the bell, plastic arms lock into place to force two surfaces into tight contact; with the foreskin trapped between them.

The device is much more bulky than a Plastibell and remains on the penis for 7 to 10 days until it falls off. If the foreskin is tight, a dorsal slit is required to gain access for the bell to be applied over the glans. The foreskin trapped forward of the clamping device is cut away after the clamp has been in place 20 minutes or so. The glans and frenulum are protected and the frenulum is never cut during this procedure.

Prior to surgery, at least a local anesthetic is used. The dorsal nerve ring block is my preferred choice. For children, a trial in Manila does give encouragement that EMLA cream does help. Immediately after the surgery and for the next day or two, oral analgesics are required. In addition, we found that the use of oral proteolytic enzymes also help, as swelling proximal to the occlusion is prevented.

On discomfort, I would feel there could be some discomfort as the patient will have the device on him for a minimum of 4-5 days. However, we get feed-back that patients do not mind that, as they realize that the many benefits that they otherwise obtain, have really taken away their fears etc. and are grateful for that.

Dr. T. Gurcharan Singh

The results are similar to the Plastibell when used on a child (moderate to loose). Adults circumcised with the Tara KLamp have reported that the circumcision wound occasionally opens after the KLamp is removed. Naturally healing takes place in this instance, and the circumcision usually heals without further incident. The Tara KLamp has been used on many thousands of boys in Malaysia and other countries where routine pre-adolescent circumcision is the custom, by and large without incident and achieving excellent results from non-medically trained circumcisers.

The Tara KLamp, invented by Malaysian doctor Gurcharan Singh, uses a bloodless and less painful "clamp and cut" technique that allows the patient to go back to work or school after surgery, if he so desires. He can wear the device under his pants if he wishes, for up to four days, and due to the KLamp's "total occlusion" technique, the patient is also not restricted from bathing or any other activities -- well, most other -- since the wound is blocked out from the environment. For doctors, the Tara KLamp promises a faster turnaround time and, say its distributors, prevents cross-infection. "The main advantage is that patients now don't have to wait for the long holidays to get circumcised -- they only need a long weekend," said Erwin Soo, senior manager (wholesale division) of Apex Pharmacy International Pte Ltd, which is marketing the KLamp in Singapore. Dr Singh, in his early 40s, left his practice a few years ago to start his own company called Taramedic, which develops medical products. The idea for the KLamp was developed "a long time ago", said Mr. Soo, but the product only hit the market after it won the bronze award at Mindex, Malaysia's annual medical products exhibition earlier this year. The US male shown in the photo at left, was born and raised in California, USA.  He was not circumcised at birth in order to be like his father (who is of Hispanic decent.)  As a youth, he desired however, to be like his circumcised friends and as a young adult, choose to be circumcised with the Tara KLamp.  Prior to his circumcision, he routinely wore his foreskin in the peeled back position.  Some two years after his circumcision, he reports he continues to be very pleased with his decision, as is his girlfriend.  The Tara KLamp circumcision resulted in a moderately high and rather tight circumcision when erect.

The Tara KLamp, which has been fully approved in Malaysia, is now used in hospitals and private clinics. Sales in Malaysia have since crossed 1,000 units and the aim in Singapore, for a start, is to achieve a penetration of 60 per cent of the 3,500 to 5,000 circumcisions performed among the Muslim community each year. It is currently being reviewed for approval by the US FDA. The Tara KLamp comes in a pre-sterilized kit (see photo below) complete with the device and special surgical blade. Sizes range from "infant" to "adult", specifically. Each KLamp costs from $23 to $26 (US), depending on the size.  Since its inception, the KLamp shown here, has been slightly re-designed to make the plastic device smaller, thereby more comfortable when worn inside a man's pants for 6-10 days.

This article was contributed by Dr Ziad Azhari MD (UKM) Dip. Trop. Med. (Bangkok, Thailand). It is based on his own personal experience and observation, therefore doesn't reflect the views of the editorial board nor of this association.

Of Circumcision and TaraKlamps - A personal experience

I have the opportunity of trying out The TaraKlamp in some of my adolescent "clients" during the recent circumcision season. For the uninitiated , the TaraKlamp is a device consisting of two parts - a hollow "cap" fitting the glans penis, and a circular clamp made to press against the redundant foreskn and the aforementioned penile cap. The prepuce is then lopped off with a curved scalpel blade. It is made entirely of disposable plastic. The patient wears it for a few days before separation is affected between the two parts. The cut edges are sealed by the resultant necrotic tissue, which laters drops off, rather like the clamped umbilical cord of a newborn. The device is claimed to have the following advantages compared to the traditional method:

1. Quicker operation time 2. Not requiring sterile operating conditions 3. "Bloodless" 4. Relatively painless 5. Requires no stiches or dressing; the wearer can even go swimming! 6. Quicker healing time 7. Aesthetically more pleasing due to the "moulded" cut

Out of a total of 520 circumcisions, 44 was performed by TaraKlamp using the sizes 15mm, 17.5mm and 20.5mm, which are the mean sizes of most 12 year olds. In carrying out the procedure, the device lived up to its claim. Generally I took less than 5 minutes from the administration of the local anaesthetic to the actual clamping and lopping off, except for a few obese patients. This was in comparison to about 20 minutes for the traditional method.

Complications

Within 24 hours: 2 patients with sizes 20.5mm came back on the same day with retrograde haematoma, proximal to the clamp, and having severe pain. The skin was also found to have slipped off from the clamp. The clamp had to be removed, haematoma relieved and stitching done by traditional method. 2 patients with sizes 17.5 mm complained of severe "clamping" pain ("macam dikepit") and difficulty to PU. These were treated by analgesics and reassurance.

Within 48 hours: 3 patients of sizes 17.5mm and 15.5mm complained of intense pain and "itchiness". The clamps had to be removed prematurely rather than the stipulated 5 days. Surprisingly the results were good.

After 5 days: 1 patient of size 17.5mm had too much left over skin which is not acceptable to the Sunnah. The patient had to be reanaesthetized and extra skin removed by the traditional method.

After 1 week: 6 patients of sizes 17.5mm and 20.5mm had swelling of the coronal sulcus, giving to a mushroom-like appearance. In one patient, part of the necrotic area had also given way to infection.

The probable explaination is that upon removal of the device, the necrotic ring had slipped back to the proximal part of the penis, forming a constricting band. This had hindered the normal flow of blood and lymphatics.

As for the rest of the 476 patients performed by traditional method, only 5 came back for being secondarily infected. None had any bleeding complications.

Conclusion

Most of the complications occurred in the larger sized clamps (and corresponding organs) where the blood vessels and lymphatics are larger and more numerous. Nevertheless, the rate of complications for TaraKlamps of 32% is far too high even for a first time user. This may be compared to just 1% for the traditional method. These are my honest, albeitly tongue in cheek, personal observations, and it is not my intention to cast any aspersions on the inventor, TARAMedic Corporation, whose original idea is good, except it goes against one basic principle in surgery; Necrotic tissue attached to the extremity of a warm, living body is never absolutely safe, what more if the distal portion is still viable organ, like the glans penis.

That's why we have procedures such as desloughing or even outright amputation. I only wish that some illustrious member of our alumni, such as Dr Jalil Jidon, can come up with a better device that fulfills at least the following conditions;

1. Universal fit for all penile sizes (adults included)

2. Minimal foreign body contact with the glans penis, easy to PU.

3. Made in Malaysia, approved by SIRIM or The MOH, and relatively inexpensive.

Otherwise the TaraKlamp, and other would-be devices might just be dismissed as an expensive gimmick. A circumcision, is after all just a circumcision. Why, even in the kampongs the Tok Mudim is still doing it with the good old perangan, pisau lipat and the batang pisang.....and with less complications.

Dr Ziad Azhari MD (UKM) Dip. Tropical Medicine (Bangkok)

I am not so sure however, the TaraKlamp is the best solution in a civilized country where the hygiene is no problem. It is designed to be used in a  hygienically uncontrolled ambient and there it has advantages. At home, this might be a risk, too. Therefore for a do-it-yourself circumcision when you want  to do it yourself with nobody else as a doctor or circumciser attending, it could  be a solution. It is not expensive but you have to keep in mind that you will  carry this dongle on your dick for nearly a week.

In most countries however, it is much easier to go to a doctor or to ask a circumciser. In the  doctor's office it is a half hour job and with some probability (and the good  reasons you may have - tell you are suffering recurrent inflammations) the  insurance will pay for it.  When you really want to have it done at home - the doctor will not do it there -  call a circumciser. In the big cities you find them through the Islamic communities. The cost in this case is (in Germany) about 150 DM, equivalent to US$ 80, when  the circumciser comes to your home. Another possibility is to use the service of the Islamic communities with their  big circumcision events which take place periodically. The boys are cut there in  the public, the older or adults are circumcised separately. For that service including a one night stay in their house would cost 300 DM (US$ 160). As I have in mind this service is also available for non Moslem. In any case you should discuss with the circumciser whether his method is acceptable for you. You normally have no choice for tight or less tight  circumcision. He will do it as he had done his last some thousand circumcisions before. Also anesthesia is not usual but sometimes available on special request.

After all of the facts are considered, I think you will agree that having an experienced person circumcise you is the best option.

The Tara KLamp is shown here being applied to an adult who was previously circumcised freehand. The Tara KLamp can be used to tighten a circumcision by removing more of the loose (remaining) foreskin.

CIRCLIST Home Page	Medical Terms & Penile Anatomy	Considering Circumcision?	Styles & Results of Circumcision	Instruments & Techniques
	Personal Preferences & Experiences	Rites & Practices Around the World	Circumcision Discussion Group	Circumcision Resources

Copyright 1992 - 2008, All Rights Reserved CIRCLIST