User:Petersmillard/sandbox

Unicirc

Inception	2013
Manufacturer	Kapasmed
Available	Sub-Saharan Africa
Website	Unicircglobal.com

Unicirc is a single-use-only, disposable surgical instrument, which permits rapid minimally-invasive circumcision of males from infancy to adulthood. Unicirc uses topical instead of injectable anesthetic, is completed rapidly in a single visit without sutures, and heals by primary intention.

History and usage

Unicirc was developed by a team led by Cyril Parker, Family Physician, and Elisabeth Pillgrab-Parker, project development specialist, in Cape Town, S. Africa. It is a single-use-only metal and plastic disposable surgical instrument.

After the foreskin is retracted, the Unicirc transparent bell is placed over the glans at the level of the corona and the foreskin is then replaced into the anatomic position. The yoke is placed over the bell and the screws are tightened, creating circumferential compression at the base of the foreskin for 5 minutes, which fuses the mucosal and skin surfaces. This allows for bloodless excision of the foreskin. Other than a scalpel, no other surgical instruments are needed. The fused skin edges are sealed with cyanoacrylate tissue adhesive to allow healing by primary intention. The procedure uses topical anesthesia cream, does not require sutures, and is completed in 9 minutes with no subsequent visits needed.

Advantages

Unicirc is a single-use-only instrument with a locking device that prevents reuse, eliminating the possibility of transmission of infection from one person to another. It can be used in all age groups. Topical anesthetic cream is used instead of injectable anesthetic and the use of cyanoacrylate tissue adhesive obviates the need for sutures. It is quick to perform and is completed in a single visit, healing by primary intention is rapid, and cosmetic results are excellent.

Unicirc can also be used in males when the foreskin is tight or adherent to the glans (phimosis), after a dorsal slit (similar to that performed in newborns). Frenulectomies can be performed under topical anesthetic immediately prior to Unicirc circumcision.

An international group of researchers estimated that compressive instruments (like Unicirc and Gomco) could displace up to 85% of surgical circumcisions. A meta-analysis of randomized controlled trials suggested that compressive instruments were associated with less blood loss, more rapid healing, and less pain compared to other techniques.

The risk of tetanus following surgical circumcision is low, and the risk with Uncirc is likely even lower, as there is never an open wound, no necrotic material, and the fused line of excision is sealed with cyanoacrylate, which has antibacterial properties.

Complications

As a result of intraoperative and postoperative bleeding episodes using Unicirc version 1, the developers made changes to the tightening mechanism. The current version 2 has the same bleeding risk as surgical circumcision. A small proportion of patients experience partial wound separation in the following week, which does not require treatment.

References

HIV prevention

In 2011, UNAIDS prioritized 14 high HIV prevalence countries in eastern and southern Africa, with a goal of circumcising 80% of men (20.8 million) by the end of 2016. In parallel, WHO developed a Framework for evaluating new, simpler circumcision techniques, which gave impetus to the development of two new devices (Prepex and Shang Ring) that are currently being scaled-up in the 14 high HIV prevalence countries. Overall, 14.5 million males were circumcised as of the end of 2016. UNAIDS' Fast-Track Plan for ending the AIDS Epidemic by 2030 calls for an additional 25 million MMC in these high-priority countries by 2020, which will require increasing circumcisions to 5 million per year, nearly double the current rate. To reach this goal, UNAIDS is counting on advances in circumcision techniques.

Newly circumcised men must refrain from sexual activity until the wounds are fully healed. Some circumcised men might have a false sense of security that could lead to increased risky sexual behavior.