261Archivio Italiano di Urologia e Andrologia 2019; 91, 4 CASE REPORT Preputial circumcision performed with a new mechanical stapling tool. The “langhe disposable circumcision suture device”. Preliminary experiences Diego Pozza 1, Carlotta Pozza 2, Augusto Mosca 3, Mariangela Pozza 1 1 Studio di Andrologia e di Chirurgia Andrologica, Rome, Italy; 2 Department of FPM, Sapienza University, Rome, Italy; 3 U.O. Urologia ed Andrologia, Osp. S. Sebastiano, Frascati, Italy. The Authors present their preliminary clini- cal experiences in performing preputial cir- cumcision utilizing a new stapling tool. KEY WORDS: Circumcision; Phimosis; Stapling surgical tool. Submitted 17 July 2019; Accepted 29 July 2019 Summary No conflict of interest declared. DOI: 10.4081/aiua.2019.4.261 INTRODUCTION Male circumcision was performed since 2300 BC in Egypt (1) and is one of the most common surgical pro- cedures performed on males for religious, ethical, sexu- al or medical reasons (2). Circumcision is undertaken using a variety of surgical methods (3). Since the years '80, "Stapler" tools that allow to make sections and sutures of circular and longitudinal organs in very short time have become a "standard" for many surgical branch- es. Genital surgery, due to the narrowness of the opera- tive field and the limited dimensions of the organs, did not admit the use of these mechanical staplers. We want to present our preliminary experiences on the use of the "Langhe disposable circumcision suture device" (LDCSD), which is an innova- tive mechanical "Stapler" tool to carry out a circumcision (4). CASE REPORT We utilized the LDCSD in 20 patients (pts) aged 14 to 80 years with congenital phimo- sis, redundant prepuce or balanopostitic outcome (Figure 1). In the Operating Room local anesthesia or anesthesiological seda- tion is performed according to age and clin- ical data of the pts. After disinfection it is checked that the preputial frenulum is suffi- ciently extensible, otherwise it is engraved. The part of the instrument, conformed like a small cup with a stem, is introduced under the prepuce to completely cover the gland. The prepuce is fixed to the stem with a safe- ty buckle, the stem of the instrument is introduced into the handpiece until it pro- trudes. The screw is turned until the hand- piece is fixed to the Cup under the prepuce. The two handles of the handpiece are firmly tightened so that there is a further compression and section of the cuta- neous and mucosal layers. The compression of the han- dles determines their circular section and suture with 12 staples with perfect mechanical and hydraulic seal. After 1 minute the screw is unscrewed to distance the two parts and free the perfectly circumcised and sutured penis (Figure 2). The prepuce is wrapped with sterile gauze and a strong circular pressure is maintained with the fingers for 4-5 minutes. The penis is tightly bendaged and the pt. is returned to bed with the band- age which is maintained for at least 2-3 hours for hemo- static purposes. If there are no signs of bleeding when the bandage is removed, the patient is sent home. If, on the other hand, a bleeding is observed, a local compres- sion or an absorbable stitch should be applied. The first 3 cases required special prudence and atten- tion; the 17 following pts were performed with simple local anesthesia and in 3 pts (< 20 years) with sedation. Operating times varied between 5 and 7 minutes. Figure 1. A. The Box containing the LDCSD. B. The Instrument ready for use. C. The 12 staples assembled in the circular resection part. Pozza_Stesura Seveso 10/01/20 08:55 Pagina 261 Archivio Italiano di Urologia e Andrologia 2019; 91, 4 D. Pozza, C. Pozza, A. Mosca, M. Pozza 262 We have never observed any major complica- tions. No significant intraoperative blood loss. In 2 cases we have prudentially applied few absorbable suture stitches. Metallic staples fell spontaneously after 15-25 days. In 2 cases after 30 days we removed some staples still present with a simple and painless ambulato- ry maneuver. All pts reported full satisfaction concerning operative, postoperative, aesthetic and functional results (Figure 3). CONCLUSIONS The LDCSD with his advantages of simple and easier manipulation, shorter operation time, fewer complica- tions, better cosmetic results, could be considered a use- ful tool to carry out a rapid, aesthetic, effective and safe circumcision. REFERENCES 1. Meijer B, Butzelaar RM. Circumcision from a historical perspec- tive. Ned Tijdchr Geneeskd. 2000; 144:2504. 2. Bronselaer GA, Schober JM, Meyer-Bahlburg HF, et al. Male cir- cumcision decreases penile sensitivity as measured in a large cohort. BJU. 2013; 111:820. 3. Featherstone NC, Murphy FL. Paediatric suturless circumcision and modified circumcision: video demostration. J Pediatr Urol. 2012; 8:240. 4. Lv BD, Zhang SG, Zhu XW, et al. Disposable circumcision suture device: clinical effect and patient satisfaction. Asian J Androl. 2014; 16:453. Figure 2. A. The prepuce is fixed around the metallic stem. B. The stem is introduced into the handpiece. C. The handpieces are strictly tightened. D. The system is disassembled; the prepuce has been cut. Figure 3. A. Result after 1 week in young patient with phimosis. B. Result in a 80 years old patient after balanoposthitis. C. The metallic staples. D. Result in a young patient after one month. Correspondence Diego Pozza, MD (Corresponding Author) diegpo@tin.it Mariangela Pozza, MD Studio di Andrologia e di Chirurgia Andrologica Via B. Gozzoli, 62H - 00142 Roma (Italy) Carlotta Pozza, MD Department of FPM, Sapienza University, Roma (Italy) Augusto Mosca, MD U.O. Urologia ed Andrologia, Osp. S. Sebastiano, Frascati (Italy) Pozza_Stesura Seveso 10/01/20 08:55 Pagina 262