Thermal Cautery in Circumcision
How it works, why SafeCirc uses it, and what the published evidence shows.
The published literature supports thermal cautery as a useful technique for circumcision when paired with appropriate patient selection, local anesthesia, procedural technique, and follow-up.
A brief history
The use of thermal cautery dates back to antiquity, when heated instruments were used to control bleeding and treat wounds. Today, thermal cautery remains a practical tool in modern medicine because it is simple, reliable, and effective for tissue hemostasis in many office-based procedures.
Thermal cautery and circumcision
Thermal cautery has also been used in male circumcision because it can incise tissue while providing hemostasis. The studies below evaluate recent clinical evidence for thermocautery-assisted circumcision.
The Geiger Thermal Cautery Unit
The Geiger/Delasco TCU is a plug-in thermal cautery system. It heats a metal instrument tip, which transfers heat directly to tissue. No electrical current is passed through the patient. The Geiger Thermal Cautery Unit (TCU), was first introduced in 2000 and has provided reliable thermal cautery for minor surgical procedures for over 20 years. Unlike disposable battery-powered cauteries, the TCU maintains the desired temperature during tissue contact, which provides better cutting and coagulation.
Different from electrosurgery
No patient grounding pad
No high-frequency current through tissue
No electrosurgical channeling
Sustained heat during tissue contact
Peer-Reviewed Evidence
Comparison of the Safety and Efficacy of Thermocautery-Assisted Circumcision and Conventional Surgical Circumcision
ARCHIVES OF BASIC AND CLINICAL RESEARCH
Demir DÖ, Bürlükkara S, Yıldız AK. Arch Basic Clin Res. 2024;6(3):183-187.
Of the 1,425 patients included in the study, 737 underwent conventional circumcision and 688 underwent thermocautery-assisted circumcision.
Thermocautery-assisted circumcision is a practical circumcision method that can be safely applied with low complication rates and short operation times.
Circumcision With Thermocautery After Local Anesthesia in Males: A Retrospective Single-Center Study With 1,821 Patients
UROLOGY JOURNAL
Uysal M, Şanlı A. Urol J. 2022;19(3):221-227. doi:10.22037/uj.v19i.6748. PMID:35466390.
The study results demonstrated that circumcision with thermal cautery after local anesthesia is a viable, reliable, and effective method.
Is It Safe to Use a Thermocautery Device for Circumcision? Examination of the Histopathological Changes Emerging After Thermocautery-Assisted Circumcisions
ANDROLOGIA
Akyüz O, Tatar Z. Andrologia. 2021;53(3):e13968. doi:10.1111/and.13968. PMID:33421180.
Tissue damage is extremely limited in thermocautery-assisted circumcisions, even when it is used at high temperatures.
The thermocautery device can be used for effective and safe circumcisions.
Evaluation of Short-Term Postoperative Complications According to the Clavien-Dindo Classification System in Thermocautery-Assisted Circumcision Cases
JOURNAL OF UROLOGICAL SURGERY
Ölçücü MT, Teke K. J Urol Surg. 2020;7(3):218-226. doi:10.4274/jus.galenos.2020.3266.
A total of 2,356 male thermocautery-assisted circumcision cases, performed by two urologists in a hospital, were examined retrospectively.
Thermocautery-assisted circumcision may be a useful method in regions where circumcision is common.
Reliability of Thermocautery-Assisted Circumcision: Retrospective Analysis of Circumcision Performed Voluntarily in Countries of Low Socioeconomic Status
THERAPEUTIC ADVANCES IN UROLOGY
Cakiroglu B, Gozukucuk A, Arda E, Tas T. Ther Adv Urol. 2019;11:1756287219882598. doi:10.1177/1756287219882598. PMID:31662793; PMCID:PMC6792273.
Between 2016 and 2019, 32,000 children aged 7 days to 17 years were circumcised in multiple countries. All procedures were performed under local anesthesia using thermal cautery.
Thermal cautery-assisted circumcision can be used as an effective, safe, and useful technique with few complications and rapid healing rates.
Thermal Cautery-Assisted Circumcision and Principles of Its Use to Decrease Complication Rates
JOURNAL OF PEDIATRIC UROLOGY
Akyüz O, Bodakçi MN, Tefekli AH. J Pediatr Urol. 2019;15(2):186.e1-186.e8. doi:10.1016/j.jpurol.2019.01.003. PMID:30770302.
Between 2009 and 2016, 12,355 children between 40 days and 16 years of age were circumcised at our hospital. All circumcisions were performed by urologists under local anesthesia using a thermal cautery device.
The cautery should be turned in a serial manner, both sides of the blade should be used for cutting, and the temperature should be adjusted according to skin thickness. The cutting process should be completed in two steps.
The thermal cautery-supported method can be a very safe and fast circumcision method.
Comparison Between the Bone Cutter With Thermal Cautery, Gomco, and Plastibell for Circumcision in Neonates and Infants: A Prospective Randomized Trial
THE EGYPTIAN JOURNAL OF SURGERY
El-Asmar KM, Abdel-Kader HM, El-Shafei EA, Ashraf I. Egypt J Surg. 2017;36(1):27-32. doi:10.4103/1110-1121.199886.
The thermal cautery with bone-cutter technique proved superior in hemostasis, operative time, and parent satisfaction, with less pain in the postoperative period.
All three techniques had comparable final cosmetic outcomes.
Examination of Histopathological Changes of Scalpel, Monopolar, Bipolar, and Thermocautery Applications in a Rat Experimental Circumcision Model
AMERICAN JOURNAL OF TRANSLATIONAL RESEARCH
Tuncer AA, Bozkurt MF, et al. Am J Transl Res. 2017;9(5):2306-2313. DOI requires verification.
Experimental animal study.
The use of thermocautery for circumcision was shown to be safe and resulted in better wound healing in rats with no apparent complications; if used in the human population, it may be a safe and effective technique.
Rapid Way of Circumcision: Bipolar Diathermic Knife
TÜRKIYE KLINIKLERI JOURNAL OF UROLOGY
Yildirim H, Kucuk O, Tanrikulu B. Turkiye Klinikleri J Urol. 2015;6(1):15-19. doi:10.5336/urology.2015-43558.
Circumcision with thermal cautery, or a diathermic knife, is reliable and fast, does not involve hemorrhage, and provides good cosmetic results.
Bone Cutting and Heat Cautery Circumcision
THE EGYPTIAN JOURNAL OF SURGERY
Makhlouf GA, Kootb MBM. Egypt J Surg. 2015;34(4):258-260. doi:10.4103/1110-1121.167387.
Bone cutting and heat cautery circumcision is a safe procedure, with no bleeding even in the three hemophilia cases.
Comparison of Thermal Cautery-Assisted Circumcision With the Conventional Technique
HUMAN ANDROLOGY
Saracoglu M, Ozturk H, Zengin T, Kerman HS. Hum Androl. 2014;4:34-37. DOI requires verification.
Thermal cautery-assisted circumcision is a reliable technique that results in less bleeding and shorter operation time.
Circumcision in Bleeding Disorders: Improvement of Our Cost-Effective Method With Diathermic Knife
UROLOGY JOURNAL
Karaman MI, Zulfikar B, Özturk MI, Koca O, Akyüz M, Bezgal F. Urol J. 2014;11(2):1406-1410. PMID:24807751.
A total of 147 patients with bleeding diathesis were circumcised under local anesthesia using thermal cautery, or a diathermic knife, between 1996 and 2010.
When circumcision is necessary in patients with bleeding diathesis, the authors concluded that it can be performed with lower costs and complication rates using the thermal cautery technique and their perioperative protocol.
The Use of Thermal Cautery for Male Circumcision
JKAU: MEDICAL SCIENCES
Abdel Hay S. JKAU Med Sci. 2009;16(1):89-93. doi:10.4197/Med.16-1.8.
This technique was used in 2,000 cases for primary circumcision under local anesthesia. Patient age ranged from 1 to 3 months, with a mean of 35 days.
The operative time ranged from 2 to 5 minutes, with a mean of 3 minutes. No post-circumcision bleeding was reported, and the cosmetic results were acceptable.
Bloodless Circumcision
BJU INTERNATIONAL
Fearne C. BJU Int. 1999;83(6):717. doi:10.1046/j.1464-410x.1999.00059.x. PMID:10233587.
Point-of-technique article.
The operative technique described here using thermal cautery, or a diathermy knife, may be useful to decrease the rate of postoperative bleeding.
Evidence conclusion
The current literature supports thermal cautery as a useful circumcision technique that can reduce bleeding and procedure time when applied by trained clinicians using appropriate technique.