1. Atraumatic Circumcision Device (AccuCirc) Overview

2. Atraumatic Circumcision Device Kit
Betadyne prep
Circumcision drape
Surgical marking pen
2 curved hemostats
AccuCirc device
Gauze & wipe
Xeroform dressing
Entirely disposable kit with everything required to perform newborn circumcision (anesthesia and sterile gloves not included).

3. Atraumatic Circumcision Device

4. Atraumatic Circumcision Device Method of Use

5. Create surgical pen mark
The included surgical pen is used to mark where the incision will be made, helping to ensure the desired amount of foreskin will be removed.

6. Grasp foreskin
The foreskin is gently pinched (pushing the glans down and out of the way) and grasped at the 3:00 and 9:00 position.

7. Remove adhesions
The flexible probe of the shielding ring is used to remove any adhesions that exist between the foreskin and the glans.

8. Insert shielding ring
The shielding ring is inserted into the foreskin without making a dorsal slit. If necessary, the foreskin can be gently stretched to help accommodate the shield.

9. Align foreskin
The foreskin holder is activated and the foreskin is precisely positioned on the shielding ring.

10. Apply clamping and cutting device
This is a series of pictures showing the application of the clamp

11. Activate lever arm until it locks, then release.
This is a picture of the clamp in place and the results immediately post op.
With a single actuation the device crushes and cuts the foreskin.

12. Atraumatic Circumcision Device outcome at 2 weeks

13. Atraumatic Circumcision Device Overview of Benefits

14. Surgical Pen
A surgical pen is included in each kit. The pen mark helps ensure the correct amount of skin is removed improving the accuracy of the procedure. 1
1. Kaplan GW. Complications of circumcision. Urol Clin North Am 1983;

15. Shield to protect penis
Some devices do not use a shield to protect the penis during the clamping and cutting action. This can result in injury to the penis regardless of the level of experience of the user.2 The Atraumatic Circumcision Device uses a shield that protects the penis during the procedure.
2. Strimling BS: Partial amputation of glans penis during circumcision. Pediatrics 97: , 1995.

16. No Dorsal Slit
Some devices require a dorsal slit. This step can result in injury to the urethra.3 The Atraumatic Circumcision Device is designed to be used without making a dorsal slit while still using a shield that protects the penis. The need for scissors and the dorsal slit is eliminated.
3. FDA MedWatch Reports, January 2000, "Potential for Injury from Circumcision Clamps"

17. Foreskin Holder
Some devices require the use of a safety pin to help position the foreskin. The Atraumatic Circumcision Device uses a foreskin holder that allows the provider to accurately position the foreskin prior to the application of the clamping and cutting device, ensuring a precise amount of skin is removed.

18. No mismatching parts Unique Diameters
act as a key to ensure shield matches clamp
No mismatching parts
Mismatching device parts can lead to penile laceration.3 The Atraumatic Circumcision Device has built in safety features that protect against mismatching device parts. The device will only work when the correctly sized shielding ring is locked in place, ensuring the penis is protected during the procedure.
3. FDA MedWatch Reports, January 2000, "Potential for Injury from Circumcision Clamps"

19. Circular, Protected Blade
The Atraumatic Circumcision Device eliminates the scalpel and instead uses a circular self contained blade that is precisely controlled by the device itself. By controlling the circular blade, the device protects against injuring the penis.

20. No Retained Parts
The Atraumatic Circumcision Device delivers a hemostatic crushing force (to control the bleeding). Following the procedure, no string or bell is retained. This protects against urinary obstruction and other complications related to retained parts.4,5
4. Mihssin N. Retention of urine: an unusual complication of the Plastibell device. BJU International. 1999; 84, 745.
5. Jee LD. Ruptured bladder following circumcision using the Plastibell device. Br J Urol 1990;65:216-7

21. Contaminated Instruments
Of particular importance in resource limited areas, the Atraumatic Circumcision Device protects the contaminated parts (blade and shield) and prevents their reuse.

22. Entirely Disposable
The Atraumatic Circumcision Device kit is entirely disposable. No part requires reprocessing or re-sterilization. This helps prevent injuries that can occur from worn or mismatched clamps and, in resource limited areas, contaminated instruments.

23. Minimal Waste
With any crushing and cutting device, the cutting surface will have to be discarded. The Atraumatic Circumcision Device protects the cutting surface and also functions as a disposable clamping device with minimal waste.

24. Self Contained Kit, Simplified Inventory
A single kit contains everything needed to perform newborn male circumcision simplifying inventory and decreasing the likelihood of a provider performing the procedure without having the adequate supplies.

25. Minimal Cost
Because the entire kit is disposable and requires no reprocessing, no infrastructure is required to use this device. The device is made out of inexpensive injected molded plastic parts that can be manufactured in large volumes at a low cost.

26. Summary Complication AccuCirc Gomco Mogen Plastibell
Removal of excessive or an insufficient amount of foreskin.
Reduced risk
(prevented by using a surgical marking pen and foreskin holder)
Increased risk
(difficult to gauge amount of tissue
to remove)
(difficult to gauge amount of tissue to remove)
Urethral Injury
No risk
(dorsal slit is
never made)
(dorsal slit routinely required)
(not all providers use a dorsal slit)
(dorsal slit
routinely required)
Penile Laceration/
Amputation
(device ensures
protection)
(related to mis-matched parts)
(glans is not shielded)
Urinary retention, bladder rupture, injury from retained parts
(no retained parts)
(bell stays in
place on infant)
Resource Limited Areas
Transmission of Infection through contaminated parts
(Disposable, contaminated parts protected)
(Parts needs to be processed and sterilized)
(Parts need to be processed and sterilized)
(Scissors need to be processed and sterilized)

27. Summary
Our goal has been to design and engineer a device that can help protect patients from accidental injury during circumcision, particularly in resource limited areas and for the purpose of HIV prevention.