Summary

The use of thermal cautery dates back to ancient Egypt around 3,000 BC, where heated instruments were employed to control bleeding and treat wounds. Today, thermal cautery remains a valuable tool in modern medicine, appreciated for its simplicity, reliability, and effectiveness. It continues to play a key role in many office-based procedures, particularly for its ability to quickly control bleeding and remove tissue with precision. Thermal cautery has also been an integral part of male circumcision since the earliest recorded times, primarily for its ability to stop bleeding and enable a faster, more efficient procedure. Below is a review of recent evidence demonstrating the safety and effectiveness of thermal cautery in the context of male circumcision.

The Geiger Thermal Cautery Unit (TCU), manufactured and sold by Delasco, was first introduced in 2000 and has provided reliable thermal cautery for minor surgical procedures in dermatology, ophthalmology, ear nose and throat, urology, and plastic surgery for over 20 years. Thermal cautery uses electricity to heat the instrument tip, made of metal, and applies direct heat to the tissue. No current is passed through the tissue. This is different than an electrosurgical instrument that passes high frequency current through the tissue causing the tissue to heat up. Advantages of thermal cautery over electrosurgery include no aberrant currents that could cause unintended tissue damage, no opportunity for electrosurgical channeling, and patients do not need to be grounded. The Geiger/Delasco TCU is a plug in unit and unlike disposable battery powered cauteries, the TCU maintains the desired temperature during tissue contact providing better cutting and coagulation. FDA 510K clearance, link here. Operating manual, link here. Catalogue page, link here.

Peer Reviewed Published Studies

Demir DÖ, Bürlükkara S, Yıldız AK. Comparison of the safety and efficacy of thermocautery-assisted circumcision and conventional surgical circumcision. Arch Basic Clin Res. 2024;6(3):183-187. Link to PDF

“Of the 1425 patients included in the study, 737 underwent conventional circumcision and 688 underwent thermal cautery-assisted circumcision. Thermocautery-assisted circumcision is a practical circumcision method that can be safely applied with low complication rates and short operation times.”

Uysal M, Şanlı A. Circumcision with Thermocautery after Local Anesthesia in Males: A Retrospective Single-center Study with 1821 Patients. Urol J. 2022 Apr 20;19(3):221-227. doi: 10.22037/uj.v19i.6748. PMID: 35466390. Link to PDF

“A Retrospective Single-center Study with 1821 Patients. The study results demonstrated that circumcision with thermal cautery after local anesthesia viable, reliable, and effective method.”

Akyüz O, Tatar Z. Is it safe to use a thermocautery device for circumcision? Examination of the histopathological changes emerging after thermocautery-assisted circumcisions. Andrologia. 2021 Apr;53(3):e13968. doi: 10.1111/and.13968. Epub 2021 Jan 9. PMID: 33421180. Link to PDF

“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.”

Ölçücü MT, Teke K . Evaluation of Short-term Postoperative Complications According to the Clavien-Dindo Classification System in Thermocautery-assisted Circumcision Cases. J Urol Surg. 2020 Sep;7(3):218-226. doi:10.4274/jus.galenos.2020.3266. Link to PDF

“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.”

Cakiroglu B, Gozukucuk A, Arda E, Tas T. Reliability of thermocautery-assisted circumcision: retrospective analysis of circumcision performed voluntarily in countries of low socioeconomic status. Ther Adv Urol. 2019 Oct 13;11:1756287219882598. doi: 10.1177/1756287219882598. PMID: 31662793; PMCID: PMC6792273. Link to PDF

“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 by using thermal cautery. Thermal cautery-assisted circumcision can be used as an effective, safe and useful technique with few complications and rapid healing rates.”

Akyüz O, Bodakçi MN, Tefekli AH. Thermal cautery-assisted circumcision and principles of its use to decrease complication rates. J Pediatr Urol. 2019 Apr;15(2):186.e1-186.e8. doi: 10.1016/j.jpurol.2019.01.003. Epub 2019 Jan 19. PMID: 30770302. Link to PDF

“Between the years 2009 and 2016, a total of 12,355 children between the ages of 40 days and 16 years (mean: 5.1 ± 2.0 years) 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 and both sides of the blade should be used for cutting, and temperature of the thermal cautery should be adjusted according to the skin thickness. The cutting process should be achieved in two steps. Thermal cautery supported method can be a very safe and fast circumcision method.”

El-Asmar, Khaled M. MD, PhD, MRCS, FEBPS; Abdel-Kader, Hesham M.; El-Shafei, Ehab A.; Ashraf, Ibrahim. 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 36(1):p 27-32, Jan–Mar 2017. | DOI: 10.4103/1110-1121.199886. Link to PDF

“The thermal cautery with bone-cutter technique proved superiority in hemostasis, operative time, and parent satisfaction, with less pain in the postoperative period. All three techniques had comparable final cosmetic outcome.”

Tuncer AA, Bozkurt MF, et al. Examination of histopathological changes of scalpel, monopolar, bipolar, and thermocautery applications in rat experimental circumcision model. Am J Transl Res. 2017;9(5):2306-2313. doi:10.xxxx/ajtr0047747. Link to PDF

“The use of thermocautery for circumcision has shown to be safe and resulted in better wound healing in rats with no apparent complications, and, if used in the human population, it may be a safe and effective technique.”

Yildirim H, Kucuk O, Tanrikulu B. Rapid way of circumcision: bipolar diathermic knife. Turkiye Klinikleri J Urol. 2015;6(1):15-19. doi:10.5336/urology.2015-43558. Link to PDF

“Circumcision with thermal cautery (diathermic knife) is reliable, fast, does not involve hemorrhage and provides good cosmetic results.

Makhlouf, Gamal A. MD; Kootb, Mohamed B.M.. Bone cutting and heat cautery circumcision. The Egyptian Journal of Surgery 34(4):p 258-260, Oct–Dec 2015. | DOI: 10.4103/1110-1121.167387 Link to PDF

“Bone cutting and heat cautery circumcision is a safe procedure, with no bleeding even in the three haemophilia cases. “

Saracoglu M, Ozturk H, Zengin T, Kerman HS. Comparison of thermal cautery-assisted circumcision with the conventional technique. Hum Androl. 2014;4:34-37. doi:10.5336/urology.2015-43558. Link to PDF

“Thermal cautery-assisted circumcision is a reliable technique that results in less bleeding and shorter operation time.”

Karaman MI, Zulfikar B, Özturk MI, Koca O, Akyüz M, Bezgal F. Circumcision in bleeding disorders: improvement of our cost effective method with diathermic knife. Urol J. 2014 May 6;11(2):1406-10. PMID: 24807751. Link to PDF

"A ‎total‎ of‎ 147‎patients‎ with ‎bleeding‎ diathesis‎ circumcised‎ under‎ local‎ anesthesia‎ by ‎using thermal cautery (‎diathermic ‎knife) ‎between‎ 1996‎ and ‎2010‎. When ever ‎it‎ is ‎necessary ‎for‎ an‎ individual ‎to‎ be‎circumcised‎ for ‎any‎ reason, ‎we‎ think‎ that‎ circumcision ‎can ‎be‎ performed ‎in‎ the ‎patients‎ with‎ bleeding‎ diathesis‎ with‎ lower‎ costs‎ and‎ complication ‎rates ‎by‎ using thermal cautery (‎diathermic ‎knife‎) and ‎the ‎protocol‎ that‎ we‎ used."

Abdel Hay S. The use of thermal cautery for male circumcision. JKAU: Med Sci. 2009;16(1):89-93. doi:10.4197/Med. 16-1.8. Link to PDF

"This technique was used in 2000 cases for primary circumcision under local anesthesia. The age ranged from 1 to 3 months (mean 35 days). The operative time ranged from 2 to 5 minutes (mean 3 minutes). No post-circumcision bleeding was noted in all patients and the cosmetic results were acceptable."

Fearne C. Point of Technique. Bloodless circumcision. BJU Int. 1999 Apr;83(6):717. doi: 10.1046/j.1464-410x.1999.00059.x. PMID: 10233587. Link to PDF

"The operative technique described here using thermal cautery (diathermy knife) may be useful to decrease the rate of postoperative bleeding.”