The RYPS disposable circumcision device is a Chinese invention which takes the principle of the Accucirc device one stage further by both cutting off the foreskin and stapling the cut edges together all in one hit. We first reported it in our News section on 12th April 2016, which includes a link to a journal paper about it. At that stage it was only an adult device but it is now available in sizes from 12mm diameter to an (ahem) impressive 34mm.
This means that it caters for children as well as adults. The picture above shows two versions of the device, with code names RYCP (made of metal) and RYAP (made of plastic). No reason is given for the existence of two models - both are available in all sizes. The right-hand version (RYAP) is the one shown in their promotional material.
Use of the device clearly requires considerable skill, and an assistant as well as the surgeon. A bell is inserted under the foreskin (which may require separation of adhesions and / or enlargement of a phimotic opening). The foreskin is then tied to keep it in position and the cutting part is placed in position and clamped with the screw. This needs to be adjusted precisely to cope with different foreskin thicknesses. An indicator line shows when it is correct. Then the safety pin (red in the pictures) is removed and the device is 'fired' (their word) by pulling the handles together with both hands.
This both cuts the foreskin with a circular knife and staples the edges together, with a thin silicone membrane under the staples. After 60 seconds the handles are opened again, the screw undone, and the outer device removed. The bell is then removed with the foreskin.
As these images show, the result is a loose circumcision with the frenulum preserved but otherwise very little inner skin left. Aftercare requirements are surprisingly stringent. A tight compression bandage is worn and after 3 days the patient must return to hospital to have it changed. At the same time the silicone membrane is cut into 4 segments so that it cannot form a constricting ring. After one week you are allowed to have a shower (!) with a condom over the dressing. After 10 days you can remove the dressing but must disinfect the site twice a day. Nocturnal erections are not permitted (though it is not explained how to achieve this) nor must you drink alcohol or eat spicy food or seafood (?). The staples will start to come out after a week, and if any remain after 3 weeks you need to go back to the hospital to have them removed. Sex is permitted after a month.
These aftercare requirements rather suggest that the suturing and haemostatic quality of the staples is a little bit suspect. Otherwise it is very hard to see why compression dressings (or indeed any dressings) should be needed.
The device seems mostly confined to China though the company states it has been used in Malaysia, Vietnam, Iran and Turkey and they plan to introduce it to Indonesia.
|Manufaturer:||Wuxi Ryps Medical Appliance Co., Ltd.|
|Ezhou Road 328, Heqiao Town ,Yixing city, Jiangsu Province, China|