Je n’ai rien contre la circoncision des adultes, mais circoncire un mineur sans raison médicale est un crime et un acte de barbarie. Certes, les pays occidentaux ne le pénalisent pas encore par lâcheté, mais espérons que cela ne tardera pas.
La circoncision des adultes sans raison médicale pose un problème déontologique: est-ce qu’un médecin a le droit d’amputer une partie saine d’un corps humain? Oui, s’il s’agit d’une opération esthétique visant à corriger une anomalie. Mais il est difficile de comparer la circoncision à une opération esthétique puisque le prépuce est une partie intégrante du pénis voulue par la nature au même titre que le clitoris chez la femme. Reste donc la possibilité que celui qui veut se faire circoncire le fasse lui-même, à ses risques et périls. Il y a des appareils pour cela, dont un est exposé dans cet article et qui ressemble à un tire-bouchon.
Cet appareil, appelé Tara Klamp et fait par une Malaisien, a remporté en 1996 une médaille d’or au salon des inventions à Genève. Je ne peux résister au plaisir de vous copier la page de publicité de cet appareil. Si jamais vous voulez l’essayer, c’est à votre risque et péril. Et si vous le faites et vous n’êtes pas satisfait du résultat, vous pouvez toujours restaurer votre prépuce…. en tirant sur la peau et en y accrochant un poids (voir la photo ci-après). Cela peut vous prendre jusqu’à 45 mois, alors que couper un prépuce prend cinq minutes au maximum. Mais comme on le sait, lorsqu’on aime on ne compte pas. Avertissez-nous si jamais vous vous faites circoncire avec cet appareil…. ou si vous restaurez votre prépuce. Sachez que vous pouvez utiliser ce tire-bouchon même si vous êtes déjà circoncis (voir plus bas en rouge). Bonne chance.
Tara KLamp
This is a Malaysian invention, developed by Dr. Gurchran Singh Tara Singh during the 1980s and early 1990s. It was first marketed in 1995. Gurch, as he is known to his friends, should properly be regarded as the father of the modern disposable circumcision clamp. His circumcision device is highly regarded in SE Asia and in Africa it is making inroads into the sub-Saharan market. In June 2009, Dr. Singh’s tireless work promoting safe circumcision earned him the Malaysian Medical Association’s Outstanding Public and Healthcare Services Award, a rare honour equivalent to a Lifetime Achievement Award.
As is so often the case with clever inventions, a host of similar devices soon followed in the wake of the original. Each one differs slightly, in an attempt to skate around the intellectual property rights of their competitors. Elsewhere on this website you will find descriptions of (in alphabetical order) the Ali’sKlamp, Ismail Clamp, KirveKlamp, SmartKlamp and Sunathrone devices.
The principle of operation of the Tara KLamp is illustrated by the following diagrams, based upon the manufacturer’s original publicity material dating from the 1990s:
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Once the clamp is closed, the fate of the foreskin is sealed. There’s no going back; the powerful crushing action causes irrecoverable tissue damage. In theory an option exists not to cut with a scalpel, instead leaving the condemned part of the foreskin in place to necrotise – the clamping action having totally cut off the blood supply. However, this approach is not recommended due to the possibility of the considerable quantity of dead tissue harbouring infection during the week or so until the clamp drops off naturally. Normally, a scalpel will be used to sever the foreskin a few minutes after the clamp is applied. The correct position of the cut is 2mm to 3mm clear of the distal face of the clamping ring. When marking out a circumcision using one of these clamps, it is vital to realise that the eventual scar line will form at the position of the proximal face of the clamping ring, not at the position of the scalpel cut.
Unlike the Plastibell device, which uses string to strangulate the condemned tissue, a Tara KLamp can achieve fairly tight styles of circumcision without the inner part digging into retained tissue.
The inventor claims the following benefits viz-a-viz conventional circumcision surgery:
- The device is delivered pre-sterilised.
- The latching mechanism is designed to ensure single use only, thus guarding against cross-infections (hepatitis, HIV).
- The device totally shields the glans from the scalpel, making the procedure very safe.
- The method is non-invasive; no sutures, ligatures or dressings are required.
- Haemostasis is maintained during surgery.
- There is no open wound.
- Results are predictably neat and even across a wide range of style choices.
- A sterile environment is not required. The device can be used in homes, schools, at religious sites and other non-medical places.
- There is no post-surgical bleeding or oozing. The patient can resume normal activities straight away.
In the years since the Tara KLamp was first marketed, a number of incremental design improvements have been made. Most notable of these is that the material used to mould the clamp has been changed. This has enabled the size of the device to be reduced without compromising on strength. Only clamps made the newer material should now be in circulation, any unused devices moulded using the old material now being past their use-by date in terms of sterility.
Sterilisation is by the EO process. The current grade of plastic used is not suited to sterilisation by Gamma-Ray irradiation (Cobalt 60 exposure). In common with many plastics, it goes brittle when irradiated. So, despite the environmental concerns that some people attach to the Ethylene Oxide process, the old-fashioned method prevails. Experimentation with sterilisation by ultra-high voltage electrostatic fields is in prospect, but not yet implemented.
Current clamp production is in a range of sizes from newborn to adult. From the outset, the production and marketing company TaraMedic supplied these clamps as part of a kit that also included a scalpel blade and a measuring device. This accords with the company’s original design concept, which envisaged a device useable in remote places by those with only ad-hoc training. Although a greater degree of medical expertise is now recommended, the concept of a “Field Kit” has been retained. No means of anaesthesia is included; users must organise that separately. The recommended form of anaesthesia is a Dorsal Penile Nerve Block (DPNB). For children, this can usefully be preceed by an application of a topical anaesthetic cream to dull the pain of the first injection.
On the subject of pain relief, Dr. Singh himself writes: “On discomfort, I would feel there could be some discomfort as the patient will have the device on him for a minimum of 4-5 days. However, we get feed-back that patients do not mind that, as they realize that the many benefits that they otherwise obtain, have really taken away their fears etc. and are grateful for that.”
Here are some images of adult size Tara KLamps in use:
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Click on any of these thumbnails to enlarge the image. Having viewed the enlarged version, use the BACK button of your browser to return here.
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Recircumcision with a Tara KLamp
The Mk.1 Tara KLamp shown below is being applied to an adult who was previously circumcised freehand, showing that the Tara KLamp can be used to tighten a circumcision.
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Child circumcision with a Tara KLamp
The following image shows an Indonesian boy being circumcised with the latest model of Tara KLamp. Note especially the more compact size of the clamp compared with the original and the narrow necrotic ring it achieves along with a low and moderately tight style. The latching mechanism remains as secure as before, making this clamp especially suitable for use on disabled, autistic or meddlesome boys.
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