Circumcision Stapler: Principles, Development, and Clinical Application

Circumcision Stapler: Principles, Development, and Clinical Application

A circumcision stapler is a specialized medical device used in circumcision procedures, capable of simultaneously excising redundant prepuce and stapling the wound edge in a single operation. In recent years, it has become one of the mainstream choices in urology for treating phimosis and redundant prepuce, owing to its advantages of simple operation, minimal bleeding, rapid recovery, and aesthetically pleasing wound margins.

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I. Development History: From Manual Suturing to Intelligent Stapling

Circumcision is one of the oldest surgical procedures known to humanity, and its instruments have undergone a long evolution.

During the early exploratory phase, traditional circumcision relied on scalpel excision followed by manual suturing, which resulted in prolonged operative time, significant bleeding, marked postoperative pain, and the need for suture removal. In the 20th century, auxiliary instruments such as the Gomco clamp (introduced in 1934) emerged, but they still followed the basic model of separate "cutting and suturing."

The birth of stapling technology can be traced back to 1908, when Hungarian surgeon Hümér Hültl invented the first surgical stapler for gastrointestinal surgery. Inspired by this, the world's first dedicated circumcision stapler—CCSAC (Circular Cutter with Stapled Anastomosis for Circumcision)—was introduced into clinical practice in China in 2012.

In China, Mr. Shang Jianzhong is a landmark figure in this field. He began developing a circumcision device in 2002 and filed a patent for a "circumcision anastomosis stapler" in 2009. His product, named the "Shang Ring" (Shanghuan), was designated by the World Health Organization and hailed as "a revolution in the history of male circumcision." Subsequently, products such as the ZSR Circumcision Stapler (launched in 2015) and CircCurer (Langhe) were introduced, receiving international certifications including CE and FDA approval.

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II. Structure and Working Principle

The design of the circumcision stapler draws on the principles of gastrointestinal anastomosis staplers. Its core components include:

· Glans shield (bell): Fits over and protects the glans during the procedure.

· Circular cutting blade: Removes the redundant foreskin.

· Cartridge and staples: Usually made of titanium alloy, arranged in a circular array.

· Firing handle and adjustment mechanism: Controls the cutting depth and stapling pressure.

During surgery, the device is placed over the penis and positioned appropriately. When the firing handle is actuated, the mechanical transmission pushes the staple pusher, driving the staples into the tissue to achieve hemostasis and closure. Simultaneously, the circular blade excises the excess foreskin. Because cutting and stapling are completed synchronously, the operative time can be shortened to 8 to 15 minutes, or even within a few minutes.

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III. Clinical Applications and Advantages

The circumcision stapler is primarily indicated for patients with redundant prepuce and phimosis.

Compared with traditional surgery, its core advantages include:

· Minimally invasive and efficient: Short operative time; typically performed as an outpatient procedure with same-day discharge.

· Minimal bleeding: Hemostasis is achieved concurrently with cutting.

· Aesthetic wound margin: Staples are evenly arranged, resulting in a smaller scar after healing.

· No suture removal needed: Staples typically fall off spontaneously within about one month, eliminating the discomfort of stitch removal.

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IV. Limitations and Precautions

· Not suitable for all patients: Cases with severe balanopreputial adhesions, severe phimosis, short frenulum, obesity, or a small penis should be carefully evaluated.

· Postoperative edema: Some studies suggest that the incidence of postoperative edema may be higher than with traditional surgery.

· Higher cost: The procedure is generally more expensive than conventional circumcision.

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V. Conclusion

The circumcision stapler represents a significant advancement in the field of circumcision. It integrates the traditional steps of "cutting" and "suturing" into a single action, greatly simplifying the surgical workflow and improving the patient experience. With ongoing innovations in materials and technology, it continues to evolve toward even greater safety and comfort.