Male Circumcision under Local Anaesthesia: Supplement: Diathermy and Service Efficiency

Diathermy is a technique that uses high-frequency alternating current to produce heat within tissues, causing coagulation of bleeding vessels and cutting through tissue. The basic principles of diathermy involve the use of high-frequency alternating current (HFAC) to produce heat within tissues. This heat causes coagulation of bleeding vessels and cutting through tissue. The main electricity supply of 240v/ 50 or 60 Hz produces intense muscle and nerve activation, resulting in painful muscular contractions and shock. However, when this normal, alternating current passes through a diathermy machine, it is converted to HFAC ranging from 300 kHz to 3 MHz, which produces minimal or no effects on muscles and nerves. There are two main types of diathermy circuits used in surgical practice: monopolar and bipolar. Monopolar diathermy involves the use of a diathermy forceps, through which the current runs from the machine, through the tissue held by the forceps, and then through the patient's body to a grounding plate placed elsewhere on the body. The heating effect is inversely proportional to the surface area of the electrode, making the smaller the electrode the larger the diathermy effect. Bipolar diathermy, on the other hand, involves the use of a diathermy forceps with two prongs, through which the current runs from the machine to one prong, through the tissue grasped between the prongs, and then back to the machine through the other prong. The use of diathermy in male circumcision has several potential advantages, including significantly reduced procedure time, potentially lower costs of sutures in the long term, and fewer instruments used, reducing the cost of reprocessing. However, there are also risks and complications associated with the use of diathermy, including interference with pacemaker functions, arcing with metal instruments and implants, superficial burns with alcohol-based skin preparation, burns if the plate is not properly applied, and channeling effect if used on viscous with narrow pedicle. Precautions must be taken to ensure that the patient is not in contact with any metal or conducting material, as there is a risk of earth leakage and burns at the point of contact with the conducting material. The grounding plate should be placed so that there is a broad area of contact between the plate and the patient's skin, and sometimes it is necessary to shave hairs to ensure good contact. If the machine fails to respond when the surgeon activates the current or there is no obvious and immediate visual evidence of coagulation, the surgeon should immediately stop applying the current and check all connections and the grounding plate. In terms of service efficiency, the use of diathermy in male circumcision can be optimized by implementing efficient use of facility space, conventional and modified surgical approaches, client scheduling and flow, commodities management and supply chain management system, and bundling of MC commodities. Clinical success factors to address efficiency include proper positioning of the patient, choice of operating tables and clinic construction, and careful positioning of the grounding plate.