A Randomized Controlled Trial of Open Surgical vs. Rapid, Minimally-invasive Voluntary Adult Male Circumcision
|Circumcision||Procedure: Open surgical circumcision Device: Unicirc device with tissue adhesive|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||A Randomized Controlled Trial of Open Surgical vs. Rapid, Minimally-invasive Voluntary Adult Male Circumcision|
- Intraoperative Duration [ Time Frame: 1 hour ]Amount of time from first manipulation of tissue under local anesthesia to dressing
- Difficulty in Learning and Performing Technique [ Time Frame: 1 year ]
Evaluated by doctor survey based on 5 point Likert scale
- Unicirc is much easier
- Unicirc is easier
- Open surgical is easier
- Open surgical is much easier
- Number of Participants With Complete Wound Healing by Post-Surgery Week 4 [ Time Frame: Within 4 weeks after surgery ]
- Pain Experienced [ Time Frame: Within 2 days after surgery ]Pain experienced during and after the procedure evaluated using a 10 point pain scale (0 signifies no pain and 10 signifies maximal pain
- Overall Patient Satisfaction [ Time Frame: Within 6 weeks after surgery ]
Patient satisfaction evaluated with questionnaire using satisfaction scale
- Very satisfied
- Not satisfied
- Cosmetic Result [ Time Frame: Within 6 weeks after surgery ]Cosmetic result evaluated by classification of scar line as regular (straight without any irregularity), irregular (not completely straight), or scalloped (with a wavy appearance)
- Number of Participants With Adverse Events [ Time Frame: 1 year ]Number of participants with intraoperative and post-operative adverse events, such as bleeding, hematoma, and infection
|Study Start Date:||June 2013|
|Study Completion Date:||August 2013|
|Primary Completion Date:||August 2013 (Final data collection date for primary outcome measure)|
Active Comparator: Open surgical circumcision
The open surgical technique, which is commonly used for circumcision in South Africa, requires good surgical skills and minor complications are common.
Procedure: Open surgical circumcision
Open surgical circumcision using a technique approved by the WHO (dorsal slit)
Experimental: Unicirc device with tissue adhesive
Coupling removal of the foreskin using the disposable Unicirc device with wound sealing using tissue adhesive results in a procedure that can be performed by generalist doctors with minimal training.
Device: Unicirc device with tissue adhesive
Removal of foreskin with Unicirc disposal device and wound sealing with tissue adhesive.
Voluntary medical male circumcision (VMMC) is a priority preventive intervention for HIV transmission. Currently, the most widely used VMMC technique in South Africa is open surgical circumcision.
According to the Framework for Clinical Evaluation of Devices for Adult Male Circumcision (WHO, 2011): "WHO and other health authorities wish to identify one or more devices that (a) would make the VMMC safer, easier, and quicker; (b) would have more rapid healing than current methods and/or might entail less risk of HIV transmission in the post-operative period; (c) could be performed safely by health-care providers with a minimal level of training; and (d) would be cost-effective compared to standard surgical methods for male circumcision scale up."
This randomized controlled trial compares the open surgical technique to an alternative minimally-invasive technique using a disposable Unicirc device with tissue adhesive. The investigators postulate that VMMC using the Unicirc device meets WHO criteria for the ideal method to scale up: it is an easier technique to learn and perform, requires less intraoperative time, is safer for both surgeons and patients, heals quicker, and is more cost effective than other currently available techniques. The disposable nature of the device is an immense advantage as it eliminates the need to sterilize and can therefore be used in resource-limited settings. It also reduces the chances of infection caused by contaminated instruments.
The study will randomly assign participants to one of two groups:
- Unicirc device with tissue adhesive: 100 men
- Open surgical circumcision: 50 men
The participants will be evaluated during follow-up visits at 2 days, 7 days, 14 days, and 28 days after surgery.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01877408
|Simunye Primary Healthcare|
|Mitchells Plain, Western Cape, South Africa|
|Principal Investigator:||Peter S Millard, MD, PhD||Simunye Primary Health Care|