Volume 104, Issue 4 p. 529-532

The number of procedures required to achieve optimal competency with male circumcision: findings from a randomized trial in Rakai, Uganda

Valerian Kiggundu

Valerian Kiggundu

Rakai Health Sciences Program, Entebbe, Department of Surgery, Urology Unit, Mulago Hospital,

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Stephen Watya

Stephen Watya

Rakai Health Sciences Program, Entebbe, Department of Surgery, Urology Unit, Mulago Hospital,

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Godfrey Kigozi

Godfrey Kigozi

Rakai Health Sciences Program, Entebbe, Department of Surgery, Urology Unit, Mulago Hospital,

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David Serwadda

David Serwadda

School of Public Health, Makerere University, Kampala, Uganda, and

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Fred Nalugoda

Fred Nalugoda

Rakai Health Sciences Program, Entebbe, Department of Surgery, Urology Unit, Mulago Hospital,

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Denis Buwembo

Denis Buwembo

Rakai Health Sciences Program, Entebbe, Department of Surgery, Urology Unit, Mulago Hospital,

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Absolom Settuba

Absolom Settuba

Rakai Health Sciences Program, Entebbe, Department of Surgery, Urology Unit, Mulago Hospital,

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Margaret Anyokorit

Margaret Anyokorit

Rakai Health Sciences Program, Entebbe, Department of Surgery, Urology Unit, Mulago Hospital,

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James Nkale

James Nkale

Rakai Health Sciences Program, Entebbe, Department of Surgery, Urology Unit, Mulago Hospital,

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Nehemiah Kighoma

Nehemiah Kighoma

Rakai Health Sciences Program, Entebbe, Department of Surgery, Urology Unit, Mulago Hospital,

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Victor Ssempijja

Victor Ssempijja

Rakai Health Sciences Program, Entebbe, Department of Surgery, Urology Unit, Mulago Hospital,

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Maria Wawer

Maria Wawer

Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

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Ronald H. Gray

Ronald H. Gray

Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

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First published: 21 July 2009
Citations: 31
Ronald Gray, Johns Hopkins University, Bloomberg School of Public Health, E4132, 615 N. Wolfe St, Baltimore, MD 21205, USA.
e-mail: [email protected]

Abstract

OBJECTIVE

To assess the number of procedures required to achieve optimal competency (time required for surgery with minimal adverse events) in Rakai, Uganda, and thus facilitate the development of guidelines for training providers, as male circumcision reduces the acquisition of human immunodeficiency virus (HIV) in men and is recommended for HIV prevention.

PATIENTS AND METHODS

In a randomized trial, 3011 men were circumcised, using the sleeve method, by six physicians who had completed training, which included 15–20 supervised procedures. The duration of surgery from local anaesthesia to wound closure, moderate or severe surgery-related adverse events (AEs), and wound healing were assessed in relation to the number of procedures done by each physician.

RESULTS

The median age of the patients was 24 years. The number of procedures per surgeon was 20–981. The mean time required to complete surgery was ≈40 min for the first 100 procedures and declined to 25 min for the subsequent 100 circumcisions. After controlling for the number of procedures there was no significant difference in duration of the surgery by patient HIV status or age. The rate of moderate and severe AEs was 8.8% (10/114) for the first 19 unsupervised procedures after training, 4.0% for the next 20–99 (13/328) and 2.0% for the last 100 (P for trend, 0.003). All AEs resolved with management.

CONCLUSION

The completion of more than 100 circumcisions was required before newly trained physicians achieved the optimum duration of surgery. AEs were higher immediately after training and additional supervision is needed for at least the first 20 procedures after completing training.