Tara Method

CAUTION:
Selection of the right size of the Tara KLamp is important.
If Tara KLamp is too large, it may result in difficulty in pulling or adjusting the foreskin over the rim of the tube.
If Tara KLamp is too small, it may result in difficulty in adjusting the device over the glans. This may result in pulling the skin too far forward in order to remove the correct amount of tissue. This may cause pressure on the tip of the glans.
The parents should be instructed to call the physician or the clinic where the circumcision was performed, if there is any swelling or haematoma on the penis during the post-surgery period.
Circumcision surgery performed with Tara KLamp, should strictly follow the method as set out, in this
instruction leaflet. Tara KLamp shall not be used in conjunction with any other method or apparatus.
Failure to follow the instructions, misuse or alteration of Tara KLamp, shall be at the user’s risk.
IMPORTANT:
· PAIN PREVENTION: A local anaesthetic, is strongly recommended for all circumcisions performed with Tara KLamp.
· Prior to any circumcision surgery, ensure that the external meatus is visible and there are no anatomical abnormalities present e.g. hypospadius.
1. The penis is first cleansed with sterilising fluids.
Use surgical marking pento mark the level on the skin of the prepuce where the circumcision is to be performed. This is the level where the clamp is to be applied. This prevents too much pulling of the prepuce and thus avoids removal of too much tissue.

2. Gently retract the prepuce. Free any adhesions, if they are present. (If phimosis is present, see NOTE on next page)

3. As shown above, apply vaseline or cmc oinment:-
(a) to the inner and outer surfaces of the flared
(b) end of the tubular part
and
(c) to the inner and upper part of the ring.
This prevents the tissue from sticking to the device over the next few days.

4. Place two artery forceps, apart from each other, at the tip of the prepuce and gently pull the prepuce distally and away from the glans. The tip or opening of the prepuce now appears slit-like.
5. The rim of the tubular part of the clamp is now placed in this slit-like opening, obliquely at first and then gradually introducing it through the slit-like opening.

6. The prepuce is now pulled over the rim of the tube.

7. Adjust the prepuce over the tube, so that the level which has been marked earlier, is just above the rim of the tube.
8. After adjusting the level of theprepuce, a grip-like pressure is applied on the two arms. As this pressure is increased, the two arms are brought closer to the locking mechanisms on the device.

9. Resistance to further movement of the arms is felt when the arms come in contact with the locking mechanisms on the device. Apply further pressure on the arms until two clicks are heard and felt. This means that the arms are already locked and the necessary occlusion has been obtained.

10. The prepuce that is distal to the clamping ring is then cut circumferentially, at a level about 2 – 3mm. away from the angle between the tube and the clamping ring. A tissue cutter is included in some of the circumcision kits.

11.The tube is cleansed with clean gauze and a mild antibiotic ointment is applied at the cut edge and also at the angle on the proximal aspect of the occlusion. Apply the ointment a few times daily, during the next few days. The device is allowed to remain on the penis for the next few days. Urine is easily voided through the distal opening of the device.
In some cases (eq. phimosis) the prepuce opening is small and does allow easy application of Tara KLamp over the glans. In such cases, a dorsal slit up to 1 cm. distal to the level which has been marked in 1 above (The dorsal slit should not extend beyond this level). After th follow the rest of the procedure from step 2 onwards.
The device may be removed on the 4th. to 6th. day. (On the 4th or 5th day for children and 6th to 7th day for adults)
The removal procedure results in the device separating into two parts ie., • the clamping ring which consists of the lever mechanism • the tube and involves 2 steps as follows:
[A] Removal of the clamping ring
[B] Removal of the tube.
fA] Removal of the clamping ring

1. The device has two rectangular openings. The magnified view of a rectangular opening above shows:
· a slit-like narrow band as shown in (a)
· a wide knob-like band as shown in M.

2. The tip of the tissue cutter is first placed at one side of (a), as shown. The tissue cutter is then moved to cut through the narrow band completely. This step is repeated in the other rectangular opening.

3. The tip of the cutter is then used to push the wide band (b) inwards into the tube. This step is repeated in the other rectangular opening. The above steps release the clasps between the tube and the lever mechanism

4. Place the tissue cutter in the space of the already cut narrow band and gently twist the tissue cutter. Separation is achieved by gently pulling the lever mechanism out of the tube. This leaves the tube on the glans as it is held
firmly by the necrotic band of tissue.

[B] Removal of the tube
Removal of the tube may be done by either of the following methods:
1. If the necrotic band of tissue is not too dry, it may be gently eased off the rim of the tube with the blunt side of the tissue cutter.
2. Sometimes, the tube is not easily removable as the necrotic tissue may be stuck to it. DO NOT ATTEMPT TO REMOVE IT BY FORCE. Instead, the dried tissue may be softened by wrapping a moist paraffin gauze over the dried tissue or by frequent moistening with warm clean water and the tube will come off by itself it a day or two.
DO NOT DEBRIDE THE SLOUGHING TISSUE AS IT WILL DROP OFF BY ITSELF OVER THE NEXT FEW DAYS.
Apply the ointment on the healing edges of the skin, until the wound has healed.
[Alternatively, the device may be left on the penis until i drops off by itself. On an average the device drops off between 10 – 12 days. Many however, prefer to remove the device after 4 – 6 days, as showne in DEVICE REMOVAL PROCEDURE]