Laser Circumcision Using Holmium YAG in Paediatric Patients

Background: Circumcision is a frequently performed paediatric surgical procedure, undertaken for both cultural and medical indications. While the conventional techniques may be associated with postoperative pain, bleeding and delayed healing, laser technology may reduce these morbidities, but paediatric data relating specifically to the Holmium:YAG laser remain limited. Objective: This study aimed to describe the early clinical outcomes of circumcision performed with the Holmium:YAG laser in children. Methods: A prospective, single-centre descriptive case series of 60 consecutive boys aged 2 to 11 years who underwent Holmium:YAG laser circumcision under general anaesthesia at a tertiary care surgical department between March 2023 and February 2025. Operative time, estimated intraoperative blood loss, postoperative pain, bleeding, infection, and scarring or fibrosis were recorded intraoperatively and at 6 hours, 24 hours, 1 week and 3 weeks. Data were summarised descriptively; no comparative or inferential analysis was undertaken. Results: All 60 procedures were completed with the laser without conversion, and follow-up was complete at every time point. Mean operative time was 15.02 ± 2.93 minutes (range 10.2–19.7). Estimated blood loss was less than 5 ml in 55 patients (91.7%) and 5–10 ml in 5 (8.3%); no patient required transfusion or an additional haemostatic procedure. The mean pain score at 6 hours was 2.65 ± 1.33 (range 1–5), and every child recorded a score of zero at 24 hours, 1 week and 3 weeks. Mild or moderate oozing was documented at 6 hours in 42 patients (70.0%), all of which settled spontaneously; no bleeding was recorded at 24 hours, 1 week or 3 weeks, and no infection occurred at any assessment. At 3 weeks, appearances at the incision line were graded as none or minimal in 17 patients (28.3%), moderate, defined as scarring producing a mild glanular tilt, in 27 (45.0%), and as fibrosis producing chordee in 16 (26.7%); no patient required intervention during the follow-up period. Conclusion: Holmium:YAG laser circumcision was feasible in this paediatric cohort and was associated with short operative times, low estimated blood loss, rapid resolution of pain and no infective complications over three weeks. Early oozing was common though self-limiting. Scarring exceeding the minimal grade was recorded in 43 of 60 children (71.7%) at three weeks, including appearances graded as glanular tilt or chordee, although none required intervention and three weeks is too early an interval to characterise the final cosmetic result. As a single-arm series without a comparator, this study cannot establish superiority over conventional or device-assisted techniques; comparative studies with longer follow-up are required. Keywords: Circumcision, Lasers, Solid-State, Paediatrics, Postoperative Complications; Treatment Outcome