Sterilization by spring clip: a report of 1000 cases with a 6-month follow-up

Abstract

In September 1972, clinical trials of a spring-loaded clip for laparoscopic sterilization were begun and extended to a number of centers in the United States and overseas. As of March 1974, more than 1000 patients had undergone the procedure, usually performed under local anesthesia in an outpatient setting, with no fixed contraindications. Complications and pregnancy rates based on a preliminary 6-month follow-up are presented. Complications due to application of the clip appeared to be limited to postoperative cramps lasting 24 to 48 hours (26% of the patients). No ectopic pregnancies were reported. Pregnancies, when corrected for unsuspected pregnancies and misapplication of the clip, occurred in 2 of these first 1000 patients. The difficulties and relative contraindications learned from this unselected series and the advantages over electrocagulation techniques are discussed.

PIP: Between September 1972 and March 1974 more than 1000 patients had undergone laparoscopic sterilization by spring-loaded clip under local anesthesia in outpatient settings in the United States and overseas. No fixed contraindications were noted. Complications and pregnancy rates based on a 6-month follow-up were as follows: 1 death of a patient with artificial mitral and aortic valves resulted 5 days after surgery; cramps similar to menstrual cramps were reported in 26% of patients for 24-48 hours after clip application; some prototype complications occurred. The centers with the highest pregnancy rates were teaching centers employing experienced electrocoagulation physicians with the highest rate occurring at Chapel Hill where physicians were becoming familiar with the new technique. Of 24 pregnancies, 3 women were pregnant at the time of clip application, 11 resulted from improper placement of the clips, 5 pregnancies followed correct clip application and 3 resulted from weak springs (a manufacturing defect). The corrected pregnancy rate counting only those good and properly applied clips was 2/1000. Contraindications to this procedure include the presence of adhesions preventing visualization of the isthmic portion of the tube, obesity and enlarged uteri. The clip, designed to eliminate the need for electrocoagulation, thus eliminates possible bowel burn, mesosalpingeal hemorrhaging, pain and general anesthesia. Use factors combined with the advantage of potential reversibility via end-to-end anastomosis make sterilization by spring clip an effective possibility.