Laparoscopic sterilization with the spring clip: instrumentation development and current clinical experience

Abstract

Since the original spring clip sterilization studies were reported, a number of clinically important modifications to the spring clip and applicator have been developed. The spring-loaded clip, manufactured by Richard Wolf Medical Instruments Corporation of Chicago, Illinois, and Rocket of London, Inc., London, England, and New York, New York can be applied with either a one- or two-incision applicator and the clips and applicators currently available incorporate improvements to the original prototypes in design, manufacture, and quality control. The two-incision applicator is associated with significantly fewer misapplications and the high pregnancy rates reported with the original clip and applicator have not occurred with the current designs. Comparative studies between the clip and band have revealed less operative bleeding and pain associated with the clip. The method is appropriate to all women requesting sterilization but especially to those in the younger age group who may subsequently request reversal because of divorce and remarriage.

PIP: Since the 1st human sterilization by spring-loaded clip was performed in September '72, several clinically important modifications to the spring clip and applicator have been developed. Hulka and Clemens designed the original clip and applicator which were later improved by Richard Wolf Medical Instruments Corporation of Chicago, Illinois. Lieberman and Rocket of London and New York developed the 2-puncture applicator. Hulka also developed a 2-puncture applicator activated by 1 thumb rod which utilizes a mechanically interlocking internal spring system for clip application and release. The clip originally had a molded silicone rubber end to present a smooth surface to the peritoneum. Due to problems in manufacture and assembly, the clip was redesigned to eliminate the silicone rubber and hence simplify assembly and manufacture. Between the original clip and the modified version, the original clip which is no longer available had the highest pregnancy rates. The 2-incision applicator has significantly fewer misapplications than the original clip; there are no reports of mesosalpingeal hemorrhage in contrast to the 2% hemorrhage rate reported with the original clip, and electrocoagulation and division of the tube. The modified clip was designed to be large and strong enough (3 mm wide) to positively occlude the oviducts and yet small enough to perform laparoscopic sterilization. This method is especially appropriate for young women who may subsequently request reversal of sterilization because of remarriage or divorce.