What is the Filshie clip technique for laparoscopic tubal ligation?

Updated: Apr 03, 2018
  • Author: Jessica L Versage, MD; Chief Editor: Christine Isaacs, MD  more...
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Answer

The Filshie clip method was approved in 1996 by the US Food and Drug Administration. It involves applying a titanium clip with silicone rubber lining around the fallopian tube. The Filshie clip works by exerting continued pressure on the fallopian tube, causing avascularization for the 3- to 5-mm area it encompasses. The silicone continues this pressure even after necrosis starts and the fallopian tube decreases in size. Fibrosis then occurs, and the clip is peritonealized.

The applicator may be placed though a 10-mm operating laparoscope or a 7- or 8-mm accessory trocar. The Filshie clip applicator is loaded externally with the clip open. To fit it through the port, the clip must be closed partially by compressing the applicator handle halfway; care must be taken to not close the clip completely. Once the end of the applicator is in the abdomen, pressure on the handle should be released so the clip opens.

The uterine manipulator should be used to improve visualization and accuracy by straightening the fallopian tube. The clip should be placed perpendicular to the isthmic portion of the tube, about 2 cm from the uterine cornu, so that it completely encompasses the tube and the lower edge of the jaw can be seen in the mesosalpinx. Tension should be avoided on the fallopian tube during this process.

The clip should then be partially closed by pressing the handle halfway to ensure that it is correctly placed. The clip may be gently twisted to ensure that the tube is completely encompassed. If the clip is incorrectly placed, pressure should be removed from the handle and the clip moved. Care should be taken to not injure the fallopian tube by tearing it when removing the clip.

If the clip is placed correctly, slowly compress the handle completely until blanching is seen in the fallopian tube and the jaws of the clip are clearly seen in the mesosalpinx. Release the clip by relaxing on the handle and carefully pull it away from the fallopian tube.


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