Filshie Clip Placement Distance
Place a single Filshie clip across each fallopian tube, approximately 1-2 cm from the uterine cornua, with one clip per tube being the standard technique.
Standard Technique
The evidence consistently supports single-clip application per fallopian tube for interval laparoscopic sterilization 1, 2. The clip should be positioned:
- 1-2 cm from the uterine cornua on the straight portion of the tube (not the convoluted portion)
- Perpendicular to the tube's long axis
- Completely across the tube to ensure full occlusion
When Multiple Clips Are Used
Multiple clips on the same tube are not routinely recommended but may be employed when surgical difficulties arise 2. A study of 102 women who received multiple clips showed this occurred primarily when:
- Surgical difficulties were encountered during the procedure
- Tubal or mesosalpingeal injury occurred
- The surgeon was uncertain about adequate initial clip placement
Importantly, using multiple clips did not increase short-term complications or pelvic pain at one-month follow-up 2, but this represents a deviation from standard technique rather than a planned approach.
Efficacy Data
Single Filshie clip application demonstrates excellent long-term efficacy:
- 10-year cumulative failure rate: 2.8-9.8 per 1,000 procedures 3
- 12-month failure rate: 1.7 per 1,000 women 1
- These rates compare favorably to other permanent contraception methods
Critical Technical Points
- Apply the clip to the straight portion of the tube rather than the convoluted portion to facilitate potential future reversal 4
- Ensure complete tubal occlusion—consider methylene blue dye testing if uncertainty exists about adequate closure 5
- Avoid placing clips too close to the cornua (increases failure risk) or too far distally (reduces reversibility potential)
Common Pitfall
The main error is applying clips to the round ligament instead of the fallopian tube. Always confirm tubal anatomy before clip application. A gentle tug on the structure will cause the ipsilateral ovary to move if you've correctly isolated the tube.