Untying tied tubes: Hulka clips
Hulka Clip Sterilization
One common form of female sterilization is the use of Hulka clips to block the fallopian tubes. The Hulka clip was approved for use in the United States in the 1970’s and was invented in Chapel Hill, North Carolina by Dr. Jaroslav Hulka at the University of North Carolina at Chapel Hill.
The Hulka clip is a small, gold plated stainless steel spring loaded clip. The clip in introduced into the abdominal cavity via a laparoscopic clip applicator. This image shows the open clip in the applicator and the tip of the laparoscope with its fiber optic lighted end. When the clip is placed across the fallopian tube, it is closed and a small spring holds the clip firmly across the tube. The Hulka clip has the advantage of damaging only a very small portion of the fallopian tube- approximately 7mm (the thickness of three quarters stacked on each other).
The Hulka clip causes bilateral tubal occlusion by squeezing a very small portion of the tube. The squeezed portion is deprived of its blood supply and eventually undergoes avascular necrosis (dies and is absorbed by the body). This causes the fallopian tube to be divided in half and the two ends to close up. The Hulka clip is held in place between the two divided tubal segments by a small amount of scar tissue which forms within the clip.
Hulka Clip Reversal
A common misconception is that the Hulka clips can simply be opened to reverse the sterilization process - that the tubes can be unclipped. Unfortunately, tubal ligation reversal for Hulka clips is not as simple as opening the clips. Hulka clip tubal occlusion is reversed by removing the section of the tube with the clip across it and then, using microsurgical techniques, joining the remaining tube segments back together in perfect alignment.
Tubal reversal of Hulka clip tubal occlusion is better than for most other methods of sterilization because such a minimal amount of tube is destroyed in the occlusion process. Approximately 76% of patients at Chapel Hill Tubal Reversal Center become pregnant after a reversal of a Hulka clip sterilization procedure.
Common Misconception About Tied Tubes
Many patients seem to imagine the fallopian tube is like a shoe lace which is tied up like a bow to prevent pregnancy. As tubal ligation reversal specialists, we wish it were that easy- then untying tied tubes would be easier!
‘Tying ones fallopian tubes’ is a common language phrase used to describe several different surgical procedures which result in sterilization (a procedure intended to permanently prevent pregnancy). The more correct medical term is bilateral (both sides) tubal occlusion (closure of the fallopian tube).
There are many different ways to occlude (close) the fallopian tubes: ligation and resection (tying and cutting), clips and rings, and coagulation (burning). No matter how the procedure is done the end result causes the tube to close, heal shut, and prevent sperm from fertilizing an egg.
Tubal Sterilization is Reversible
Many people believe tubal sterilization is permanent and irreversible. Although Hulka clip sterilization is intended to be permanent, this procedure is ideal for tubal reversal. The Chapel Hill Tubal Reversal Center is the one medical facility which specializes in tubal ligation reversal.
We have become experts in reversing all types of tubal ligations- or ‘untying’ tubes that have been ‘tied’!
Submitted by Dr. Charles Monteith
May 11th, 2008 at 1:27 pm
This is very clear information to help illustrate what occurs with the clip technique and reversal of this type of sterilization. It also clears up the misconception that the clip can simply be removed to open or “untie the tubes”.
May 11th, 2008 at 1:43 pm
Whenever I read about the Hulka clip, I think of Dr. Hulka, one of my influential professors when I was an ob/gyn resident. Dr. Hulka stimulated my interest in the fallopian tube and tubal reconstructive surgery.
May 11th, 2008 at 2:23 pm
Thank you Dr. Monteith for the very informative blog about Hulka clip ligations. This will be a great resource to show patients who have had the Hulka clip ligation so they can understand a little better what they had done and how it can be reversed.
May 11th, 2008 at 4:05 pm
Thank you, Dr. Monteith!
May 12th, 2008 at 4:26 am
I think that this information will be helpful to women as they are researching tubal reversal surgery. Information is always the key to making an informed decision.
May 12th, 2008 at 7:36 am
Thank You Dr. Berger and Dr. Monteith, by explaining the types of tubal sterilization. Maybe when women are asked if they want their “tubes tied” they can let the physician know what type they prefer.So if they want reversal surgery they will have some idea of what takes place.
May 12th, 2008 at 11:43 am
These are great illustrations and descriptions! And, like the Filshe Clip, makes for a very nice tubal reversal!
May 12th, 2008 at 11:50 am
The Hulka clip is an amazing invention and has helped so much as far as tying and untying tubes goes. It does its job at preventing pregnancies but is so good to reverse or “untie” and has the best results.
Thank you, Dr. Hulka!
May 12th, 2008 at 1:19 pm
This is another excellent example of the extent CHSC staff take to inform and provide education for the public regarding tubal reversal.
May 13th, 2008 at 3:21 pm
Thank you for the information and pictures, Dr. Monteith. It definitely helps to see an illustration of the Hulka clips!
May 15th, 2008 at 10:26 am
Pictures are always helpful for patients. It makes the process so much easier to understand. Thanks Dr. Monteith.
June 4th, 2008 at 8:15 am
Thank you, Dr. Monteith, for explaining the various sterilization procedures available to women to help them make an informative decision on the possibility of a future tubal reversal. It’s nice to know there are choices available of sterilization procedures that are less damaging to the fallopian tube.
July 18th, 2008 at 12:01 am
I’m one of the lucky 76% that got pg after having a reversal with Hulka clips.
I’m thanking Dr.Hulka as well!