214 medically indicated sterilizations using Hulka Clemens and Filshie clips were performed between March 1977-December 1981. Lieberman's Samaritan Clip Applicator and later the more manageable Hulka Applicator were used with the Hulka clips and the Filshie applicator was used with Filshie clips. Any laparoscope may be used with the clips, and the Palmer forceps is recommended for better application of the clip, which is only 14 mm long. All the applications were done under general anesthesia with intubation and involved overnight hospitalization, but the procedures have been done under local anesthesia on an outpatient basis in other centers. The procedure takes only a few minutes once the pneumoperitoneum is established. A 3-puncture technique was used, 1 for the laparoscope, 1 for the forceps to grasp the tube and present it perpendicularly to the jaws of the clip, and 1 for the clip applicator. No accidents were observed. Incidents may be related to local conditions, equipment, or operator. Obesity and previous interventions can make pneumoperitoneum and visualization of the tubes difficult. Thick tubes may escape the clip during closing. A 2nd clip was required in 1.4% of cases. In 1.4% of cases the clip dropped into the pelvic cavity and was retrieved with the Palmer forceps. Dropping never occurred when the Hulka applicator was used. In 2.2% of cases more pressure had to be exerted on the clip. No cases of tearing of the large ligament occurred. No pregnancies were recorded among the 214 patients in 11,474 cycles but 30% of patients did not respond to inquiries. The method affords good prospects of reversibility because of the minimal tubal loss. X-rays of the 1st 50 patients 1 1/2 months after the operation showed a unilateral tubal passage in 3 cases. It is likely that a sclerotic reaction would in time have completed the tubal obstruction in the absence of intervention. Some other form of contraception should be used for 3-4 months after application of clips.