Video-assisted thoracoscopic ligation of a patent ductus arteriosus in a very low-birth-weight infant using a novel retractor.

Patent ductus arteriosus (PDA) ligation is a potentially lifesaving procedure that is frequently performed in very low-birth-weight (VLBW) infants. Video-assisted thoracoscopic surgery (VATS) PDA ligation has many advantages; however, this approach has not been widely used in these extremely small patients. We present a technique using a novel retractor that allows safe VATS PDA ligation in the VLBW neonate. A 740-g male infant with necrotizing enterocolitis underwent general anesthesia. After placement in the right lateral decubitus position, he underwent a left VATS PDA ligation using a new 3-mm fan retractor for lung retraction and exposure. A thoracostomy tube was not used. He recovered uneventfully and is well at 6-month follow-up. The technique is minimally invasive and provides superior visualization of the PDA and surrounding anatomical landmarks. Using this novel retractor, VATS PDA ligation is practical in even the smallest infants. This retractor may facilitate the performance of more advanced thoracoscopic procedures in VLBW infants.