Introduction: Patent ductus arteriosus (PDA) ligation is a potentially life saving procedure that is often required in very low birth weight infants (VLBW). Thoracoscopy is an ideal approach. However, thoracoscopic PDA ligation has only been reported in infants greater than 1500 grams, there is no data documenting a technique that could be utilized in VLBW infants. We present a technique utilizing a novel retractor that allows safe PDA ligation in these neonates.

Methods: This infant is a 740 gram neonate who developed perforated necrotizing enterocolitis 4 days prior to this operation. He was treated with drain placement and is stable. He was not a candidate for medical therapy. He underwent a left thoracoscopic PDA ligation. A thoracostomy tube was not utilized.

Results: This infant recovered uneventfully and post operative echo confirmed ligation of the PDA with no ductal flow. Post operative chest xray did not show a pneumothorax. The operative time of this procedure was 25 minutes.

Conclusion: Our technique is minimally invasive and provides superior visualization of the patent ductus arteriosus and surrounding anatomic landmarks. Utilizing this novel retractor, thoracoscopic PDA ligation is safe and feasible in even the smallest infants. The ease and practicality of thoracoscopy utilizing this retractor may facilitate the performance of more advanced thoracoscopic procedures in very low birth weight infants.