PDA ligation by Dr. Steven Rothenberg

Thoracoscopic PDA ligation can be performed in a 2 kg infant using a modified prone position with the left side elevated approximately 30 degrees

Simple insufflation to collapse the lung is sufficient for thoracoscopic PDA ligation; single lung ventilation is not required, although it can be carried out in larger patients

It is important not to use monopolar cautery at the level of the ductus because of the risk of injuring the recurrent laryngeal nerve

Creating a pleural flap over the mid portion of the aorta is helpful to safely retract the vagus and recurrent laryngeal nerves out of the way during PDA dissection

Gentle spreading with the 3 millimeter vessel sealer is an excellent way to get adequate mobilization of the ductus

It is generally recommended to spread in the direction of the ductus to eliminate the risk of tearing the ductus

Test clamping of the ductus should be performed with a distal pulse oximeter present on the foot to ensure the correct structure is being occluded

It is very important to have proximal and distal monitoring during PDA ligation

It is important to deploy the clip into the clip applier before placing it onto the duct, as deploying the clip while already around the duct can force the tissue away

A 5 millimeter stapler fits appropriately for lung biopsy in a 2 kg infant

Care must be taken to ensure the tissue is far enough in the stapler to make sure the staple line will reach across the entire line of the resected specimen during lung biopsy