Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
The patient is a 2 kg infant undergoing thoracoscopic PDA ligation.
Modified prone position with left side elevated approximately 30 degrees is used for thoracoscopic PDA ligation.
Port placement includes a 4mm scope slightly behind and above the scapula tip, with 3mm and 5mm working ports.
Simple insufflation is used to collapse the lung; single lung ventilation is not required, although it can be carried out in larger patients.
A 3mm port is initially placed in the posterior axillary line in approximately the fifth intercostal space, later changed to 5mm for clip placement.
It is important not to use monopolar cautery near the ductus because of the risk of injuring the recurrent laryngeal nerve.
Creating a pleural flap over the mid portion of the aorta helps safely retract the vagus and recurrent laryngeal nerves out of the way.
In this case, the ductus is large, approximately 2/3 the diameter of the aorta.
Careful blunt dissection is used to dissect behind the ductus to avoid injuring the recurrent laryngeal nerve or tearing the ductus.
Gentle spreading with the 3mm vessel sealer is an excellent way to achieve adequate mobilization.
It is generally recommended to spread in the direction of the ductus to eliminate the risk of tearing.
Test clamping of the ductus is performed with a distal pulse oximeter on the foot to ensure the correct structure is being occluded.
It is very important to have proximal and distal monitoring during PDA ligation.
Care must be taken to ensure tissue is far enough in the stapler so the staple line reaches across the entire resected specimen.
No chest drain was left because there was no air leak at the end of the procedure.
It is important to deploy the clip into the clip applier before placing it onto the duct, as deploying while already around the duct can force tissue away.
A single 5mm clip achieved complete occlusion of the ductus.
The patient had evidence of interstitial lung disease on CT scan, prompting a lung biopsy request from the pulmonologist.
A 5mm stapler fits appropriately for the size of a 2 kg infant for lung biopsy.