Evidence for Thoracoscopic Ligation of Patent Ductus Arteriosus.
We read with great interest the publication by Dingemann et al1 concerning the best available level of evidence for thoracoscopic procedures in pediatric surgery. Five surgical procedures have been investigated: congenital diaphragmatic hernia repair, esophageal atresia/tracheoesophageal fistula repair, lung resection, treatment of pneumothorax, and resection of neuroblastoma. The authors state that only retrospective comparative studies (RCS) are available, thus reaching level III of evidence according to the "Oxford Centre for Evidence Based Medicine (CEBM)" They conclude that randomized controlled trials (RCTs) comparing video assisted thoracoscopic surgery (VATS) and the corresponding open procedures are mandatory to obtain the highest possible evidence. We applied the authors' criteria to a surgical procedure that, despite usually performed by cardiothoracic surgeons, we have recently adopted in our department, namely, the patent ductus arteriosus (PDA) thoracoscopic ligation. To the best of our knowledge (PubMed accessed on November 7, 2014) there are neither RCTs nor systematic review/meta analysis available.We couldfind threeRCSs. Only statistically significant data are reported in >Table 1.2 4 Furthermore, our search revealed some relevant case series5 7 (level IV of CEBM) stating that the VATS technique for PDA closure is simple, effective, rapid, cost effective, and more
European journal of pediatric surgery official journal of Austrian Association of Pediatric Surgery [et al] Zeitschrift fur Kinderchirurgie