Totally endoscopic surgery for VSD repair in an 8-yr-old
There are few reports on applying totally endoscopic surgery (TES) for repairing ventricular septal defect (VSD), especially in children.

Published in the International Journal of Surgery Case Reports, the authors, present a case of an 8-year-old girl, weighing 17 kg, who was diagnosed with peri-membranous VSD and patent ductus arteriosus (PDA).

The patient had undergone trans-catheter PDA closure first, and 3 weeks later, TES was performed for VSD repair through 4 small trocars (one 12 mm trocar and three 5 mm trocars) without robotic assistance. Arterial line was set up indirectly to the right femoral artery (FA) through a graft with an additional line to the left side for reducing arterial pressure.

Major takeaways:-
- FA cannulation in small children induce some risks, such as: FA trauma, critical lower limb ischaemia, and iliac or femoral arterial stenosis.

- This new method of FA cannulation was safe with 13 months of follow-up. The major concerns in this case were repairing VSD through small trocars in a small child.

- Bilateral FA cannulation and the way to set up small trocars may facilitate totally endoscopic VSD repair in small children.

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