To assess the feasibility of thoracoscopic primary repair of esophageal atresia (EA) in patients with very low birth weight (VLBW). 

We reviewed patients with EA who underwent thoracoscopic primary surgery in our center from June 2013 to June 2024.Cases were divided into two groups based on the birth weight (group A<1500g, group B≥1500g).Both mortality and postoperative prognosis were compared.

A total of 57 cases were enrolled, including 5 cases with VLBW.The incidence of prematurity in group A was significantly higher.The most common comorbidity involved was cardiac anomaly in both groups.Operative time and length of postoperative drainage were all comparable.Patients in group A required longer duration for ventilator support after surgery and required 18 more days of median length of total stay.The incidence of postoperative complications and mortality were not higher in VLBW infants.

Thoracoscopic primary repair of EA seems a feasible and safe surgical method even in VLBW patients.