Background <p>Hemodynamically significant patent ductus arteriosus (hsPDA) remains a major clinical challenge in preterm infants. Surgical ligation remains necessary in selected patients when medical treatment fails or is contraindicated, or when transcatheter closure is not feasible. Left anterior mini-thoracotomy (LAMT) has been proposed as a less invasive alternative, and bedside ligation in the neonatal intensive care unit (NICU) may avoid transport-related risks in critically ill neonates.</p> Methods <p>This retrospective cohort study included preterm infants weighing ≤ 1500&#xa0;g who underwent surgical PDA ligation between August 2020 and May 2025. Patients were grouped according to the location of surgery: bedside ligation in the NICU or ligation in the operating room (OR). All procedures were performed by a single surgeon using a standardized LAMT. Demographic characteristics, perioperative variables, postoperative outcomes, and mortality were compared between groups. Continuous variables were analyzed using the Mann–Whitney U test, and categorical variables using Fisher’s exact test.</p> Results <p>Sixty-eight preterm infants were included (NICU group, <i>n</i> = 25; OR group, <i>n</i> = 43). Baseline demographic characteristics and preoperative comorbidities were largely comparable between groups. All procedures were completed without conversion to sternotomy, intraoperative mortality, major bleeding, or vascular injury. The duration of postoperative mechanical ventilation, postoperative NICU stay, and postmenstrual age at NICU discharge did not differ significantly between groups. Two deaths occurred in the NICU group from progressive multiorgan failure on postoperative days 11 and 15. Both weighed less than 1000&#xa0;g, had preoperative acute renal dysfunction, and required vasoactive support before surgery. Neither death was associated with an intraoperative complication. No surgical site infection or postoperative sepsis was documented in either group within the first 7 postoperative days.</p> Conclusions <p>Bedside PDA ligation via LAMT was technically feasible in selected preterm infants weighing ≤ 1500&#xa0;g, and all procedures were completed as planned. However, the small sample size and differences in referral status between groups limit definitive conclusions regarding comparative safety.</p> Trial registration <p>Not applicable. This study is a retrospective observational study and did not require trial registration.</p>