We present an original surgical approach--posterolateral thoracotomy--for hybrid stage I procedure. This is a review of prospectively collected data on patients treated for hypoplastic left heart syndrome (HLHS) using a hybrid approach (n=33) between December 2007 and March 2010. The hybrid approach includes pulmonary artery bands, a ductal stent through posterolateral thoracotomy access. Overall survival was 88.5%. Our original surgical approach in hybrid stage I on patients treated for HLHS can yield acceptable intermediate results that are comparable with a traditional Norwood strategy. Potential advantages of the lateral thoracotomy in the hybrid approach include the avoidance of median sternotomy, minimal postoperative pericardial adhesions, better access to patent ductus arteriosus (PDA) stenting, the possibility of visual and manual control of the stent position, and short operative time.