1. H.R.Kadkhodaie.MD.Thoracic Surgeon
Department of Thoracic Surgery
Rasoul Akram Medical Center (RAMC )
Iran University of Medical Science

2.  Video assisted thoracoscic surgery
(VATS) now has become a popular
procedure for management of most
thoracic disease .
 In spit of this, debate exists for
thoracoscopic intervention in the
management of hydatid cyst .
 One of the most anxious point in the
management of hydatid cyst is spillage of
hydatid fluid throughout the bronchial tree or
pleural space which may be conducted to
anaphylactic shock or hydatitosis.

3.  The hydatid cyst is an alive parasite with high
internal pressure and alkaline PH . So,
any changes in these characteristic (such as
rupture of cyst,… ) can lead to dead cyst and
potentially doing as a lung abscess .
 In this setting, hydatid cyst can be evacuated
thoracoscopicaly without hesitancy of
spillage and related complications

4.  Twelve selected patients with hydatid cyst
of lung who were admitted in our hospital
(RAMC) during last three years (2005-
2008).
 Among of these patients, were7 male and
5 female with age from 11 to 64 years.
 The main criteria for selection of patients
were ruptured and peripherally located
(outer one third of lung)cyst .
 From ethical point , all patients were
considered and explained for surgical
intervention

5.  All patients underwent general anesthesia
with double lumen endotracheal tube and
proper position for thoracoscopy .
 Through the thoracoscopic ports,
delineation of cyst and evacuation of contents
was performed
 With resection of cortical layer of cyst and
proper control of air leakage, pleural cavity
was drained with a large bore chest tube.

6. Thoracoscopic drainage was done successfully In
9 patients (75% ) with mean 5 days hospital
stay
In one case, (8.3%) air leakage continued beyond
the 7 days and in two patients (16.6%)
thoracoscopy turned to open procedure due to
inaccessibility of cyst and uncontrollable air
leakage .
No recurrence was detected on the site of
operation in the followed patients (7 cases )

7.  Although, debate exists for applicability of
thoracoscopy in the management of hydatid
cyst of lung ,however it can be managed
successfully with acceptable result in
selected patients who have peripherally
located and/or ruptured cyst