Uniportal video assisted thoracoscopy versus open surgery for pulmonary hydatid disease—a single center experience

Hydatid cyst disease is a zoonotic parasitic disease with high morbidity rate and socioeconomic impact in the endemic regions as in the Middle East, Eastern Europe and China (1). Its Annual costs estimated to be 3 billion US $ for treatment and losses to the livestock industry as the WHO reported (2). The disease caused by metacestodes of Echinococcus granulosus. The parasite invades the human body and colonizes it after their eggs ingested through the digestive system (1). Four species of Echinococcus cause infection in humans. E. granulosus and E. multilocularis are the most common, while E. vogeli and E. oligarthrus, are less frequent (3). The parasite moves from the digestive system to the bloodstream, then settles in the body organs and forms vesicles. The liver is most commonly affected (75%) followed by lungs (20%), other organs are affected at varying rates (3). Single organ involvement occurs in 85% to 90% of cases, and single cyst observed in 70% of cases (4). Pulmonary hydatid cyst was first identified by Rudolf Virchow in 1855, since then, more Acknowledgements about the disease started to be well shaped (5). Records are the highest in South America, the Middle East, and Eastern Mediterranean, China, and the former Soviet Union. According to the WHO, in highly endemic regions, incidence rates in humans can exceed 50 per 100,000 person-year. The Mediterranean region where cystic echinococcus (CE) is endemical, Tunisia and Morocco reported the highest incidence of 12.5 and 5.1 surgical cases per 100,000, respectively (6). Individually, talking about Palestine, microbiologist series was published on 2017 reporting that CE found to be present in thirteen out of sixteen Palestinian districts. Al-Khalil (Hebron) and Bethlehem were the main foci of CE in Palestine with an incidence of 4.2 and 3.7 per 100,000 respectively. In some villages belonging to those provinces, the percentage was very high compared to the other governorates, as it reached, for example, 23.3 per 100,000 citizens in “AL-Shawawreh” area in Bethlehem (6). We also noted this relatively high incidence through our operative work. Surgical intervention is still considered to be the gold standard in the treatment of the pulmonary hydatid cysts once diagnosed. Parenchymal sparing surgery can be carried out in most cases without the need to resect a lung tissue, but this may be impossible in some cases, such as in consolidated cyst or in case of lobe destruction where lobectomy, segmentectomy or wedge resection should be considered (7-12). In our series, parenchymal-sparing operation