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

Abstract

Background: Although rare in the Western world, the incidence of hydatid disease is still prevalent and strikingly endemic among the Palestinians. Until 2017, surgical treatment of lung pathologies was performed through the traditional incision (open thoracotomy). Uniportal video-assisted thoracoscopic surgery (VATS) approach has recently been applied in the cases of the pulmonary hydatid cysts with very satisfactory results.

Methods: Between January 2010 and January 2019, 39 patients with pulmonary HC disease have been surgically treated. The cases divided into two cohorts: operations performed by thoracotomy classified as group A, (n=16). Operations performed by uniportal VATS classified as group B, (n=23). Prospectively collected data was analysed retrospectively, and the results compared between both groups.

Results: No significant statistical differences were noticed in terms of demographics and comorbidity. Laboratory tests were similar except haemoglobin level, which was higher in group A (P=0.001). Despite that, blood transfusion was higher in group A (P=0.016). Moreover, operation time was longer in group A (P=0.000). Chest drainage remained longer in group A (P=0.077). The level of postoperative pain was significantly higher in group A certainly in POD 1 (P=0.000). Patients in group B discharged earlier from the hospital (P=0.011) and experienced lower complications (P=0.060). No significant difference in length of ICU stay. Neither recurrence nor 30-day mortality recorded in either group.

Conclusions: Uniportal VATS can be safely applied for pulmonary hydatidosis. It also seems to have a preference in several aspects compared to open Thoracotomy approach.

Keywords: Echinococcosis; intra-operative ultrasound; pulmonary hydatid cyst; pulmonary parasitic infestation; uniportal VATS.

Video1

Uniportal VATS capitonnage of hydatid cyst.

Video 2

Localization of small cysts using intra-operative ultrasound.

Figure 1

Germinative membrane after removal.

Figure 2

A diagram illustrates the geographic distribution of the patients.

Figure 3

CT-scan showing ruptured hydatid cyst “Water-Lily sign”.

Figure 4

A diagram showing the distribution of the cysts among the pulmonary lobes and the rate of involvement of each lobe. RUL, right upper lobe; RML, right middle lobe; RLL, right lower lobe; LUL, left upper lobe; LLL, left lower lobe.

Figure 5

A diagram shows the difference in VAS scale between the two groups in the first three post-operative days. POD, post operative day; VAS, visual analog scale.