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

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.

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

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

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.

Thoracoscopic drainage was done successfully In 9 patients (75% ) with mean 5 days hospital stayIn 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 )

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