Robotic Resection of a Pulmonary Hydatid Cyst

The patient was a 34-year-old male from Syria who presented with an incidental finding on his chest X-ray during a visa work up. Further testing revealed a 7.5 x 7.5 x 7 cm cyst in the left lower hemithorax, raising concern for either a bronchogenic cyst or a hydatid cyst. After an extensive infectious disease workup, he was prepared with perioperative anthelminthics for surgical resection. Robotic resection of the cyst was planned. Upon entry, it was clear that the patient had a hydatid cyst. Using the puncture, aspiration, instillation/injection of Betadine, and reaspiration (PAIR technique), the cyst was resected. The cyst was first unroofed with partial excision of the wall/roof. The germinal layer was removed intact, and two bronchopleural fistulae were identified. They were sewn closed with 3-0 PDS in a figure-of-eight fashion, followed by a layered capitonnage procedure. No air leak was detected at the end of the procedure, and the lung re-expanded well. The postoperative course was unremarkable, and the patient was discharged on postoperative day two with an appropriate postoperative anthelminthic course. The patient did well on short-term outpatient follow-up but was lost to follow-up as he returned to his home country. 

References

1. Zhu A, Tan C, Meredith G, Chard R. Minimally invasive surgical resection of a large primary pulmonary hydatid cyst: a thoracoscopic approach. J Surg Case Rep. 2023 Mar 7;2023(3):rjad090. doi: 10.1093/jscr/rjad090. PMID: 36896158; PMCID: PMC9991583.

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