ЗНАЧУЩІСТЬ ЕНДОВІЗУАЛЬНИХ ТЕХНОЛОГІЙ У ХІРУРГІЇ ЕХІНОКОКОЗУ ЛЕГЕНЬ

Pulmonary echinococcosis remains a significant surgical challenge in the endemic regions of Central Asia. The choice of an optimal approach for cysts of varying size and location, together with the role of endovisual technologies in managing this condition surgically, remains debated. Aim. To evaluate the efficacy and substantiate the significance of endovisual (video-assisted thoracoscopic surgery, VATS) technologies in the surgical treatment of pulmonary echinococcosis relative to conventional open approaches. Materials and methods. A retrospective–prospective comparative study assessed the surgical outcomes of 317 patients with pulmonary echinococcosis treated in the endosurgical and surgical departments of the Samarkand State Medical University clinic (2000–2025). The control group comprised 138 patients who underwent conventional wide-access surgery (102 with isolated pulmonary echinococcosis and 36 with combined hepatic and pulmonary echinococcosis). The main group consisted of 179 patients managed using minimally invasive endovisual techniques (132 with isolated pulmonary echinococcosis and 47 with combined hepatic and pulmonary echinococcosis). Diagnosis relied on multipositional radiography and chest multislice computed tomography (MSCT). Quantitative variables were expressed as absolute numbers and percentages, and between-group differences were assessed using Pearson's χ² test, with statistical significance set at p < 0.05. The study followed the principles of the Declaration of Helsinki of the World Medical Association (2013 revision). The protocol received approval from the local bioethics committee of Samarkand State Medical University, and written informed consent was obtained from all patients. This work formed part of the research plan of Samarkand State Medical University, addressing the theme "Improvement of minimally invasive methods for the diagnosis and surgical treatment of pulmonary and hepatic echinococcosis" (2022–2026). Results. A total of 379 cysts were identified (217 in the right lung and 162 in the left), predominantly localized in the lower lobes (53.03%). A complicated course of echinococcosis occurred in 107 patients (39.63%): bronchial rupture developed in 65 (60.75%), suppuration in 27 (25.23%), and pleural rupture in 15 (14.02%). Among 86 patients of the main group with uncomplicated echinococcosis, thoracoscopic echinococcectomy was undertaken in 14 (16.28%), echinococcectomy via video-assisted mini-thoracotomy in 61 (70.93%), and wide thoracotomy in 11 (12.79%). For small cysts (n = 21), 8 patients received albendazole chemotherapy, 5 underwent navigation-guided transthoracic puncture, and 8 had cyst removal under videothoracoscopic guidance. In 47 patients with combined pulmonary and hepatic echinococcosis, interventions were staged, with video-assisted minimally invasive approaches applied at individual stages in 74.47% of cases. Of the 46 patients with complicated echinococcosis, all received minimally invasive treatment (transthoracic drainage, mini-thoracotomy) followed by albendazole chemotherapy; conservative therapy achieved efficacy of 58.37–82.23%, with a recurrence rate of 17.77%. Conclusions. Modern navigation and endovisual technologies enhance treatment efficacy in pulmonary echinococcosis surgery while reducing access-related trauma and the extent of pulmonary parenchymal resection. Their adoption calls for strict adherence to the principles of aparasiticity and antiparasiticity, complemented by prophylactic albendazole chemotherapy to lower recurrence rates.