Objective:To evaluate the efficacy and safety of video-assisted thoracoscopic surgery (VATS) and thoracotomy in the treatment of pulmonary echinococcosis.Methods:Pubmed, ScienceDirect, Medline, Wanfang Data Knowledge Service Platform, China National Knowledge Infrastructure (CNKI) and VIP Chinese Journal Service Platform were searched by computer from the earliest publication time of the documents included in the database to August 2020. Comparative studies on VATS and thoracotomy in the treatment of pulmonary echinococcosis were included and the quality was evaluated. The data were combined and analyzed by RevMan 5.3 software.Results:Eleven articles were finally included, including two randomized controlled trials (RCT) articles, and the rest were case-control studies. A total of 878 patients were included, including 447 in VATS group and 431 in thoracotomy group. The results of meta analysis showed that compared with thoracotomy group, VATS operation time [ MD (95% CI): - 28.59 (- 41.79, - 15.39)], intraoperative blood loss [ MD (95% CI): - 35.83 (- 49.65, - 22.01)], postoperative drainage volume [ MD (95% CI): - 94.83 (- 150.55, - 39.01)], postoperative catheterization time [ MD (95% CI): - 2.26 ( - 2.94, - 1.59)], hospital stay [ MD (95% CI): - 4.59 (- 6.51, - 2.67)], and postoperative complications [ MD (95% CI): 0.48 (0.32, 0.73)] in VATS group were significantly lower ( P < 0.05). There was no significant difference in postoperative recurrence between VATS group and thoracotomy group [ MD (95% CI): 0.75 (0.26, 2.16), P > 0.05]. Conclusions:Compared with thoracotomy, VATS in the treatment of pulmonary echinococcosis has the advantages of shorter operation time, less intraoperative blood loss, less postoperative drainage volume, shorter postoperative catheterization time and fewer postoperative complications. VATS is a safe and effective surgical method for the treatment of pulmonary echinococcosis.