Volume 06
Issue 02
May 2018
Inside This Issue
Opinion/Editorial, 2
Technology Corner, 3,4
Tips from the Experts, 5,6
Humanitarian News, 7,8,9
Educaon and Training, 10
WABIP News, 11
Research, 12,13
Special News, 14-21
WABIP Academy Webcasts, 22
Links, 22
Upcoming Events, 23,24
4.3mm) underwent roboc-assisted
biopsy. There were no complicaons
and the overall diagnosc yield was
83%. A similar roboc plaorm
(Monarch) developed by Auris
Health has been shown to be able to
reach further out in the lung com-
pared to a convenonal thin bron-
choscope with an idencal outer
diameter in cadavers [4]. Further-
more, Auris Health recently received
FDA approval for the clinical use of
the Monarch system. The unique
features of the roboc plaorms
may be the ability to navigate out
into the distal airways under conn-
uous visualizaon and the ability to
maintain stac posion. These new
roboc plaorms will likely improve
the diagnosc yield but more inter-
esngly enable precise transbron-
chial therapeucs. The future of
guided bronchoscopy is bright, and I
look forward to the innovaons.
Kazuhiro Yasufuku
1. Wang Memoli et al. Chest 2012; 143;
2. Ost et al. Am J Respir Crit Care Med
2016; 193: 68-77
3. Fielding et al. Chest 2017; 152: Sup-
plement A858
4. Chen et al. Ann Thorac Surg. 2018
Feb 24 [Epub ahead of print]
Surgeons and pulmonologists are
asked to see an increasing number of
paents with pulmonary nodules.
When ssue diagnosis is required,
transthoracic needle aspiraon
(TTNA) has been the standard of care
for the majority of paents. TTNA
has a high yield of 90% which is usu-
ally not limited to the locaon of the
nodule. However, TTNA also has a
pneumothorax rate of about 25%
and as such, may not be suitable for
some paents. Tradional exible
bronchoscopy has a relavely low
yield for the diagnosis of pulmonary
nodules depending on the size and
locaon of the nodule. Newer tech-
nologies to guide exible bronchos-
copy has emerged over the past 10-
20 years as a viable opon when the
bronchoscopist has the experse.
These technologies include virtual
bronchoscopy, electromagnec navi-
gaon bronchoscopy (ENB), radial
probe endobronchial ultrasound (RP-
EBUS) and ultra-thin bronchoscopy.
A meta-analysis published in 2012
looking at the role of guided bron-
choscopy for the evaluaon of pul-
monary nodules showed a pool diag-
nosc yield of 70% which is sll low-
er than TTNA but signicantly higher
than tradional exible bronchosco-
py (1). Perhaps the advantage of
guided bronchoscopy is the low ad-
verse event rate with only 1.5%
chance of pneumothorax. However,
the majority of the publicaons as-
sessed in the meta-analysis were
from expert centers in the world,
data from clinical studies and the
numbers may not reect the real
world. A recent study looking at the
AQuIRE Registry for the diagnosc
yield and complicaons of bronchos-
copy for peripheral lung lesions
showed a slightly dierent result (2).
The overall diagnosc yield of bron-
choscopy was only 53.7%, although
the sensivity for lung cancer was
between 60-74%. Interesngly, unad-
justed for other factors, the diagnos-
c yield was 63.7% when no RP-EBUS
and ENB were used, 57% with RP-
EBUS alone, 38.5% with ENB alone
and 47.1% with ENB and RP-EBUS
combined. Transbronchial needle
aspiraon (TBNA), larger lesion size
and non-upper lobe locaon was as-
sociated with increased diagnosc
yield on mulvariate analysis. Compli-
caons only occurred in 2.2% of pa-
ents. Aer over a decade of experi-
ence with guided bronchoscopy, are
we sll not geng any beer with
transbronchial biopsy of peripheral
lung nodules?
The introducon of robocs has
changed the landscape of minimally
invasive surgery. In parcular, retro-
specve studies published over the
past decade show that roboc sur-
gery for lung cancer has the ad-
vantages of minimally invasive sur-
gery for paents and some ad-
vantages over VATS for the surgeon.
Although data is limited, oncological
outcomes are comparable with those
of VATS and open surgery while
lymph node dissecon may be more
radical. However, the high costs of
purchase, maintenance and consum-
ables are a concern. Nevertheless,
roboc thoracic surgery is widely be-
ing adopted into pracce, especially
in North America. What about ro-
bocs for bronchoscopy?
At least two companies are develop-
ing roboc bronchoscopy plaorms.
A rst in human study was presented
at the Chest 2017 annual meeng
using the Intuive Surgical roboc
assisted bronchoscopy system [3]. 30
paents with small peripheral lung
nodules (mean axial size 12.5 +
Guest Opinion/Editorial
WABIP Newsletter
M A Y 2 0 1 8 V O L U M E 6 , I S S U E 2
Zsolt Papai MD
Székesfehérvár, Hun-
Silvia Quadrelli MD
Buenos Aires, Argen-
Hideo Saka MD
Nagoya, Japan
Secretary General
Hojoong Kim MD
Seoul, Korea
Eric Edell MD
Rochester MN, USA
President WCBIP 2018
Quangfa Wang MD
Beijing, China
President WCBIP 2020
Henri Colt MD
Laguna Beach, CA
Immediate Past-chair
Michael Mendoza
General Manager
Judy McConnell
Kazuhiro Yasufuku
Newsleer Editor-in-
P A G E 2
Future of Guided Bronchoscopy for Transbronchial Biopsy of Peripheral Lung Nodules
Technology Corner
Transcutaneous Microwave Ablaon for Inoperable Lung Cancer
Robert D. Suh, M.D.
Professor, Department of Radiological Sciences
Director, Thoracic Imaging and Intervenon
Vice Chair, Radiology Educaon
David Geen School of Medicine at UCLA
With an esmated 234,030 new cases for 2018 (American Cancer Society 2018), lung cancer is by far the leading cause of cancer
death in the United States, accounng for an esmated 154,050 deaths, more than breast, prostate and colon cancers combined.
Despite relentless advances in surveillance and imaging and knowledge, the number of paents at inial presentaon with surgi-
cally resectable local disease remains soberly small at under 30%, compounded by the realizaon that many with resectable dis-
ease are rendered medically inoperable by comorbid disease. Over recent decades, most importantly the last, evoluonary inera
has rened local control measures on all fronts, surgical and nonsurgical, through improved technology and its applicaon and pa-
ent selecon. Although surgical lobectomy remains the gold standard for early stage non-small cell lung cancer (NSCLC), noninva-
sive and minimally invasive nonsurgical measures for local control stereotacc body radiotherapy (SBRT) and image-guided tumor
ablaon (IGTA), respecvely, have been increasingly accepted and ulized for local control and cure for both medically inoperable
and even medically operable lung cancer paents. To date, much of the medical literature has focused on radiofrequency ablaon
(RFA) in the “high-risk,” or medically inoperable populaon with NSCLC, but more recently, has featured microwave ablaon
(MWA), reecng the technologic shi and availability to more ecient heat energy delivery.
Similar to RFA, MWA achieves cell injury and death through ssue heang and coagulaon necrosis and can be performed percuta-
neously, laparoscopically or via open surgical access; however, unlike RFA, MWA operates at higher frequencies on the electromag-
nec spectrum, and most importantly, the energy is not distributed through an electrical current, eliminang the need for ground-
ing pads. At the 2 most used microwave frequencies (915 MHz and 2450 MHz), electromagnec microwaves induce friconal heat
by inducing kinec energy in aected water molecules through oscillaon. The spinning water molecules interact and transfer ki-
nec energy into the surrounding ssues resulng in ssue heang. With more ecient heang compared to RFA, MWA oers
superb ssue penetraon, higher temperatures and less sensivity to potenal vascular and bronchial heat sinks, all of which con-
tribung to quicker and larger volume ablaons.
Clinical Applicaon
Although MWA has yet few 5-year results and the literature sll premature in terms of paent numbers and uniformity, MWA has
demonstrated comparable, if not improved, overall and cancer-specic survival and local control rates compared to RFA at 1-, 2-
and 3-years in some series with favorable complicaon proles. As comparison, the rst RFA 5-year data
, published in 2007,
showed overall survival rates of 78%, 57%, 36%, 27% and 27% at 1-, 2-, 3- , 4- and 5-years, respecvely. Although the results were
modest, it is important to realize that these results were achieved in stage I NSCLC paents who were medically inoperave. Over-
all survival and local tumor progression-free rates were signicantly beer for those paents with 3 cm tumors compared to
those paents with > 3 cm tumors. With rened paent and lesion selecon and technology and operator experience, results have
notably improved. The ACOSOG z4033 trial
(RFA of Stage IA NSCLC in Medically Inoperable Paents) reported overall survival at
86.3% and 69.8% at 1- and 2-years, respecvely, and local tumor recurrence-free rate at 68.9% at 1-year and 59.8% at 2-years. At
this me, there are no large mulcenter trials evaluang MWA, and most published reports are single center retrospecve series
which oen include the use of mulple MWA systems using variable powers and antennas and heterogeneous treated paent pop-
P A G E 3
ulaons with both early and advanced stage NSCLC and pulmonary metastases.
The rst large study of MWA
in the lung included 50 paents, 27 of whom with NSCLC, with overall 1-, 2- and 3-year survival rates of 83%,
73%, and 61%, respecvely. Survival in this series was not associated with tumor size, in contrast to previous RFA studies. Belore et al
ablated 69 unresectable lesions (44 lung cancers, 25 lung metastases) in 56 paents with cancer-specic survival rate of 69% at 1-year, 54%
at 2-years and 49% at 3-years, although did not report specically for early stage lung cancers. Lu et al
performed MWA on 69 medically
inoperable paents with NSCLC and lung metastases. The overall survival rates for NSCLC at 1-, 2- and 3 years were 75.0%, 54.2% and
29.2%, respecvely, and the recurrence-free survival rates at 1-, 2- and 3- years were 72.9%, 50.0% and 27.1%, respecvely. Yang et al
formed MWA on 47 paents with stage I medically inoperable NSCLC with overall survival rates at 1-, 2-, 3- and 5- years of 89%, 63%, 43%
and 16 %, respecvely. The local control rates at 1-, 3- and 5- years were 96%, 64% and 48%, respecvely. The median cancer-specic and
median overall survivals were 47.4 months and 33.8 months. Zheng et al
performed MWA on 183 paents, including 138 NSCLC, with me-
dian survival at 23.7 months and 4-year overall survival at 29.6%. Local tumor progression occurred in 19.1% and was associated with em-
physema and larger maximal tumor diameters. More recently, Healey et al
ablated 108 paents (82 NSCLC) and reported the actuarial sur-
vival rates at 1-, 2- and 3-years of 78%, 54% and 39%, respecvely. The odds of primary technical success were 11.1 mes higher for tumors
< 3 cm versus those > 3 cm, and for every millimeter increase in original tumor maximal diameter, the odds of not aaining success in-
creased by 7%. Local tumor recurrence rates were 22%, 36% and 44% at 1, 2 and 3 years, respecvely. Finally, Yao et al
recently compared
propensity-matched 54 paents undergoing MWA to 108 paents undergoing lobectomy for the treatment of stage I NSCLC without signi-
cant dierence between the two groups in overall survival, disease free survival, local tumor progression or rate of distant metastases. The
complicaon rate was lower in the MWA group. While this data should not support MWA supplant surgical resecon, it idenes the need
for randomized controlled trials evaluang MWA versus other local therapies.
As a method for safe and eecve local therapy, image-guided tumor ablaon, including MWA, for NSCLC is parcularly poised for success,
given it provides a reasonable balance of comparable survival especially when considering the longer track record of RFA results, low cost
and experienal use in the high-risk paent and other emerging paent populaons, much of which unfathomable a decade prior. When
crically compared to surgical resecon and SBRT, image-guided ablaon is an aracve opon with an acceptable threshold for local con-
trol balanced with risk and cost without detriment to survival.
1. Simon et al. Radiology. 2007 Apr; 243(1):268-275.
2. Dupuy et al. Cancer. 2015 Oct 1; 121(19):3491-3498.
3. Wolf et al. Radiology. 2008 Jun; 247(3):871-879.
4. Belore et al. Eur J Radiol. 2013 Jan; 82(1):177-181.
5. Lu et al. World J Surg Oncol. 2012 May 7; 10:80.
6. Yang et al. J Surg Oncol. 2014 Nov; 110(6):758-763.
7. Zheng et al. J Vasc Interv Radiol. 2016 Dec; 27(12):1806-1814.
8. Healey et al. J Vasc Interv Radiol. 2017 Feb; 28(2):206-211.
9. Yao et al. Int J Hyperthermia. 2018 Feb; 12:1-8.
W A B I P N E W S L E T T E R P A G E 4
Figure A) Screening CT image demonstrates 8 x 8 mm
part-solid nodule within the right upper lobe; subse-
quently biopsy-proven invasive adenocarcinoma.
Figure B) Intraprocedural axial image shows micro-
wave antenna inially posioned for ablaon and
conrmed on sagial (Figure C) and coronal (Figure D)
images relave to the cancer.
Figure E) Intraprocedural axial image displays charac-
terisc ground glass aenuaon beginning to encom-
pass the cancer and conrmed on sagial (Figure F)
and coronal (Figure G) images. The antenna was repo-
sioned twice (not shown) to cover the enre cancer;
total ablaon me at 3 staons = 10 minutes at 65
Figure H) Postprocedure image demonstrates ex-
panding ground glass aenuaon now clearly encasing
the cancer in its enrety without pneumothorax.
Figure I) Single CT image shows retracon and now
well-margined ablaon zone, typically seen at 1
month, without visualizaon of the original cancer.
Figure J) 6 month CT demonstrates connued involu-
on of the expected ablaon zone.
Figure K) 12 month CT shows further contracon of
the expected ablaon zone without evidence for tu-
mor progression/recurrence.
Tips from the Experts
P A G E 5 V O L U M E 6 , I S S U E 2
Airway recanalizaon is generally aempted to provide palliaon for symptoms (1) due to lung volume loss and hypoxemia. It is also done
to decrease the likelihood of a signicant airway hemorrhage leading to blood loss or drowning. Relief of mechanical airway obstrucon also
reduces the likelihood of post obstrucve pneumonia. The majority of airway recanalizaons are done for malignant airway obstrucon.
However, paents with non-malignant airway obstrucons may also derive benet (2). Airway recanalizaon modalies broadly fall into two
categories: heat based and cold based. Examples of heat based recanalizaon devices include Laser and Argon plasma coagulaon. Exam-
ples of cold based recanalizaon devices include cryo spray ablaon and exible cryo probe. Mechanical debriders such as rigid bronchosco-
py and micro debrider bronchoscopy are also available. A combinaon of these modalies are used commonly to achieve palliave goals.
Heat based recanalizaons require the airway FiO2 to be less than 0.4 to avoid airway res. Gas embolism is also a potenal complicaon of
argon plasma coagulaon. It is beyond the scope of this arcle to discuss all modalies of airway recanalizaon. We will focus on cryo spray
ablaon for central airway obstrucon.
Spray cryotherapy (SCT) is a relavely new modality available to the trained intervenonal pulmonologist or thoracic surgeon as a reliable
tool in providing palliave airway recanalizaon to a carefully selected paent. The third generaon truFreeze system (CSA medical, Lexing-
ton, MA, USA) is approved for airway applicaons. This system uses liquid nitrogen as the cryogen and is delivered through a specialized
braided catheter that is compable with the working channel of a standard therapeuc bronchoscope. The liqueed gas is delivered through
the catheter at low pressure (2-4 PSI). The gas expands 700 fold aer exing the catheter and drops the temperature to -196C, thereby
providing the desired eect on ssue. Therefore, allowing egress of the gas is of paramount importance to avoid barotrauma.
SCT is a temperature dependent modality that is shown to be safe and eecve in the treatment of central airway obstrucon (CAO). It u-
lizes ash freezing of ssue at a temperature of approximately 196C, resulng in non-contact cell death of ssue with relavely high water
content (malignant cells, granulaon ssue). Anhydrous ssue such as extracellular matrix and collagen that are an important component of
airway tree is spared, making it a desirable tool for airway recanalizaon (3). Regenerave growth of ssue is also not impaired. Targeted
delivery of low dose liquid nitrogen with 2 cycles of 5 second duraon has been shown to cause ssue damage of up to 1.5 mm in the hu-
man airway (4).
Paents with symptomac central airway obstrucon (CAO) due to malignant or non-malignant disease processes are candidates for Cryos-
pray ablaon (5). Paents should be able to tolerate general anesthesia. It is preferred that in most cases a rigid bronchoscope be used to
allow passive venng of nitrogen. However, a exible bronchoscope with an endotracheal tube can also be safely used in paents who are
unable to tolerate rigid bronchoscopy. In our instuon, we undertake specic precauons when we use a exible bronchoscope: we de-
ate the cu of the endotracheal tube during acvaon and use an endotracheal tube with a subgloc port connected to a sucon tubing
for acve venng of nitrogen. The endotracheal tube is stabilized with a mouth guard that holds the tube in posion when the cu is deat-
ed. In both situaons, the paent is disconnected from the venlator during acvaon. Airway FiO2 need not be adjusted for this proce-
dure. Transient desaturaons is not uncommon as nitrogen displaces oxygen from the pulmonary circuit but recovery is usually quick. We
recommend not more than ve to seven acvaons per site in the tracheobronchial tree. Visual and tacle vericaon of gas egress is im-
portant. The device is used as a noncontact form of ssue destrucon. The catheter is passed approximately a cenmeter distal to the work-
ing channel of the bronchoscope. Aer the nitrogen is acvated with a foot pedal, shortening of the catheter is observed followed by cir-
cumferenal ice formaon. The mer is started at this point for 5 seconds and counts as an acvaon. Two sengs, low and medium ow
are available to the operator. We strongly recommend having trained support sta. Palpaon of the chest wall and neck for crepitus aer
each acvaon will also allow early recognion of potenal complicaons. Gas embolism has not been reported with SCT.
Spray Cryotherapy
Ganesh Krishna, MD, FCCP.
Professor of Medicine,
University of California, San Francisco.
Intervenonal Pulmonologist,
Palo Alto Medical Foundaon.
Tips from the Experts
P A G E 6 V O L U M E 6 , I S S U E 2
Proximal tracheal lesions present a specic challenge for airway recanalizaons in general and parcularly with SCT. Given the proximity of
the entrance of the gastrointesnal tract, there is a signicant risk of gas egress into the GI tract causing visceral organ damage or rupture.
Proximal tracheal lesions are usually addressed with laryngeal mask airway (LMA) or suspension laryngoscopy, as rigid bronchoscopy and
endotracheal tube is not praccal. Access to physicians trained in suspension laryngoscopy and the equipment itself is not readily available in
most instuons. In our instuon, we devised a method by which we use an esophageal balloon to occlude the proximal GI tract and were
able to successfully perform SCT on paents with proximal airway obstrucon with laryngeal mask airway (accepted for publicaon, with re-
visions). We used a 5.5 cm esophageal balloon (Merit Medical Endotek, South Jordan, UT) and inated it to 12 mm at 8 ATM pressure to fully
occlude the esophagus to prevent nitrogen entry into the gastrointesnal tract. In addion, a dedicated sta member was asked to palpate
the abdomen for distension during acvaon as an extra precauon.
We view SCT as one of the myriad tools available for airway recanalizaon for malignant or non- malignant CAO. It can be used as a
standalone device or in conjuncon with other tools. Specialized training is necessary for the operator as well as support sta. In trained
hands and carefully selected paents, it is a valuable tool that provides long lasng palliaon of symptoms caused by airway obstrucon.
1. Mahmood et al. Respiraon. 2015; 89(5): 404-413.
2. Bhora et al. Head Neck Surg. 2016; 42(11): 1082-1087
3. Gage et al. Cryobiology. 1998; 37(3): 171-186.
4. Krimsky et al. J Thorac Cardiovasc Surg. 2010; 139(3): 781-782.
5. Finley et al. Ann Thorac Surg. 2012; 94 (1): 199-203.
Figure 1: Cryo spray therapy console
Figure 2: Pre treatment and 6 weeks post treatment
Humanitarian News
W A B I P N E W S L E T T E R P A G E 7
The Global Displacement Crisis Requires a Global Responsibility
More than 65 million people around the world are now ocially displaced from their homes by conict, violence and perse-
cuon. Since the Second World War such high gures had not been ever recorded by the United Naons.
Between January and September 2017, nearly 140,000 refugees and migrants arrived on European shores. Two-thirds of
them came through the Central Mediterranean Route, but an increasing amount of people are using the Eastern Mediterra-
nean Route to cross to Greece. In the previous year more than 360,000 migrants, including refugees, had arrived in Europe
by sea. The Central Mediterranean is the deadliest migrant route in the world. Nearly 5,000 deaths recorded killed or missing
in 2016, mostly travelling on smugglers’ boats deparng from Libya, Tunisia or Egypt, risking their lives in search of safety in
In spite of the huge impact of the so called “migrant crisis” in Europe on the media and on the daily life of Europeans, that
massive displacement is not at all the main desnaon of people in need of escaping their original hometowns. The majority
of people are displaced within their country of origin, or remain close to it. The deadly conict with Boko Haram in Nigeria
has forced 1.8 million people to ee their homes and search for safety in other parts of the country. Lebanon, with a popula-
on of 4.5 million people, is hosng more than one million Syrian refugees. And also many refugees are currently living in
overcrowded camps on the borders of Turkey and Jordan.
As the crisis enters its third year, Europe connues to struggle with how to respond to the inux of more than a million refu-
gees and migrants. The overall proporon of children among arrivals remains being around 15%. Recepon condions re-
main of concern, parcularly on the Greek islands where the refugee and migrant populaon increased by 27 per cent in
2017, leading to overcrowding and lack of services in Recepon and Idencaon Centres. UNICEF has also shown a deep
concern about the increase in the number of unaccompanied and separated children (UASC) in protecve custody. It is
known that children and teen-agers traveling alone due to limited resources, as well as those showing the lower levels of
educaon, are highly vulnerable to exploitaon by smugglers and criminal groups over the course of their journeys.
The EU and its member states connue eorts to prevent arrivals and outsource responsibility for migraon control to coun-
tries outside the EU. In Libya the EU is pursuing a containment strategy in cooperaon with their authories, despite over-
whelming evidence of pervasive abuse against asylum seekers and other migrants arbitrarily detained in Libya. However, the
situaon is so dangerous mainly in Syria and Afghanistan, that no barrier, whether administrave or physical is being able to
stop the migrant arrival. Not even the risk of death in a highly dangerous journey.
European border closures and restricons have dramacally worsened the situaon for these vulnerable people and created
a humanitarian crisis. More than 60.000 of them have been le stranded in Greece as well as more than 8,000 in Macedonia
and Serbia due to the implementaon of the EU/Turkey deal in March 2016 and the shutdown of the Western Balkans route
to Europe. Ninety-four percent of refugees are from the world's top 10 refugee-producing countries, led by Syria (69 per-
cent), Afghanistan (19 percent) and Iraq (6 percent).
The current condions make these survivors of the perilous journey across the Mediterranean, live in overcrowded sites that
lack food and basic services such as medical care, water and sanitaon.
As Filippo Grandi (UNHCR High Commissioner) told “Syria is the biggest humanitarian and refugee crisis of our me, a con-
nuing cause of suering for millions which should be garnering a groundswell of support around the world.”
Nongovernmental organizaons performed roughly 40 percent of rescues in the central Mediterranean in the rst half of
2017. However, many organisaons had to stop their acvies due to security concerns and increased intercepons, some-
mes reckless and accompanied by abuse, by Libyan coast guard forces.
Unfortunately, this increase in mass movement of people has been accompanied by hoslity and a cry of overpopulaon in
some of the countries in Europe. Most probably with no reasonable argumentaon, some of the recent terrorist aacks,
Humanitarian News
W A B I P N E W S L E T T E R P A G E 8
have been linked to incoming migrants. Probably the worst face of this crisis is that mass migraon has also created the con-
dions for smuggling humans into Europe via illegal channels. Many people in Europe have shown hate and fear and gave
rise to other expressions of racism and xenophobia. And large groups of people blame the migrant or refugees for the im-
pairment of working condions and unemployment. Probably the only thought behind those feelings is that many people do
not like the idea of sharing their land and resources with non European peoples.
However, on the other hand, the favourable recepon of refugees from a large part of the European civil society is strong
enough to have pushed the government leaders- some more than others- to a less restricve discourse.
Displacement of peoples during hard mes has been constant along history. Europe itself is the product of migraons that
took place during the Middle Ages. There is no “pure” naonality anywhere. All the countries have been built on the dis-
placement of dierent peoples in the past, and they are what they are because of the work and the eorts of generaons of
people coming from remote lands, eeing from the dangers of the me. Beginning in 1845, nearly 2 million refugees from
Ireland crossed the Atlanc to the United States in the dismal wake of the Great Hunger. About 2 million Italians seled be-
tween 1880–1920, and just 1 million between 1900–1914 in Argenna. But even quite recently, during and aer Second
World War, Europeans were eeing. Most European Jewish who had survived concentraon camps or had been in hiding,
were unable or unwilling to return to eastern Europe because of postwar ansemism and the destrucon of their commu-
nies during the Holocaust. They were housed in displaced persons camps and urban displaced persons centers established
in Allied-occupied Germany, Austria, and Italy for refugees waing to leave Europe.
At that me, the legal body of refugee law was created in Europe’s interest for borders to be permissive for “their” people to
reach whatever desnaon they had chosen (mostly in the Americas). And during those years (only one or two generaons
before the current one) European leaders spoke of solidarity and compassion. In contrast, today facing the people who are
coming in, Europe wants its external borders sealed and solidarity and compassion seem to have been forgoen. The cur-
rent argumentaon is not about how to help but about how to avoid reselements of refugees in their constuencies.
It shows that the EU was never prepared for a large-scale migraon like Syria. Unprepared to the huge inow of asylum
seekers, the European Union strongest strategy has been to reform its immigraon policies and refugee laws making more
dicult the access. The new laws have altered the recepon of asylum seekers. Years ago migraon to countries like Greece
and Italy was signicantly easier than migrang to Germany or Switzerland. Now, the EU has set up oces at every border
displacing the main responsibility of control at the dierent entrance borders.
The situaon is polically complex, but mainly morally challenging not for the polical leaders but for every single cizen of
any country in posion to receive refugees. Local people may fear the arrival of migrants may lead to a draining of EU re-
sources and adversely impact the job opportunies for the nave Europeans, even when current gures do not support that
idea. But in spite of those concerns, people should understand that the displacement is not going to stop and at some me
Europe will need to deal with the fact that these people will connue to ee their countries of origin in spite of the awful risk
of the journey and the high possibility of never reaching Europe. In the words of Eugenio Ambrosi (director of the IOM’s re-
gional oce for the EU, Norway and Switzerland): “We’re talking about thousands of people that move out of desperaon.
And if you’re desperate, yes, you might know that you’re going to risk your life or run into serious trouble, but you’re already
in serious trouble back home so you have nothing to lose.”
So, as members of the civil society, cizens of every country must face the need of taking posion in front of this challenge,
avoiding the opinion clichés and the media manipulaon. Europe (and some other well developed countries) has been al-
ways proud of itself as a leading defender of human rights. But now, the very same countries that are “donors” in humani-
tarian crises all over the world and that demand other countries to keep in the moral high ground, have to nd the way of
responding responsibly when they have a crisis at home. Increasingly during the last decades donors coming from dierent
government agencies from the EU and individual European countries have increased the pressure on the humanitarian com-
Humanitarian News
W A B I P N E W S L E T T E R P A G E 9
munity to improve their eciency and accountability standards. Now it is me to ask themselves for a beer job in terms of
assistance and to adherence to the laws that they have always defended and pushed for less developed countries to ob-
A large number of people have entered Europe with a desperate need of an asylum. These vulnerable people require inter-
naonal protecon and the EU is in the moral and legal posion to do provide it. Reacng to this crisis by rejecng and deny-
ing the humanitarian dimension of the problem is not an acceptable answer for a connent with a long tradion of respect
of the dignity of human beings and observaon of human rights.
It means that, just as ordinary cizens, it is our responsibility to learn about the origin, consequences and dimension of the
crisis and take posion about that. It is our personal decision if our polical leaders must receive or not the message that we
must take the responsibility to provide services to those in need. Even in the imperfect democracies of the current mes, we
sll live in democracy and so, polical leaders cannot make interminable decisions against the will of the majority. The deci-
sions they are going to make in the next future about the migrant crisis, we like it or not, are in our hands and are our re-
sponsibility. We cannot elude our own decisions.
*The views expressed in this arcle are those of the author and do not necessarily reect the ocial posions of the Execu-
ve Board or Internaonal Board of Regents of the WABIP. Dr. Silvia Quadrelli is Vice-chair of the WABIP.
High Tech in Melbourne, Australia, 2018
February 2018 marked another important step forward in the history of WABIP-cosponsored Train the Trainer seminars. In partnership with
TSANZ and Oympus Australia, a Train-the-Trainer program and Introducon to Flexible Bronchoscopy seminar was conducted at Olympus
Headquarters in Glen Waverly, just at the outskirts of Melbourne, Australia. Guided by host organizer Dan Steinfort, and with assistant instruc-
tors Jon Williamson (Liverpool), Elaine Yap (Auckland), and Ma Salamonson (Perth), two and a half days were dedicated to learning how to
implement competency-oriented instruments such as checklists and bronchoscopy assessment tools (BSTAT, BSAT, and Step-by Step) into a
pulmonary training program. These tools are now part of competency-based educaon in Australia and New Zealand.
An excing new session included Anatomy of a Bronchoscopy Suite. Jon Williamson conducted this capivang, interacve session with parci-
pants as they discussed equipment, instruments, personnel, organizaon, and access to a dedicated emergency box in order to respond swily
and eecvely to bronchoscopy-related complicaons. Other mes during the course, simulators were employed to pracce step-by-step bron-
chial inspecon (including Laerdal, Symbionix, and TruCorp models). Two-to-one learner/teacher raos allowed hours of individualized instruc-
on, enhanced by the use of visionary glass markerboards and ample me to develop neural pathways learning bronchoscopy on an iPAD
(BronchPilot™ Anatomy available free for download from the apple store).
On a personal note, I want to thank all my colleagues down under, and I can say with condence that Aussies and Kiwi bronchoscopists
(Australia and New Zealand) are at the forefront of our mes, changing the educaonal paradigm and revoluonizing bronchoscopy training.
Not only are assessment tools and checklists being ocially introduced into naonal training programs and competency assessments, but new
guidelines are also being accepted regarding pleural disease educaon (see the new ICC-STAT and UG-STAT assessment tools*, both available
for download on the www.Bronchoscopy.org website). Case-based exercises using the Praccal Approach method are being used in many cen-
ters to eecvely assess not only what trainees know, but also how trainees think as they gain skills, knowledge and experience, and most eve-
ryone agrees that breaking bronchoscopy down into separate steps allows rapid acquision of technical skills without endangering paents or
unnecessarily prolonging procedures.
And of course, a big thank you to Natasha Botvinik and the enre Olympus Australia team, and to our many Aussi and Kiwi trainers, and to all
the young people who enthusiascally contributed to the success of this program. Next stop…a Train-the-Trainer program in Auckland, New
*Intercostal Catheter Skills and Tasks Assessment Tool. Ultrasound-Guidance (thoracentesis) Skills and Task Assessment Tool.
Education and Training
P A G E 10
Figure 1A: Physician trainers in
Melbourne, Australia. Figure
1B. iPAD-based BronchPilot
Anatomy™ and magic marker-
Figure 2: Congratulaons to everyone who parcipated in the
Train-the-Trainer and Introducon to Flexible Bronchoscopy
course held in Melbourne, Australia, 2018.
WABIP Vising Scholar Grant – We are excited to announce the all new WABIP Vising Scholar Grant, whose rst recipient is Dr.
Omer Elhag, WABIP Regent from Sudan. This grant provided support to Dr. Elhag to complete EBUS and convenonal TBNA training
as part of a Sudanese naonally supported program to expand lung cancer diagnosis and management.
Dr Elhag is an opinion leader in Sudan and department head of a major university teaching
hospital in Khartoum. His credenals include a medical doctorate degree from the University
of Cluj, Romania. As part of the WABIP vising scholars grant, Omer returned to Romania
from March 24, 2018 to April 20, 2018. Under the tutelage of Dr. Mariaora Simon, he
completed a structured Bronchoscopy Internaonal curriculum that included reading and
analysis of The Essenal cTBNA Bronchoscopist, the Essenal EBUS Bronchoscopist, coached
praccal approach exercises, analycal review of EBUS-related teaching videos available from
the BronchOrg YouTube channel, training in cytology and specimen/smear preparaon,
commentary of the WABIP podcast on small samples in lung cancer, and numerous hours of
hands-on training using models, then live clinical cases aer achieving 100 percent technical skill scores using assessment tools
such as EBUS-STAT.
Furthermore, Omer assisted with preparaons for a rst hands-on EBUS training course
in Romania, addressing endobronchial ultrasound physics, equipment (processors,
bronchoscopes, needles, radial and linear array transducers), diagnosis and mediasnal
staging, Bronchoscopy skills and techniques, anatomy, lung cancer classicaon
according to universally accepted IASLC guidelines, clinical case analyses, and EBUS-CT-
White light bronchoscopy correlaons.
Having returned to the Sudan, Dr. Elhag can share his new knowledge and experse with
his colleagues in his country, expanding clinical care and serving paents with greater
skill and competence. Many congratulaons to Dr. Elhag for building a strong foundaon
of knowledge and clinical experse that will help hundreds of paents and advance
intervenonal pulmonology in Sudan.
New Member Society It is our honor and pleasure to welcome Dr. Liu Xicheng and colleagues as
members of the Asian Pediatric Intervenonal Pulmonology Associaon (APIPA), newly joined member
society of the WABIP. The APIPA has just completed its rst congress in China to great success (read
more about it here). We would like congratulate Dr. Xicheng on this step to improve the respiratory
health of children in Asia and the world.
New Board of Regents Members – Please welcome new board members, pictured le to right, Dr. Shaheen Islam (AABIP – USA),
Dr. Kiyoshi Shibuya (APAB – Japan), and Dr. Shah Shirish Piyushkant (IAB India). We are honored and delighted to have these 3
new members on our Board of Regents, which now has 62 members from over 30 countries around the world.
P A G E 11
The Marriage of Navigaon Bronchoscopy and Ablave Therapies for Peripheral Lung Cancers: You All Are Invited
Rapid progress in technologies to access peripheral pulmonary nodules including navigaon bronchoscopy, roboc navigaon, radial ultra-
sound, and trans parenchymal approach has made trans-bronchial biopsies much safer and more eecve and compared to just a few years
Ablave therapies have come a long way as well. Therapies with extensive experiences in other organs and newer modalies with a short but
robust track record of safety and ecacy are all converging towards the lung cancer, the most deadly cancer known to men.
In the recent years, increasing numbers of early-stage lung cancers are being discovered, thanks to lung cancer screening programs across the
world. A large proporon of these paents are deemed poor surgical candidates due to severe co-morbidies despite having a good potenal
for “cure” by surgical resecon. Currently, the standard of care for such paents is stereotacc body radiaon therapy (SBRT).
Navigaon bronchoscopy combined with ablave therapies for the treatment of peripheral lung cancer has been undergoing extensive tesng
around the globe. It’s a conceivable that this combinaon might oer mulple therapeuc opons besides SBRT for non-surgical, early stage
lung cancer paents. These opons would be minimally invasive, single applicaon, and probably cheaper than SBRT. .
Recently a small study from Japan (1) showed that bronchoscopic treatment of peripheral non-small cell carcinoma in poor surgical candidates
with Radiofrequency Ablaon (RFA) allowed progression-free survival in more than 80% of the paents at one year and median progression-
free survival of almost 3 years. No major early or delayed complicaons were reported. In this study, the navigaon and localizaon of the le-
sion were achieved by CT scanning.
Another such animal trial (2) was recently published describing the safety and ecacy of Photo Dynamic Therapy (PDT) in the treatment of
primary lung cancer in a canine model using navigaon bronchoscopy. Mulple dogs with biopsy-proven primary lung cancer were treated with
Diode laser in Photophyrin sensized tumors, PDT. The tumors were resected aer one week to study the eects of treatment on the tumor
and the surrounding healthy lung ssue. Authors reported no acute or chronic signicant side eects and success in the tumor ablaon in the
prescribed range of the laser from the p of the probe/catheter “kill zone.” Healthy lung showed mild inammaon easily treated with a short
course of steroids.
In another study (3), 50 paents with peripheral pulmonary malignancies were treated with percutaneous microwave ablaon using CT guid-
ance for locaon. The results of this study suggest that lesions less than 3 cm and more than 3 cm responded equally well to the microwave
ablaon technique with a 1-year survival of 83%, 2-year survival of 73%, and 3-year survival of 61%. Approximately 20% of the paents had re-
sidual disease aer the inial ablaon though.
Such studies show the relentless progress in Intervenonal Pulmonology carrying the promise to ulize cung-edge navigaonal and localiza-
on modalies with ablave therapies in opening up new doors to novel, minimally invasive, and personalized
therapies for one of the deadliest disease facing the humanity.
Editorial Staff
Associate editor: Dr. Ali Musani
Associate editor: Dr. Sepmiu Murgu
Editor-in-Chief: Dr. Kazuhiro Yasufuku
Primary Business Address:
Kazuhiro Yasufuku, Editor-in-Chief
WABIP Newsleer
c/o Judy McConnell
101 College St., TMDT 2-405
Toronto, Ontario M5G 1L7
Phone: 416-581-7486
E-mail: newsleer@wabip.com
P A G E 12
P A G E 13
Figure 1: (A and B): Computer-generated images of the bronchial tree of Dog 1 developed by the electromagnec navigaonal system
(Veran Navigaon Systems). The images also show the tumor shape and locaon (in red in A). B shows the route taken by the bron-
choscopy probe and one of the nal locaons of the opcal ber used to irradiate the tumor. (C) Photograph taken during surgical
excision of the right caudal lobe of Dog 1 at 1 week aer PDT. The tumor is clearly visible.
1. Xie et al. Respiraon. 2017. 94(3):293-298
2. Musani et al. Lasers Surg Med. 2018 . Feb 5. doi: 10.1002/lsm.22781. [Epub ahead of print]
3. Farrah et al. Radiology. 2008. 247(3):871-9.
P A G E 14
Pediatric intervenonal bronchoscopy in Indonesia is sll considered as a new procedure. In order to establish and improve skill and knowledge
on this eld, we held 1st Indonesian pediatric intervenonal bronchoscopy scienc meeng on March 22-24, 2018 in Jakarta. First acvity was
pediatric intervenonal bronchoscopy workshop which was conducted on March 22nd in Cipto Mangunkusumo Hospital, a naonal referral
hospital in Indonesia. Cipto Mangunkusumo hospital is an academic university based hospital in collaboraon with Faculty of Medicine Universi-
tas Indonesia and serve as a training and educaonal centre for medical students, residents and trainees. This workshop was endorsed by
World Associaon Bronchology and Intervenonal Bronchoscopy (WABIP), especially the pediatric secon. On March 23rd, The webinar (online
symposia) about integrated bronchoscopy services in Cipto mangunkusumo hospital was held. It was a collaboraon symposia of pediatric pul-
monologist, adult pulmonologist, Otorhinolaryngologist and guest speaker (chairman of pediatric secon of WABIP) . The webinar was broad-
casted from Cipto Mangunkusumo hospital across the country so that other hospitals and colleagues from other islands could join the sessions.
On March 24th, in conjucon with Jakarta Internaonal Chest and Crical Care Medicine Congress, a topic of pediatric intervenonal bronchos-
copy was delivered in plenary session. In the aernoon, a pediatric hands on workshop of intervenonal bronchoscopy was performed.
Day 1 (March 22nd ,2018) : Pediatric Intervenonal Bronchoscopy Workshop
The workshop was opened by the representave of educaonal and training director of Cipto Mangunkusumo hospital, Dr Anwarul Amin. A
short introducon of the workshop was delivered by Dr Wahyuni Indawa as a course director then proceed to case presentaon for live
demonstraon procedure. Aer that, live demonstraon procedure of applicaon of cryotherapy and argon plasma coagulaon (APC) was per-
formed. A case of reccurent papilloma larynx in 7 years old girl who had fully obliterated supragloc, gloc and subgloc area above the tra-
cheostomy canule as well as in the trachea just below the tracheostomy canule was exrpated using cryotherapy and APC. The procedure was
done by Prof Mohammad Ashkan Moslehi which the audience saw it in realme through livestreaming room. Prof Moslehi explained step by
step about the procedure of using cryotherapy and APC in managing the intraluminal mass.
P A G E 15
Aer the break, lecture sessions was began with “How to Develop Intervenonal
Bronchoscopy Center (Lesson Learnt From Adult Pulmonologist)” which was
presented by Dr Ceva W Pitoyo. Dr Elvie Zulka from Otorhinolaryngology Depart-
ment spoke about “Foreign Body Extracon in Children”. The topic of “Anesthesia
technique in Pediatric Intervenonal Bronchoscopy“ was delivered by Dr Bintang
from Anaesthesiology Department. Aerwards Prof Moslehi gave enlightment
about “Cryotherapy in managing granulaon ssue and foreign body extracon in
Children” and proceed by lecture on “The role of ballooning in managing airway
stenosis”. The aendees were hospital sta from muldepartment as well as resi-
dents and trainees and also pediatric pulmonologist from other part of Indonesia
such as West Sumatra, South Sumatra and South Sulawesi.
Day 2 (March 23rd, 2018) : Webinar on Integrated Bronchoscopy services in Cipto Mangunkusumo Hospital
The second day was started by online symposia (webinar) which was chaired by Dr Wahyuni Indawa. There were 4 topics in this session, “The
role of bronchoscopy in pediatric respiratory cases” was delivered by Dr Darmawan B Setyanto as Head of Respirology Division Child Health De-
partment Cipto Mangunkusumo hospital. Aerwards Dr Ceva W Pitoyo, Head of Respirology and Crical Care of Department Internal Medicine
spoke about “Current Pracce of Adult Intervenonal Bronchoscopy”. Prof Moslehi as our honoured guest gave lecture on “The Present and
Future for Pediatric Intervenonal Bronchoscopy”. The
fourth topic about “Challenges of Foreign Body Extracon in
Children” was presented by Dr Rahmanofa Yunizaf from
Otorhinolaryngology Department.
The session was broadcasted across the country thus
allowed other hospitals and colleagues from other island of
Indonesia acvely parcipated. Pediatric pulmonologist from
Jakarta, Palembang (South Sumatra), Padang (West Sumatra)
and so on were asking quesons interacvely during the
Day 3 (March 24th ,2018) : Jakarta Internaonal Chest and Crical Care Medicine (JICCIM) Congress
In plenary session of the 6Th JICCIM in Raes hotel, Jakarta, Prof Moslehi Introduced “Pediatric Intervenonal Bronchoscopy : Where are we
now?”. In the aernoon session, Dr Wahyuni and Prof Moslehi conducted hands on session on pediatric intervenonal bronchoscopy. First Dr
Wahyuni started with Hands on session of “Praccal Points to Drive Flexible Bronchoscope” and then connued by Prof Moslehi about “The
Applicaon of Cryotherapy, APC and Balloning Procedures in Pediatric Seng”. The parcipants were pediatric pulmonologists from all over the
country such as Jakarta, East Java, West Sumatra, South Sumatra, South Sulawesi, North Sulawesi, Jogjakarta, North Sumatra and West Nusa
Tenggara. All parcipants were acvely involved and directly supervised during hands on using the bronchoscopy model. The session was
wrapped up with group photo and the spirit of connuing to elaborate and improve skills and knowledge on pediatric intervenonal bronchos-
copy. Special regards to our honourable guest Prof Moslehi for the willingness of sharing his experiences and knowledge. The last but not least
we also thank to our partner Seo Harto (Olympus Indonesia) and Erbe company for the support of this workshop.
P A G E 16
This 1st Indonesian Pediatric Intervenonal Bronchoscopy Scienc Meeng is the rst plaorm for Indonesian pediatric pulmonologist to
move forward in the future for beer pracces in respiratory medicine. Collaboraon with other society in the world and region will be ex-
pected to strengthen the scienc part as well as transfer of skill. ( Jakarta, March 31st 2018, WI)
1st Congress Of Asian Pediatric Interventional
Pulmonology AssociationAPIPA
P A G E 17
1st Congress Of Asian Pediatric Intervenonal Pulmonology Associaon (APIPA) was held on March 16th to 18th, 2018 in Shangri-La Hotel,
Jinan, China. On March 16th, the congress opened at 8:00 am, in an exoc and beauful scene of dierent countries. Prof Liu Xicheng from
Beijing Children’s Hospital, the rst Chair of APIPA, read the rules and regulaons of APIAP.The aim of APIPA: To serve the world children
with bronchoscopy and intervenon. The mission of APIPA is to promote knowledge and understanding of pediatric intervenonal bron-
choscopy procedures in order to improve the respiratory health of children in Asia and further the world. To achieve these goals, APIPA was
established and provids a solitary pediatric plaorm for study and interacon. The aendees included colleagues from pediatric respiratory,
intensive medicine, neonatal, cadiothoracic surgery, anaesthesia, ENT department, et al. Other than Chinese colleagues, there were doctors
from India, Bangladesh, Malaysia, South Africa, et al. It’s an great event for Asian pediatric intervenonal pulmonology.
Opening ceremony guests included Prof Mohammad AshkanMoslehi from Shiraz University School of Medicine, Iran and Chair of pediatric
secon of WABIP, Director Li Fang from Talent Exchange Service Center Of Endoscopic Diagnosc And Therapeuc Technology Project
Oce, China Naonal Health And Family Planning Commission, prof Liu Xicheng from Beijing Children’s Hospital and the rst Chair of APIPA,
prof Kopen Wang from Balmore Union Memorial Hospital,USA, prof Lorenzo Mirabile from Meyer Children’s Hospital, Italy, prof Hugo
Boo from Garrahan Children’s Hospital, GaiZhongtao, Chair of Qilu Children's Hospital of Shandong University, Zhang Yunkui, President of
Qilu Children's Hospital of Shandong University, prof Meng Chen from Qilu Children's Hospital of Shandong University.
P A G E 18
Secon 1: Diagnosc And Therapeuc Development Of Pediatric Respiratory Endoscopy
Prof Liu Xicheng gave a lecture of "Pediatric Respiratory Endoscopic Development Status In China", focus on Chinese pediatric respiratory
endoscopy for more than 20 years of development, developing all kinds of endoscopic technology and Chinese government paying much
aenon to standard training of pediatric intervenonal pulmonologists, this eld is very promising. Prof Hugo Boo spoke of " Diagnosc
And Therapeuc Development Of Pediatric Laryngomalacia", including pathogenesis, clinical manifestaons, the eects of growth and devel-
opment of children and intervenonal therapeuc methods, and he also showed the process of intervenonal therapy via real video. Prof
Lorenzo Mirabile gave a lecture of "Airway Stenng In Tracheobronchial Disease ", including updated status of children's airway disease in
Italy, implicaons and prevenons for complicaons of airway stenng, with video showing the process of stent placement. The wonderful
lecture won warm applause. Prof Mohammad AshkanMoslehi spoke on “Lung Biopsy With Cryoprobe In Pediatrics”, he illuminated the tech-
nical principle and advantage of cryotherapy, stressing that bronchoscopy and intervenon full of challenge and was the inevitable direcon
of discipline development. Prof Kopen Wang introduced in detail about orientaon, puncture method and points for aenon when per-
forming TBNA, he also shared some ideas in equipment improvement. His presentaon fully reected connuous innovaon was very im-
portant in the work of intervenonal pulmonology.
Secon 2: Respiratory Endoscopy and Muldisciplinary Collaboraon
The development of pediatric pulmonary rehabilitaon is important for the psychosomac health of children with severe and chronic lung
disease. Prof Yu Pengming from Huaxi Medical School Of Sichuan University, explained that children's lung were dierent from adults in
physiology and anatomy, requiring more observaon, accumulaon of experience, cooperaon of children and parents, and completed lung
rehabilitaon therapy during playing. Prof Wen Hongmei from Third Hospital Aliated To Zhongshan University, showed the experience in
adult paents in her presentaon of "Endoscopic Evaluaon Of Pediatric Dysphagia", so that we could understand more about dysphagia in
pediatrics. Prof Wan Guifang from Third Hospital Aliated To Zhongshan University, gave a lecture of "Evaluaon And Management Of Dys-
phagia In Pediatrics", stressing the swallow involve mulple cooperave work of respiratory system, digesve system, et al, nding underly-
ing cause via evaluaon and prevenng aspiraon by regulated food.
P A G E 19
Muldisciplinary collaborave team from Qilu Children's Hos-
pital of Shandong University, consisng of respiratory inter-
venonal physician prof Meng, anesthest Dr. Wang Shao-
chao, cardiac surgeon prof FengZhiyu, thoracic surgeon prof
Wu Yurui, nurse RenJinlu, together introduced their experi-
ence in managing refractory airway diseases, such as trache-
oesophageal stula, tracheal stenosis due to vascular ring,
infancy congenital airway deformies, dicult airway for in-
tubaon and so on. ICU physician Prof Tang Yuanping and
cardiac surgeon prof Sun Shanquan, both from Guangdong
Provincial Maternal And Child-Care Hospital, introduced their
experience in the treatment of airway malformaon of small
infants. Excellent cases report, unique teaching method and
visualized operaon video, made the parcipants fully realize
that muldisciplinary collaboraon has unlimited prospects.
Secon 3: Team Building Of Pediatric Respiratory Endoscopy
Prof Meng Chen, prof Hugo Boo, prof Lorenzo Mirabile and prof Mohammad
AshkanMoslehi, respecvely introduced pediatric respiratory endoscopic team
building in China, Argenna, Italy and Iran, made everybody know the develop-
ment of pediatric respiratory endoscopy in these countries.
Secon 4 : Clinical Applicaon Of Pediatric Respiratory Endoscopy
Airway foreign bodies are one of the most common work for pediatric respiratory endoscopy. In “Excing Stories In Foreign Bodies Remov-
al”, Prof Jiao Anxia from Beijing Children’s Hospital, told a variety of thrilling stories. Prof MengFanzheng from First Hospital Of Jilin Universi-
ty, spoke of "The Value Of Respiratory Endoscopy In Respiratory Tuberculosis", suggested that endoscopy was very important in the diagno-
sis and treatment of respiratory tuberculosis, and could reduce misdiagnosis and missed diagnosis. Prof Lorenzo Mirabile, gave lectures of
"Category And Treatment Of Children’s Laryngeal Cysts””Pay Aenon To Pediatric Laryngopharyngeal Reux”, making the aendees under-
stand pediatric laryngeal diseases more. Prof Hugo Boo, spoke of "Rigid Bronchoscopy In Pediatrics". Prof Chen Dehui from First Hospital
Aliated To Guangzhou Medical University, stressed the importance of early endoscopic intervenon in her presentaon "Time Of Endo-
scopic Treatment For Severe Pneumonia Complicated With Atelectasis”. In the presentaon of “Missed Diagnosis Of Pediatric Pulmonary
Vascular Diseases”, prof ZhongLili fromHunan Provincial People’s Hospital, reminded that respiratory disease included not only tracheobron-
chial, pulmonary and pleural diseases, but also pulmonary vascular diseases, which requiring more aenon. Prof Huang Yan from Dalian
Children's Hospital suggested to standardize administraon of pediatric respiratory endoscopy so as to guarantee medical safety. Prof Zhou
Hongmei from Zhongshan Hospital Aliated To Guangdong Medical University, spoke of “Time Of Medical Thoracoscopy For Empyema And
Prevenon Of Complicaons”, indicated the importance of pediatric thoracoscopy.
P A G E 20
Secon 5: Case Reports
More than a dozen pediatricians shared their
wonderful cases of success or failure in their re-
specve hospitals. They are Dr. Mi Qing from
Taian Central Hospital, Dr. Niu Bo from Hebei
Children’s Hospital, Dr. Liu Xiangteng from
ZhongshanBoai Hospital Aliated To Southern
Medical University, Dr. Zhang Lei from Shanghai
Children's Medical Center, Dr. Zhang Han from
Shengjing Hospital Aliated To China Medical
University, Dr. Lin Xiaoliang from First Hospital
Aliated To Xiamen University, Dr. Yin Fengrui
from Chifeng Municipal Hospital, Dr. Cheng Xing
from Guiyang Children's Hospital, Dr. Tang Xiaodi
and Zhao Mengjiao from Qilu Children's Hospital
Of Shandong University, Dr. Shu Chang from Chil-
dren's Hospital Of Chongqing Medical University,
Dr. Ma Lanhong from People's Hospital of Xin-
jiang Uygur Autonomous Region, Dr. Wang
Yongjun from Gansu Provincial Maternity And
Child-Care Hospital, Dr. Zhou Miao from Hunan
Provincial People’s Hospital. Pediatric interven-
onal pulmonology connuously involved talent-
ed people!
P A G E 21
Secon 6: Hands-on Workshop
As one of the highlights of this session, there were many aendees in hands-on workshops. On the site, the teachers were full of energy in
instrucng, the leraners were very acve in learning. The content was very rich, including airway management, procedure of bronchoscopy,
bronchoalveolar lavage, clamping, minimally invasive thoracentesis and drainage, bronchoscopic balloon dilataon, cryotherapy, electrocau-
tery, argon plasma coagulaon, laser, medical thoracoscopy. The program of nurses included washing, disinfecon and maintenance of endo-
scope, cooperave work with praconer, equipment preparaon, applicaon of forceps, balloon and ablaon equipment. The aendees
were able to feel the charm of endoscopy and intervenon in silicone and animal models, live video transfer of operaons.
Asian Pediatric Intervenonal Pulmonology Associaon is the rst setup jointly by the pediatric intervenonal pulmonologists in the world. It’s
the window of the development of Asian Pediatric Intervenonal Pulmonology. The establishment of the plaorm will certainly promote fully
development of Asian Pediatric Intervenonal Pulmonology. We sincerely expect extensive exchanges and cooperaon with the world col-
leagues on this plaorm, and together make APIPA congress a high level pediatric respiratory intervenonal event with worldwide inuence.
The WABIP has started a new educaon project recently: THE WABIP ACADEMY. The WABIP Academy will pro-
vide free online webcasts with new and hot topics that will interest pulmonologists and intervenonalists.
Current webcast topic: Tissue acquision for biomarker directed therapy of NSCLC
You can reach these webcasts by using this link: hp://www.wabipacademy.com/webcast/
www.bronchology.com Home of the Journal of Bronchology
www.bronchoscopy.org Internaonal educaonal website for
bronchoscopy training with u-tube and
facebook interfaces, numerous teachiing
videos, and step by step tesng and assess
ment tools
www.aabronchology.org American Associaon for Bronchology and I
ntervenonal Pulmonology (AABIP)
www.eabip.org European Associaon for Bronchology and
Intervenonal Pulmonology
www.chestnet.org Intervenonal Chest/Diagnosc Procedures (IC/DP)
www.thoracic.org American Thoracic Society
www.ctsnet.org The leading online resource of educaonal and
scienc research informaon for cardiothoracic
www.jrs.or.jp The Japanese Respirology Society
Asociación Sudamericana de Endoscopía Respiratoria
P A G E 22
When: June 2-3, 2018
Where: Narayana Health City, Bengaluru, India
Program Director: Dr. Ranganatha
Program Type: Educaonal seminar (postgraduate may include physicians in pracce and trainees), Hands-on workshop, Conference
(didacc lectures)
1st Internaonal and 3rd Iranian Naonal Congress of Lung Cancers and Intervenonal Pulmonology
When: June 20-22, 2018
Where: Milad Hospital, Isfahan, I.R.Iran
Program Director: Dr. Babak Amra, MD
Program Type: Educaonal seminar (for trainees only), Hands-on workshop, Conference (didacc lectures)
Website: hp://www.chestnet.ir
Intervenonal Pulmonology and Pathology Through Clinical Pracce
When: June 23, 2018
Where: Belgrade, Serbia
Program Director: Semra Bilaceroglu M.D., Marioara Simon M.D., Spasoje Popevic M.D.
Program Type: Educaonal seminar (postgraduate may include physicians in pracce and trainees)
Conference (didacc lectures)
Website: hp://www.srbrespiratory.org/meengs.html
Introducon to Bronchoscopy and Pulmonary Procedures Course
When: June 29, 2018
Where: Beth Israel Deaconess Medical Center, Boston, MA, USA
Program Director: Mihir Parikh, M.D.
Program Type: Educaonal seminar (for trainees only), Hands-on workshop
SingHealth DukeNUS Lung Centre Advanced Bronchoscopy & Pleuroscopy Course
When: July 4-7, 2018
Where: Academia, Singapore General Hospital, 20 College Road Singapore 169856
Program Director: Dr. Melvin Tay
Program Type: Educaon seminar, Hands-on workshop
Website: hps://www.facebook.com/lungcentre/
P A G E 23
EBUS and Advanced Diagnosc Bronchoscopy: The Seventh Year
When: July 25-27, 2018
Where: Hya Regency Chesapeake Bay, Cambridge, Maryland
Program Director: Lonny Yarmus, DO, FCCP, MD
Program Type: Educaonal seminar (postgraduate may include physicians in pracce and trainees), Hands-on workshop, Confer-
ence (didacc lectures)
Website: hps://hopkinscme.cloud-cme.com/aph.aspx?P=5&EID=11444
4th Annual Scienc Meeng of the Malaysian Associaon for Bronchology and Intervenonal Pulmonology
When: October 12-14, 2018
Program Type: Hands-on workshop, Conference (didacc lectures)
Website: hp://www.mabip.com
Fih Annual Percutaneous Tracheostomy and Advanced Airway Cadaver Course
When: October 22, 2018
Where: MISTC Lab, The Johns Hopkins Hospital, Balmore, MD
Program Director: Hans Lee, MD
Program Type: Hands-on workshop, Conference (didacc lectures)
Website: hps://hopkinscme.cloud-cme.com/aph.aspx?P=5&EID=13574
Ninth Annual Evaluaon and Management of Pleural Disease
When: January 21-22, 2019
Where: The Johns Hopkins Hospital, Balmore, MD
Program Director: David Feller-Kopman, MD, FCCP
Program Type: Hands-on workshop, Conference (didacc lectures)
Website: hps://hopkinscme.cloud-cme.com/aph.aspx?P=5&EID=14934
P A G E 24