WABIP Newsletter 2025, Issue 3

Volume 13

Issue 03

September 2025

Inside This Issue

Editorial, 2-4

Technology Corner, 5-7

Tips from the Experts, 8-9

Humanitarian News, 10-16

Best Image Contest, 17

WABIP News, 18-19

Research, 20-21

Links, 22

The First Year, The Forward Path: Report from WABIP Chair Pyng Lee

WABIP Newsletter

S E P T E M B E R 2 0 2 5 V O L U M E 1 3 , I S S U E 3

EXECUTIVE BOARD

Pyng Lee, MD, PhD

Singapore, Chair

Ali Musani, MD

USA, Vice-Chair

Stefano Gasparini, MD

Italy, Immediate Past-Chair

Hind Janah, MD

Morocco, Membership

Commiee Chair

Aleš Rozman, MD, PhD

Slovenia, Educaon Com-

miee Chair

Danai Khemasuwan, MD

USA, Finance Commiee

Chair

Naofumi Shinagawa, MD

Japan, Secretary General

Rajesh Thomas, MD, PhD

Melbourne , President

WCBIP 2026

STAFF

Michael Mendoza

General Manager

Judy McConnell

Administrator

Kazuhiro Yasufuku

Newsleer Editor-in-chief

P A G E 2

Pyng Lee, MD

Chair, World Associaon for Bronchology and Intervenonal Pulmonology (WABIP)

Singapore · September 2025

Colleagues and friends,

As I approach my first full year as Chair of the World Association for Bronchology and Interventional Pulmonolo-

gy (WABIP), I’m grateful for your trust and energized by what we have achieved together. This report highlights

the progress across our core pillars—membership, standards and guidelines, education, and global collabora-

tion—and outlines where we’re headed next.

Welcoming New Member Societies & Sustained Growth

Our community has grown meaningfully in both reach and depth.

• Tunisia Bronchology and Interventional Pulmonology Group has joined WABIP with 11 members. I want to

recognize Dr. Islem Mejri for championing Tunisia’s engagement and thank our WABIP Membership Committee

Chair Dr. Hind Janah for serving as the bridge and guide that made this possible.

• Mexican Society of Pulmonology and Thoracic Surgery has joined with 16 members. We warmly welcome

this collaboration and appreciate the leadership of Dr./Prof. Jose Luis Sandoval Gutiérrez.

In addition, new members from existing societies totaled 1,868 over the past 12 months. Together, we now com-

prise approximately 12,500 members across more than 65 regions/countries. This momentum reflects your com-

mitment to a global professional home where learning, standards, and patient-centered innovation thrive.

Advancing Standards: BCAO Stenting Guidelines Accepted

Setting and disseminating standards remains central to our mission. I’m pleased to share that the WABIP Guide-

lines on airway stenting for benign central airway obstruction (BCAO) have been accepted for publication in

Respirology and are scheduled for 2025. Co-authored by Antoni (Toni) Rosell, Septimiu (Tim) Murgu, Udit Chad-

dha, Abhinav Agrawal, and colleagues, this consensus complements our earlier WABIP malignant central airway

obstruction (MCAO) guidance published in Respirology.

Why this matters: benign airway disease presents unique indications, risk–benefit considerations, device choices,

and follow-up strategies that differ from malignant CAO. These new guidelines aim to sharpen decision-making

and reduce variability in practice. In the year ahead, we will prioritize implementation support: practical teaching

cases, checklists, and webinars that bring the recommendations from page to procedure room.

Education & Skills Transfer: Courses on Two Continents

Singapore: “Focus on EBUS—What a Pulmonologist Needs to Know” (August 1-2, 2025)

Under my direction, we hosted a focused course on endobronchial ultrasound that drew 45 physicians from

across Asia–Pacific (Australia, Taiwan, Hong Kong, Indonesia, Vietnam, Malaysia, Philippines) and three endosco-

py nurses.

• International faculty: Prof Noriaki Kurimoto and Prof Dongil Park

• Local faculty: Melvin Tay, Pipetius Quah, Alvin Lo, Clare Fong

Program highlights included airway mapping and radial EBUS for peripheral pulmonary lesions; mediastinal evalua-

tion; transbronchial and mediastinal cryobiopsy; and a lively “Best and Worst Cases” session. Feedback was em-

phatic: participants found the airway mapping pearls from Prof Kurimoto and the technique-focused sessions

highly actionable. Our aim was simple—translate technology into reliable practice—and the learners’ responses

tell us we’re on the right track.

Bulgaria: Bronchoscopy Education Project—Sofia (June 12–14, 2025)

At the Department of Interventional Pulmonology, Military Medical Academy (Sofia), we delivered two linked

courses—Introduction to Flexible Bronchoscopy and a Faculty Development Program (Train the Trainers)—as part

of the Bronchoscopy Education Project.

• Lead: Prof Henry Colt (University of California, USA)

• Certified trainers: Assoc. Prof Milena Encheva (Sofia, Bulgaria), Assoc. Prof Spasoe Popevich (Belgrade, Ser-

bia), Dr Maria Zdraveska (Skopje, North Macedonia)

• Participants: bronchologists from across Bulgaria, Serbia, and North Macedonia

Beyond technical steps, the curriculum emphasized competency-based education: the BSTAT assessment tool,

“Step-by-Step” skill acquisition, checklists, the 4-box approach, informed consent, and communication—up to and

including how to deliver bad news. Role-play and case re-creation fostered a two-way exchange of experience.

Attendees reported that the methods would change and unify their training systems, strengthening how teams

teach and how patients experience care. My gratitude to Prof Colt and our Balkan colleagues for modeling how to

scale quality through education.

Save the Dates: WABIP Two-Day Global Webinar (Free)

Evolution of Interventional Pulmonology—From Fiberoptic to Robotic Bronchoscopy; From Rigid to Flexirigid

Thoracoscopy (In honor of: Prof Shigeto Ikeda and Prof Hans Christian Jacobaeus)

Saturday–Sunday, September 13–14, 2025 · Start: 8:30 AM GMT (local time auto-converts on the event page)

Across Asia, Europe, the Americas, Africa, and Oceania, a world-class faculty will lead deep dives and case discus-

sions. Selected speakers include Ali Musani, Stefano Gasparini, Danai Khemasuwan, Hind Janah, Hideo Saka,

Naofumi Shinagawa, Hervé Dutau, Carla Lamb, David Fielding, Noriaki Kurimoto, Najib Rahman, Atul Mehta, Taeko

Shirakawa, Septimiu Murgu, Felix Herth, Levent Dalar, Udit Chaddha, Sonali Sethi, Takahiro Nakajima, Thomas

Gildea, Marios Froudarakis, Thitiwat Sriprasart, Antonio Bugalho, Spasoje Popević, Gary Lee, Rainbow Lau, Wahju

Aniwidyaningsih, and many others—supported by dedicated chairs and moderators across both days.

Program snapshot

• Day 1 (Sat): Bronchoscopy—Traditional → Cutting-Edge Peripheral bronchoscopy with airway mapping/radial

EBUS; navigation & robotic bronchoscopy (workflow, anesthesia/ventilation to reduce atelectasis, augmented im-

aging vs CBCT); mediastinal access & staging (EBUS in complete lung cancer staging); biopsy adequacy and when

to trust benign results; and a round-table on balancing innovation with pragmatism.

W A B I P N E W S L E T T E R

P A G E 3

• Day 2 (Sun): Thoracoscopy & Advanced Interventions Pleural space (infections, malignant effusions, thoraco-

scopic technique); advancing rigid bronchoscopy and airway stenting; sublobar resection vs bronchoscopic abla-

tion for malignant nodules; benign disease interventions (COPD endobronchial therapies, ILD bronchoscopy, asth-

ma—thermoplasty vs biologics); and a round-table on cost, access, training, and expertise.

Sponsors: Ambu, Harada Corporation, Novatech, Intuitive, FTM, Cook Medical

The Forward Path: Priorities for Year Two

1. From guidelines to practice: Launch targeted implementation toolkits for BCAO and refresh our MCAO materi-

als—quick-reference algorithms, procedure checklists, and case libraries aligned with real-world constraints.

2. Consensus-building with AABIP: Collaborate with the American Association for Bronchology and Intervention-

al Pulmonology (AABIP) to develop joint consensus statements on thoracoscopy, tracheobronchial malacia, and

excessive dynamic airway collapse (EDAC).

3. Safety data from India: Partner with Indian colleagues to curate and share the country’s rich resources on

complications and safety in interventional pulmonology procedures—translating lessons into checklists, bench-

marks, and QI toolkits for the global community.

4. Education without borders: Expand regional courses and train-the-trainer programs so skills multiply locally.

We will continue to mix high-fidelity simulation with bedside teaching, emphasizing assessment and communica-

tion—because quality is more than a device or a scope.

5. Equity and access: Strengthen partnerships that help centers acquire appropriate tools, and share pragmatic

workflows for settings with limited resources (e.g., alternatives to CBCT, anesthesia strategies to reduce atelecta-

sis, and low-radiation pathways).

6. Mentorship and early-career growth: Build structured mentorship tracks, spotlight young investigators, and

promote scholarship opportunities linked to WABIP meetings and webinars.

7. Data and quality improvement: Encourage multi-center registries and pragmatic studies—particularly around

biopsy adequacy, stent outcomes in BCAO, and safety metrics—to move debates from opinion to evidence.

8. Community and voice: Continue to bring in societies from underrepresented regions, and nurture member-to-

member exchanges so that our 12,500-strong network remains personal, collegial, and generous.

Gratitude

My heartfelt thanks to our Executive members, Board of Regents, member societies, committee leaders, faculty,

and volunteers—and to every clinician who teaches, learns, and advocates for patients with complex airway and

pleural disease. Your work gives life to WABIP’s mission.

Let us keep translating innovation into equitable, safe, and effective care—everywhere.

With appreciation,

Pyng Lee, MD

Chair, World Association for Bronchology and Interventional Pulmonology (WABIP)

Singapore · September 2025

W A B I P N E W S L E T T E R

P A G E 4

W A B I P N E W S L E T T E R

P A G E 5

Technology Corner

Rigid Bronchoscopy-Guided Percutaneous Dilaonal Tracheostomy (RBG-PDT)- Technical

Approach and Safety for High-Risk Populaons

Introducon

Percutaneous dilaonal tracheostomy (PDT) has become the preferred approach for establishing surgical airways in crically ill pa-

ents, with over 100,000 procedures performed annually in the United States.(1) While PDT oers numerous advantages over surgi-

cal tracheostomy, several relave contraindicaons have tradionally limited its applicaon, forcing clinicians toward more invasive

surgical alternaves or delaying necessary intervenons.(2,3) The integraon of rigid bronchoscopy guidance to PDT (RBG-PDT) rep-

resents a modicaon addressing many limitaons of convenonal PDT while expanding the eligible paent populaon.

Background

Tradional PDT, rst described by Ciaglia and colleagues using a modied Seldinger technique, relies on exible bronchoscopic guid-

ance through the exisng endotracheal tube.(4) Unfortunately, several limitaons become apparent in high-risk paents and have

served previously as relave contraindicaons to this procedure. Flexible bronchoscopy may provide inadequate visualizaon in pa-

ents with altered anatomy, cannot prevent tracheal collapse in those with tracheomalacia, and oers limited therapeuc interven-

on capabilies should complicaons arise. As a result, paents with morbid obesity, coagulopathy, complex airway anatomy, and

repeat tracheostomies are commonly cited as factors precluding standard PDT approaches. (5)

RBG-PDT addresses these shortcomings through several mechanisms. The rigid tracheoscope maintains connuous airway patency,

prevenng collapse and ensuring unobstructed visualizaon throughout the procedure. It allows for sustained venlaon without

airway obstrucon, protects the posterior tracheal membrane from inadvertent puncture, and displaces the trachea anteriorly to

facilitate needle placement. Addionally, the larger diameter rigid bronchoscope provides superior sucon capacity and therapeuc

intervenon capabilies for managing bleeding complicaons. Literature supporng RBG-PDT remains limited, with only small case

series reported to date.(6,7)

Clinical Applicaon

This advanced technique addresses standard PDT limitaons in high-risk populaons including obesity, coagulopathy, and those on

concurrent therapeuc ancoagulaon in several ways. The rigid bronchoscope prevents tracheal collapse in paents with tracheo-

malacia, provides superior sucon capacity for hemostasis management, and maintains connuous posive pressure venlaon

throughout the procedure. As such it expands the eligible populaon for PDT serving as an intermediate opon between PDT and

open tracheostomy. (Fig. 1)

The RBG-PDT technical approach ulizes a rigid tracheoscope under general anesthesia with neuromuscular blockade and open-

Michael Murn, MD

Intervenonal

Pulmonology

Assistant Professor of

Medicine

Assistant Professor of

Cardiovascular & Thoracic

Surgery

Division of Pulmonary,

Crical Care & Sleep

Medicine

Zucker School of Medicine

at Hofstra-Northwell

Kai Swenson, MD

Division of Thoracic

Surgery and

Intervenonal

Pulmonology

Beth Israel Deaconess

Medical Center

Assistant Professor

Harvard Medical School

Adnan Majid, MD, FCCP

Chief, Secon of Intervenonal

Pulmonology,

Division of Thoracic Surgery and

Intervenonal Pulmonology,

Beth Israel Deaconess Medical

Center,

Professor of Medicine,

Harvard Medical School

W A B I P N E W S L E T T E R

P A G E 6

circuit jet venlaon.(Fig. 2). Typically a 12-mm outer diameter rigid barrel is ulized however for more challenging anatomy a small-

er diameter could be considered. The technique requires precise airway exchange from endotracheal intubaon to rigid bronchosco-

py without loss of venlaon or oxygenaon. Following supine posioning with cervical hyperextension, the rigid tracheoscope is

advanced through the oropharynx with anterior bevel orientaon to visualize vocal cord anatomy. Preliminary airway inspecon and

mucous suconing via exible bronchoscopy, as well as in-line rigid sucon alongside the tracheoscope, facilitates opmal visualiza-

on throughout exchange. Crical airway transion involves ETT cu deaon followed by controlled ETT retracon and rigid trache-

oscope advancement, with simultaneous jet venlaon iniaon, to 5mm distal to the true vocal cords for opmal tracheal ring visu-

alizaon. Gentle pressure with a Kelly clamp allows conrmaon of the intended tracheostomy course and adjustment of the rigid

tracheoscope bevel. The rigid bronchoscope provides connuous tracheal stabilizaon and prevents posterior wall injury during nee-

dle puncture and sequenal dilaon. Following bevel placement, RBG-PDT is performed using standard technique under direct bron-

choscopic guidance.

In our single single-center retrospecve we examined 104 consecuve paents who underwent RBG-PDT over a 15-year period.(8)

The cohort represented a high-risk populaon with median BMI of 30.25 kg/m², and 41.9% of paents having BMI exceeding 30 kg/

m². Notably, 59.6% had ASA classicaon ≥4, indicang signicant comorbidity burden. Half of all paents (51.0%) possessed at least

one bleeding risk factor, with elevated aPTT >36 seconds being most common (36.5%). Twenty-seven percent underwent tracheosto-

my while receiving therapeuc ancoagulaon with heparin. Clinical outcomes demonstrated 0.5% intraprocedural complicaon rate

with no pneumothorax, airway loss, or procedure-related mortality in line with historical PDT safety data.

While our study described RBG-PDT performed in the operang room using jet venlaon previous invesgators have reported the

use of rigid bronchoscopy in non-operang room sengs. (9) The ulizaon of posive pressure venlaon via rigid bronchoscopy, in

leu of jet venlaon, would further expand this technique to paents who cannot safely be transported due to physiologic or me-

chanical constraints, such as those requiring extracorporeal membrane oxygenaon (ECMO).

Conclusions

RBG-PDT represents a safe and eecve intermediate opon between standard PDT and open surgical tracheostomy for high-risk

paents. This technique successfully expands the eligible paent populaon for percutaneous approaches, allowing safe intervenon

in paents with morbid obesity, coagulopathy, and complex airway anatomy who might otherwise have delayed intervenon or a

more invasive surgical procedure. Implementaon requires specialized equipment, experienced intervenonal pulmonologists com-

fortable with rigid bronchoscopy, and skilled anesthesiologists. The technique's learning curve and increased procedural complexity

are oset by enhanced safety margins and expanded therapeuc opons for crically ill paents. While data remains limited to single

center retrospecve studies the comprehensive safety data provide compelling evidence for RBG-PDT. As intervenonal pulmonology

programs connue expanding their complex airway management capabilies, RBG-PDT oers an important tool for opmizing care in

challenging paent populaons previously considered unsuitable for percutaneous approaches.

References:

1. Shah R et al. Laryngoscope 2012; 122; 25-29

2. Ernst A et al. Clin Chest Med 2003; 24; 409-41

3. Chorath K et al. JAMA Otolaryngol Head Neck Surg 2021; 147; 450

4. Ciaglia P et al. Chest 1985; 87; 715-719

5. Huang C et al. Surg Today 2014; 44; 107-114

6. Majid A et al. Annals ATS 2014; 11; 789-794

7. Grigo, A et al. Br J Anaesth 2005; 95; 417-419

8. Murn M et al. J. Bronchol. Interv. Pulmonol 2025; 32; e0990

9. Mahajan AK et al. J Thorac Dis. 2025;17(6):3667-3672.

Tips from the Experts

P A G E 7 V O L U M E 1 3 , I S S U E 3

Figure 1. Proposed Paent Selecon for Rigid Bronchoscopy-Guided Percutaneous Dila-

on Tracheostomy

Figure 2. Rigid Bronchoscopy-Guided Percutaneous Dilaon Tracheostomy.

A) Rigid View of Vocal Cords prior to ET Tube retracon

B) Primary and secondary operator posioning prior to ETT exchange with rigid tracheoscope

C) Rigid tracheoscope advanced into posion below 1st tracheal ring

D) Rigid tracheoscope view of the guide wire

Tips from the Experts

P A G E 8 V O L U M E 1 3 , I S S U E 3

Introducon

General anesthesia with muscle relaxaon and endotracheal intubaon to enable docking of the robot and ensure lack of movement or

coughing during roboc bronchoscopy (RB) is universally pracced. Atelectasis under general anesthesia is common and can obscure targets

or increase CT to body divergence (CTBD) leading to subopmal diagnosc yield. While CTBD can be overcome with the use of intraopera-

ve cone-beam-CT to adjust the locaon of the target, atelectasis remained an issue. The I-LOCATE study (Incidence and Locaon of Atelec-

tasis) showed that atelectasis occurs in the dependent lung areas, mostly in lower lobes, and that its rate increases with higher BMI and du-

raon of general anesthesia(1). The authors use two dierent strategies to combat atelectasis during RB, the venlatory and the posioning

strategies. The venlatory strategy entails posive end expiratory pressure (PEEP) during mechanical venlaon and maintaining a connu-

ous posive pressure during the breath holds for the intraprocedural CT scans. Based on the current knowledge that the alveolar closing

pressure is 5 cmH

O, the VESPA trial (Venlatory Strategy to Prevent Atelectasis), a mulcenter randomized controlled study, ulized a PEEP

of 8-10 cmH

O, protecve dal volumes (VT) of 6-8 cc/kg ideal body weight (IBW), FiO

traon to keep oxygen saturaon at 92-94%, and a

recruitment maneuver immediately aer intubaon(2). This strategy decreased the rate of atelectasis from 84% (control group) to 29%.

Meanwhile, the posioning strategy places the paent in a lateral decubitus where the paent’s lung with the nodule of interest is in a non-

dependent posion(3). An ongoing randomized controlled study, (lateral decubitus vs VESPA), have so far shown 100% eecveness in elim-

inang atelectasis (personal communicaon). Of note, no special venlatory adjustments are required in the lateral decubitus. Furthermore,

if atelectasis is encountered in the supine posion, it is completely eliminated when the paent is turned to the lateral decubitus. Limita-

ons to the lateral decubitus are noted in the morbidly obese paents with laterally located lesions where iso-centering of the CT C-arm and

avoidance of its collision with the table can be challenging. Addionally, some of the RB plaorms require the paent to remain supine.

Planning

The anesthesiologist and the intervenonal pulmonologist review the paent’s history and CT to plan the paent’s venlatory protocol, po-

sioning (supine or lateral), and the need for endobronchial ultrasound guided transbronchial needle aspiraon (EBUS-TBNA) for staging

aer the RB. In the authors pracce, VESPA is ulized in paents with lesions in dependent areas of upper and middle lobes and BMI ≤ 35.

While the lateral decubitus is used in paents with dependent lesions in lower lobes regardless of the BMI and in all paents with BMI ≥35

irrespecve of the lesion locaon(4). If the lateral decubitus is not feasible, the safest lowest PEEP and dal volumes are used in the supine

posion as per the VESPA protocol. It is also important to note that paents with severe emphysema or low BMI <20 are unlikely to develop

atelectasis in the supine posion and do not need high levels of PEEP.

The paent’s procedure table is prepared with a bean bag placed under the paent’s torso to facilitate turning to the lateral decubitus if

needed while under the same general anesthec. It is important to place the anesthesia monitors wires outside the eld of the CT scan to

avoid collision with the C-arm and creang arfacts. Endotracheal tube (ETT) size 8-8.5 for male and 7.5-8 for female paents are pre-

warmed before use.

Anesthesia for Roboc Bronchoscopy in 1000 words

Mona Sarkiss M.D., Ph.D. CMQ

Professor

Department of Anesthesiology and Perioperave

Medicine

Department of Pulmonary Medicine

The University of Texas MD Anderson Cancer Center

Roberto F. Casal, M.D.

Professor, Department of Pulmonary Medicine,

Secon of Intervenonal Pulmonology

Director, Advanced Bronchoscopy Program

Director, Clinical Research Unit (C.R.U.)

The University of Texas M.D. Anderson Cancer Center

Tips from the Experts

P A G E 9 V O L U M E 1 3 , I S S U E 3

Technique

The paent is monitored with the ASA standard monitors in addion to a Bispectral index monitor (BIS) for the depth of anesthesia. A small

22G gauge IV catheter is inserted. The anesthesia is induced with a propofol infusion at 250 ug/kg/min to avoid hypotension during inducon.

Once the BIS reading is below 60 and the paent is asleep, rocuronium 1mg/kg is injected to induce muscle relaxaon. The ETT is loaded over

the bronchoscope and introduced in the paent’s airway through an Ovassepian oral airway. The airway is anesthezed with 1-2 cc of 2%

lidocaine injected through the bronchoscope during the intubaon at the level of the vocal cord and in the tracheal lumen. The trachea is

inspected for pathology during the intubaon. We do not rush the intubaon or use rapid sequence inducon to shorten the me to intu-

bate. Once the airway is secured it is handed over to the intervenonal pulmonologist. Aer compleon of the airway exam and suconing of

secreons by the intervenonalist, the venlator is set at the agreed upon venlatory parameters and recruitment maneuvers as per VESPA

protocol are performed. Navigaon and CT scan are then performed. If atelectasis is encountered during the rst CT scan in the supine posi-

on, the paent is turned to the lateral decubitus and repeat recruitment maneuvers are applied. Repeat CT scan with breath holds at the

peak of inspiraon is performed and the procedure is completed. If EBUS is required at the end of the RB, the paent is turned back to the

supine posion, the muscle relaxant is re-dosed as needed and the venlator sengs are changed to 5cc/kg/IBW dal volume, 0 PEEP, RR 8

volume controlled with pressure limit of 20 cmH2O to avoid gastric insuaon during venlaon with the supragloc airway (SGA). The ETT

is removed, and I-gel SGA is placed. The SGA placement is conrmed with the bronchoscope and the airway is secured and handed over to

the intervenonalist. At the end of the EBUS procedure, the rocuronium is reversed with 200-400 mg of sugammadex and the paent is extu-

bated in the seated posion once standard extubaon criteria are met. The paent is then transferred to recovery with supplemental oxygen

and monitored for 45 minutes before being discharged. Chest X-ray is commonly performed in recovery to assess for pneumothorax.

Conclusion

Roboc bronchoscopy can be safely performed under general anesthesia. Gentle anesthesia inducon, maintenance and complete muscle

relaxant reversal in addion to appropriate venlatory techniques and posioning as needed without rushing the intubaon are the key to

procedure success and higher yield of the biopsy. Avoiding narcocs ensures speedy recovery.

References:

1. Sagar AS et al. Chest. 2020;158(6):2658-66.

2. Salahuddin M et al. Chest. 2022;162(6):1393-401.

3. Lin J et al. J Bronchology Interv Pulmonol. 2022;29(3):220-3.

4. Khan A et al. Diagnoscs (Basel). 2024;14(2).

Humanitarian News

W A B I P N E W S L E T T E R P A G E 10

Will Someone Discover Our Fractured Femurs? : From Inial Solidarity to

Ansocial Egoism

In a widely disseminated interview, renowned anthropologist Margaret Mead was queried by a reporter on her perspecve

on the inial indicator of civilisaon within a culture. Her response, characterised by both simplicity and profundity, was: "a

healed femur." She stated that in the animal domain, when an animal fractures its leg, it is doomed; it cannot escape preda-

tors, access water, or procure nourishment. The healed femur indicates that an individual remained with the injured party,

secured the wound, transported them to safety, and administered necessary care unl the fracture healed. “Civilizaon com-

mences when an individual assists another during a challenging period”, Mead remarked¹. This narrave encapsulates a fun-

damental truth about humanity: civilisaon is not established by technology, wring, or agriculture, but by the foundaonal

connecons of caring among those who seek to support the vulnerable. Contemporary civilisaons appear to have neglected

this ancestral lesson, manifesng what may be termed a "ethics-quake," characterised by unprecedented levels of individu-

alism, greed, and systemic cruelty towards the vulnerable. That is not occurring in a polical vacuum. Numerous contempo-

rary social sciensts have demonstrated that the erosion of solidarisc ideals is intricately linked to increasing social inequal-

ity, with far-right movements globally capitalising on socioeconomic grievances to establish exclusionary and authoritarian

agendas. The central thesis of this essay posits that emergent ethical deterioraon is not merely passive but acvely cul-

vates far-right proliferaon, resulng in a pernicious loop where instuonalised cruelty underpins increasingly egregious

expressions of animosity. The foundaonal model of solidarity. The repaired femur serves as a metaphor that transcends its

anecdotal roots to become a paradigm of civilisaon. It surpasses the biological imperaves of solitary survival through an

enhanced comprehension of mutual care. The concept of 'primordial solidarity,' as arculated by theologian Dorothea

Soelle, would establish an ethical framework that inuences the maternal responsibilies inherent in all human sociees:

accountability for others in their fragility. Anthropologist Christopher Boehm's research on the hunter-gatherer lifestyle

demonstrates that cooperaon and equality are not outliers in human history, but rather fundamental characteriscs of our

social structure during the majority of our evoluonary past. Boehm posits that human civilisaons developed intricate sys-

tems of "reverse dominance hierarchy" to inhibit individuals from "emerging as aspiring despots" over the remainder of the

community. These data suggest that signicant inequality and predatory individualism represent recent deviaons from

more familial norms. By the late nineteenth century, sociologist Émile Durkheim had accurately perceived the contradicon

between the 'mechanical solidarity' of old communies, characterised by resemblance and communal es, and the 'organic

solidarity' of modern society, founded on funconal interdependence. Durkheim cauoned that the swi shi to highly indi-

vidualisc social structures could lead to condions of social "anomie," wherein individuals cease to share common norma-

ve frameworks, increasing the likelihood of societal collapse.

The Ethics of Responsibility in Emmanuel Levinas's Philosophy

To comprehend the magnitude of contemporary ethical deterioraon, we must rst interpret the philosophical innovaon of

Emmanuel Levinas, which arculates a radical ethics of uncondional responsibility for the Other. In his work “Totality and

Innity” (1961), Levinas (an extremely ne Lithuanian-Jewish philosopher who spent years at a concentraon camp in Hano-

ver and lost almost all his family to Nazism) challenges us that ethics is not derived from abstract principles or social con-

tracts, but instead is on the basis of the unmediated face-to-face encounter with the vulnerable face of the Other. For

Levinas, the face of the Other -parcularly when faces as nakedness, fragility, vulnerability- is an ethical epiphany which in-

terpellates us ‘before’ all reecon. This meeng creates an innite responsibility that is prior to our freedom itself. I have

responsibility to the Other without expecng any reciprocity, to the point of death, says Levinas, laying out a posive asym-

metry of ethical relaons⁵. The Levinasian proposal is parcularly important now, since it provides a radical alternave to

both neoliberal individualism and polical projects that reduce ethics to the defence of group identy against other groups.

According to Levinas, ethical responsibility extends beyond naonal, ethnic and religious aliaons, creang a universalism

that is not rooted in abstract principles but in a concrete acknowledgement of a shared human experience of vulnerability⁶.

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Individualism and Its Structural Habitat

Indeed, against this vocaon of ethics, modern sociees have witnessed an all-encompassing epidemic of destrucve individ-

ualism that many social crics have described as a mul-dimensional issue with profound polical consequences. Pierre

Bourdieu, in his scathing criques of neoliberalism, has shown how this logic of (the) market everywhere turns social rela-

ons into compeve transacons, systemacally dissolving the ground of collecve solidarity. Neoliberalism, Bourdieu ar-

gues, is not just an economic doctrine, but a ‘programme for the destrucon of collecves’ that fragments individuals and

leaves them unarmed in the face of the market². The Bourdieusian proposal unveils how this change funcons through a

mulplicity of discreet, but lethal devices, some of which are much more subtle than others, some of which are equally use-

ful to dierent sides. Neoliberalism inicts on us is an economic doxa that naturalizes compeon as the only human rela-

on, turning words like “solidarity” and “common good” into inecient anachronisms. This ideological monolith is driven

into sectors hitherto shielded from market logic: educaon appears as "investment in human capital", family es as

"strategic resource investment", social links as "network networking" according to the logic of personal advancement. Bour-

dieu writes that this creates a specic form of "symbolic violence" where people take the "credit" or "blame" for their own

success or failure as if this was solely personal and hides the structural condions that dictate one's life chances. This culpa-

bilisaon of the individual preempts the possibility of generang collecve identy, and it enables the expert acceptance of

staggering levels of inequality as the “natural result” of variance in merit. Concurrently, the systemac precarizaon of la-

bour and the erosion of social protecon systems, produces precariously insuranated subjects who pop up in the market

paradoxically at the moment when they have lost collecve assets to resist the imperaves of the same. This paradoxical

relaonship is what explains, for Bourdieu, the propensity of neoliberalism's subjects to endorse polices that exacerbate the

condions that make them so vulnerable, and their turn to the market as a soluon to the problems that the market has

produced.

The Corrosion of Character: Richard Senne's Essenal Dissent

Richard Senne has arculated a descripon of neoliberal individualism, wherein the erosion of character is one of the most

evident crical perspecves. In “The Corrosion of Character” (1998) and “The Culture of the New Capitalism” (2006), Senne

illustrates how structural transformaons in the labour landscape have undermined not only the material condions of exist-

ence but also the psychological and moral underpinnings of community.

Senne asserts that exible capitalism has dismantled the "life narrave" that once allowed individuals to integrate diverse

experiences and construct coherent idenes. The connual necessity for personal reinvenon, exacerbated by the rapid

evoluon of skills and the transient nature of professional relaonships, obstructs the culvaon of what Senne refers to

as "character": the capacity to maintain commitment and foster enduring loyales to others. Senne's characterisaon of

"fragmented me" is notably revealing. Senne asserts that contemporary capitalism is characterised by a "short term" tem-

porality rather than "duraon," leading its residents to be unable to envision their lives on a far horizon or to undertake en-

during societal responsibilies. Time fragmentaon extends beyond the workplace, permeang relaonships among family,

friends, and community, so fostering a culture of "weak es" that is parcularly suscepble to polical manipulaon.

Senne contends that this engenders a harsh paradox: if the system necessitates connual exibility and adaptaon, it sim-

ultaneously penalises individuals who cannot culvate their own personal "resilience". Consequently, we have perpetually

nervous individuals who perceive their own shortcomings as inherent defects rather than deciencies of an impersonal sys-

temic structure that hinders self-reecve analysis.

Senne’s observaon regarding the erosion of character as a foundaon for authoritarian leadership is parcularly signi-

cant for this analysis. Fragmented and anxious individuals seek leaders who oer simplisc soluons and idenable antago-

nists, despite the fact that these leaders are, in a fundamental sense, the idencal adversaries responsible for the inial un-

easiness.

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Liquid Modernity: An Examinaon by Zygmunt Bauman.

Zygmunt Bauman referred to the disintegraon of strong social structures and cohesive worries of the past as the transion

to "liquid modernity," when individuals exist in a state of perpetual uncertainty, blissfully numbed. Bauman's metaphor of

"liquidity" transcends mere descripon, serving as an analycal instrument to illuminate fundamental transformaons in

modern human existence.

Bauman posits that liquid modernity emerged from the ascendancy of ephemeral undertakings, supplanng the preceding

solid modernity characterised by dependable instuons, enduring idenes, and permanent fundamental endeavours,

whether communal or individual. In contrast, liquid modernity is dened by "uidity": social structures are in constant ux,

idenes are adaptable, and communal bonds are supplanted by individual survival strategies. The diverse dimensions of

liquidity support Bauman's characterisaon of a social framework for comprehending the present ethical collapse. ‘Liquid

love’ denotes interpersonal relaonships characterised by the ease of forming and dissolving connecons, priorising imme-

diate gracaon over lasng commitment. "Liquid life" signies the perpetual uidity of existence, wherein individuals are

unable to establish stable idenes or cohesion. 'Liquid surveillance' denotes mechanisms of control that operate not

through an overt state infrastructure of coercion, but rather through the internalisaon of self-monitoring and compeve-

ness.

Bauman posits that this liquidity engenders a specic type of pain, which he refers to as "liquid anxiety." In contrast to con-

venonal dread, characterised by dened targets and reasonable reacons, liquid anxiety permeates existence, resulng in

persistently uncertain subjecvies that yearn for stable anchor points. Bauman contends that the pursuit of order in a uid

environment makes individuals parcularly suscepble to the "solid soluons" proposed by fundamentalist and totalitarian

movements. The extreme right exploits this vulnerability by oering "solid" naonal idenes, clear adversaries, and the

promise of a restoraon to a supposedly stable society. He further elucidates the concept of 'wasted lives' to analyse how

this manifestaon of liquid modernity funcons as a societal mechanism that generates 'surplus' populaons devoid of a

role in the global economy. These populaons—migrants, individuals with persistent unemployment indicated solely, and

residents of urban peripheries—funcon as ideal scapegoats for movements characterised by social anxiety expressed

through xenophobic animosity.

The amalgamaon of Senne’s and Bauman’s viewpoints elucidates a paradoxical dynamic: while neoliberal capitalism un-

dermines both the material and psychological foundaons of social solidarity, the resultant fears and fragmentaons are

harnessed by polical movements that may seek to restore social cohesion through the exclusion and aggression towards

other marginalised groups.

Neoliberalism and the Far Right: Hypotheses of Social Sciensts

A signicant accomplishment of contemporary social science is the revelaon of structural links between economic neoliber-

alism and the rise of the far right. Several theorecal explanaons elucidate the mechanism by which the disintegraon of

social solidarity fosters authoritarian polical projects.

Karl Polanyi's "The Great Transformaon" (1944) presciently forecasted the polical perils of perming market logic to oper-

ate independently of legislave oversight. Polanyi posited that when naons endeavour to enrely subjugate social exist-

ence to the self-regulang forces of markets, they generate either progressive or reaconary tendencies of "social protec-

on."¹⁰ The Polanyian hypothesis situates these developments inside a perverse counter-movement opposing neoliberal

social deprotecon. Rather than confronng the economic structures that are the root cause of insecurity, these movements

redirect the aenon of that uneasiness onto scapegoats such as immigrants, minories, and cosmopolitan elites, while

leaving the economic instuons unaltered.

As Chrostowski notes, the polical democrac promise of equality increasingly clashes with the economic realies of ex-

treme inequality, fostering a sense of chronic disappointment that could potenally nesse popular fear on behalf of an-

democrac movements¹¹. For her part, Nancy Fraser has argued that neoliberalism brings about a “crisis of social reproduc-

on” through the commodicaon of care work and the degradaon of instuons that have historically supported human

life. Such a crisis, Fraser argues, harms not only working families in material terms, but also diminishes the values of solidar-

ity and mutual concern on which democrac bonds rest¹². Fraser contends that the far right is able to capitalize on this crisis

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by hawking nostalgic stories about tradional family and the naonal community, even while promong economic policies

that deepen the very contradicons that produce the crisis in the rst place.

Wring in her 2016 ethnography “Strangers in Their Own Land,” the American sociologist Arlie Russell Hochschild coined the

metaphor of the “spiral staircase” to account for working-class white backing of far-right movements — even ones that

would seem at odds with their economic interests. These voters, according to Hochschild, feel that, while they are staonary

on the staircase of social advancement, other people (ethnic minories, immigrants, women) are « passing » them through

armave acon and mulculturalism¹³. This sense of comparave injusce, culvated by decades of economic malaise and

collapse of social instuons, produces an “emoonal malaise” which the far right eecvely capitalises on in exclusionary

and resenul polical schemes.

A very popular mode of the mixed internaonal economy generaon became formulated economist Dani Rodrik’s hypothe-

sis of the ‘impossible trilemma’ of globalisaon: you cannot have them all at once: democracy, naonal sovereignty and

deep economic globalisaon. Sociees, Rodrik argues, have to choose between these three, and populist movements will

inevitably emerge when economic globalisaon is pursued at the expensive of democracy and sovereignty, with the goal

being to restore democrac management of the economy¹⁴. If the far right is a warped and irraonal answer to the actual

contradicons of the global neoliberal order, as Rodrik argues, it is a posion rooted in an understandable logic, however

monstrous its soluons are.

Social Media as a Catalyst for Authoritarianism

Digital technology have expedited narcissisc individualism and far-right movements. Shoshana Zubo, a sociologist, eluci-

dates in "The Age of Surveillance Capitalism" (2019) how digital plaorms have constructed economic models that funda-

mentally manipulate human behaviour, a phenomenon she designates as "surveillance capitalism."¹⁵ Zubo asserts that

these plaorms do not merely extract data from users, but acvely inuence user acvity to opmise trac and adversing

potenal. It is parcularly detrimental, as polical candidates have discovered, in the polical arena: algorithms designed to

capture the aenon of our limited cognive capacies typically favour hyper-emoonal content over composed, raonal

analysis. In “How Democracies Die” (2018), polical scienst Steven Levitsky and historian Daniel Zibla delineate the inu-

ence of social networks in undermining the “informal democrac norms” that previously limited extreme polical compe-

veness. These researchers contend that digital plaorms allow authoritarian leaders to communicate directly with their

supporters, bypassing intermediary organisaons, and to establish personalisc loyalty that transcends democrac process-

. Social psychologist Karen Stenner, in "The Authoritarian Dynamic" (2005), has demonstrated that around one-third of

any community have latent authoritarian predisposions that are acvated during mes when group cohesion seems jeop-

ardised. Social media, by amplifying narraves of catastrophe and peril, serves as a potent catalyst for authoritarian inclina-

ons. ¹⁷.

Systemac Deprotecon as a Polical Strategy

Among modern representaons of ethics in disarray, wse can see the polical exploitaon of social fragility. Right-wing

movements have devised intricate methods to policise the social insecurity engendered by neoliberalism, oering diverse

types of protecon to certain groups while intensifying persecuon against others.

Sociologist Loïc Wacquant has chronicled the manner in which the neoliberal "punive state" metamorphoses welfare poli-

cies into mechanisms of coercive monitoring that intenonally criminalise poverty and marginality. This shi is intenonal,

serving as a method to discipline the working classes while oering comfort, security, or unity to the middle class, allowing

them to perceive themselves as “individuals who do not belong elsewhere” by marginalising threatening “others.” Philoso-

pher Judith Butler arculates in "Frames of War" (2009) that this process is understood as the creaon of "lives that do not

deserve to be mourned" (grievable lives vs ungrievable lives). According to Butler, sociees create interpretave frameworks

that govern whose lives are deemed precious and worthy of protecon, disnguishing them from those considered disposa-

ble without provoking moral indignaon.

Illusory Economic Assurances and Fear Inducement

The far-right has eecvely exploited the disparity between neoliberalism's promises and the economic realies faced by

signicant socioeconomic groupings. Economist Thomas Pikey illustrates in Capital in the Twenty-First Century (2014) that

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W A B I P N E W S L E T T E R P A G E 14

enduring inequality engenders not only economic dicules but also crises of polical legimacy. Pikey asserts that coun-

tries cannot maintain the level of inequality prevalent during the Gilded Age without a movement that disrupts the exisng

order. However, these movements can advance in two direcons, either progressive or reaconary, conngent upon the

capacity of polical actors to convey compelling narraves on the origins and soluons to the crisis. Drew Westen, in The

Polical Brain (2007), asserts that the far-right has devised sophiscated methods of emoonal communicaon, targeng

not the logical intellect but rather primal and entrenched phobias. “The polical brain operates primarily in a primordial

fashion, ulising emoons and symbols..." The most impacul movements are those that accurately align their stances with

profound emoonal frameworks, arculate their ideas through symbols, and construct their stances from deeply entrenched

convicons.

Individualism against Cooperaon: The Contemporary Misguided Discourse on Human Nature

A fundamental inquiry in examining the current moral decline is whether it reects an inherent selshness that has been

historically repressed by societal pressures, or conversely, whether fundamentally altruisc individuals are being condioned

to endorse punive policies that contradict their core values. The empirical evidence from the social sciences strongly sup-

ports the second theory, presenng a more complex and, ironically, more favourable perspecve. Christopher Boehm's an-

thropological research on prehistoric hunter-gatherer sociees indicates that cooperaveness and egalitarianism character-

ised approximately ninety-ve percent of human history. Concurrently, Michael Tomasello's studies reveal that very young

children exhibit altruism prior to any cultural condioning or socialisaon, implying that this trait is our inherent predisposi-

on as shaped by natural selecon. This evidence is substanated by behavioural economics research conducted by Ernst

Fehr, which indicates that individuals consistently reject inequitable oers, even at a detriment to their own economic inter-

ests. The nascent eld of social neuroscience, illustrated by Antonio Damasio's research, demonstrates that our inclinaon

to assist others is intrinsically linked to a posive emoonal response; empathy is embedded in the brain and acvates re-

ward pathways. But this cooperave orientaon alone does not elucidate why individuals endorse cruel policies. Arlie

Hochschild’s research on the psychology of American far-right voters indicates that individuals' values are frequently

eclipsed by their endorsement of policies that fundamentally contradict their principles. This occurs because these policies

are presented as a "package," a term she employs, alongside other measures that align with their values, leading to disso-

nance that is ulmately resolved not through moral consistency but through parsan allegiance. George Lako illustrates

that interpretaons allow substandard policies to be arculated in a morally acceptable manner; for instance, "a strong re-

sponse to criminals" is reframed as "protecon of the innocent." The research conducted by Stanley Milgram and Philip Zim-

bardo in their infamous experiments demonstrates that instuons can compel individuals to parcipate in harmful systems

to which they would typically oppose contribung, all while preserving their moral self-image. Albert Bandura refers to this

phenomenon as "moral disengagement," which entails the temporary suspension of one's moral compass through mecha-

nisms such as the de-individualizaon of others, thereby aribung responsibility to them, moral juscaon, or the em-

ployment of euphemisc language.

Further evidence that social context delineates the manifestaon of our capacies is illustrated by cultural variety. Further-

more, sociees characterised by greater inequality exhibit increasingly individualised acons that are 'systemacally mani-

fest', and natural calamies are generally more inclined to provoke mass cooperaon rather than loong, as indicated by

Rebecca Solnit's research on community responses to crises. This indicates that humans are "condionally cooperave": we

possess the ability for both solidarity and rivalry, with social circumstances determining which aspect predominates. The

recent resurgence of cruelty has not arisen from the liberaon of selshness but rather from structures that systemacally

promote individualism, polical narraves that glorify cruelty as a virtue, social fragmentaon that disrupts empathec con-

necons, and extreme inequality that engenders a sense of scarcity. This interpretaon is paradoxically posive, indicang

that solidarity is not "dead" but rather temporarily suppressed by certain systems. It means that those atudes may be al-

tered, as current suggesons for "real utopias" imply, which are both pragmac and transformaonal. We opt to assist the

wounded, rather than abandon them.

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Contemporary experimental evidence suggests that far-right narraves about “natural” human selshness represent a deep-

ly awed understanding of our social psychology. Findings from the “Big Robber Game” reveal that the same individuals ca-

pable of prosocial behavior in face-to-face interacons can display selshness when their decisions impact abstract groups,

but this does not reect an inherently ansocial nature, but rather specic structural dynamics: the “fading of compassion”

in the face of stascal vicms and the dierent implicaons of inequality when wealth is extracted from the many versus

the few. Complementarily, Fehr and Fischbacher’s research demonstrates that humans possess evoluonarily unique altruis-

c capacies, including “strong reciprocity” that transcends self-interest, but these capacies are crucially dependent on the

instuonal context. The most signicant nding is that a small minority of selsh individuals can collapse social coopera-

on, while a minority commied to altruisc punishment can force widespread cooperaon. Thus, the far right does not

"unmask" a hidden selsh nature, but rather deliberately exploits the structural condions that favor the expression of an-

social behavior, manipulang cognive frames (abstract vs. concrete vicms) and weakening instuons of social punish-

ment that have historically sustained large-scale human cooperaon. The opportunity, then, is to awaken and mobilize soli-

darity consciences within a society.

For a Reappropriaon of Solidarity:

Responses from the Social Sciences In response to this concerning situaon, some social sciensts have proposed strategies

to prevent both moral decay and the rise of authoritarianism. Its proposals focus on reconstrucng mediang structures that

facilitate authenc human interacon and social cooperaon. In ''Bowling Alone'' (2000), Robert Putnam documented the

decline of ''social capital'' in American society while simultaneously idenfying methods to restore communal connecons.

Putnam asserts that revitalising community life necessitates the restoraon of voluntary associaons, communal gathering

spaces, and collecve rituals that can bolster social networks. Nobel Prize-winning economist Elinor Ostrom has presented

an empirical case demonstrang that human sociees can establish successful instuons for the management of shared

resources, contrary to the predicons of the "tragedy of the commons" hypothesis. The concepts established by Ostrom for

collaborave governance serve as scalable frameworks for fostering social solidarity. One of the most rened aempts to

reconcile the seeming contradicon between progressive reformism and revoluonary transformaon is that of sociologist

Erik Olin Wright, whose "Envisioning Real Utopias" (2010) oers a well-structured framework for overcoming this dichotomy.

Wright's concept of "real utopias" refers to instuons and pracces that are feasible within the current capitalist frame-

work while possessing the potenal to evolve into more democrac and equitable social organisaons. His proposal is

grounded in the noon of "symbioc transformaon," which entails reforms that not only enhance the immediate living con-

dions of marginalised groups but also establish the structural groundwork for more profound transformaons. Rather than

implemenng capitalist reforms that integrate social demands into the exisng system of dominance, hence perpetuang

unchanged power dynamics, symbioc changes enhance organisaonal power and crical awareness within popular move-

ments, eecvely addressing specic issues.

Real utopias provide a "preguraon" of desired social relaons in the present, thereby recreang the agency and experi-

ences necessary for more extensive transformaon.

Conclusion: The Ethical Imperave of Our Time

Today, the majority of us humanitarian workers, feel that our enre lives have been a complete waste. Our personal endeav-

ours, professional development, economic well-being, and physical integrity have all been sacriced without any purpose.

Today, we observe that society is becoming more cruel, selsh, and indierent to the suering of others than ever before,

which is in stark contrast to the objecves of our youth, which we believed were shared with the enre society and aimed to

marginally improve the lives of individuals in the numerous locaons where we have worked. The bale has been merciless-

ly lost. However, despite the dangers, injuries, and lasng eects of emoonal trauma we suered, we cannot renounce

to the convicon that a more just, egalitarian world in which the fundamental human rights of all people are respected is not

only possible but urgently necessary,

The ethical breakdown that denes modern sociees is a product of parcular polical, economic, and cultural choices that

have facilitated the growth of far-right movements rather than a natural or inevitable occurrence. In spite of forces that con-

stantly threaten to undermine it, civilisaon is fundamentally a collecve endeavour of mutual care, as the metaphor of the

healed femur serves as a reminder.

Humanitarian News

W A B I P N E W S L E T T E R P A G E 16

The theories put forth by modern social sciensts all point to a causal link between the rise of polical movements that take

advantage of these weaknesses to further authoritarian and exclusionist goals, the neoliberal breakdown of social safety

nets, and heightened economic and existenal insecurity. But by showing that there are workable alternaves, these same

studies also give hope. The innovave development of new instuons and pracces that address the unique challenges of

our historical era is what is needed to rebuild social solidarity, not a senmental look back at the past. Rebuilding social co-

existence based on distribuve jusce, solidarity, and the understanding that every human being has intrinsic worth is the

ethical imperave of our day. This means acvely creang alternaves that tackle the systemic issues that support modern

authoritarianism in addion to opposing the rise of the far-right.

Human sociees have shown me and me again that they are capable of reinvenng themselves in the face of existenal

crises, as historical anthropology teaches us. As Margaret Mead noted, civilisaon begins when we choose to care for the

wounded rather than leave them to their fate. Our challenge is to mobilise this transformave capacity before ethical col-

lapse becomes irreversible.

References

1. Mead M. (1970). Culture and Commitment: A Study of the Generaon Gap. New York: Natural History Press.

2. Levinas E. (1961). Totalité et Inni: Essai sur l'extériorité. The Hague: Marnus Nijho.

3. Bourdieu P. (1998). Contre-feux: Propos pour servir à la résistance contre l'invasion néo-libérale. Paris: Liber-Raisons d'agir.

4. Senne R. (1998). The Corrosion of Character: The Personal Consequences of Work in the New Capitalism. New York: W.W. Norton.

5. Bauman Z. (2000). Liquid Modernity. Cambridge: Polity Press.

6. Polanyi K. (1944). The Great Transformaon: The Polical and Economic Origins of Our Time. Boston: Beacon Press.

7. Fraser N. (2016). Contradicons of Capital and Care. New Le Review, 100, 99-117.

8. Hochschild, A. R. (2016). Strangers in Their Own Land: Anger and Mourning on the American Right. New York: The New Press.

9. Zubo S. (2019). The Age of Surveillance Capitalism: The Fight for a Human Future at the New Froner of Power. New York: Public

Aairs.

10. Levitsky S. & Zibla, D. (2018). How Democracies Die. New York: Crown Publishing.

11. Stenner K. (2005). The Authoritarian Dynamic. Cambridge: Cambridge University Press.

12. Wright E. O. (2010). Envisioning Real Utopias. London: Verso.

13. Fehr E., & Fischbacher U. (2003). The nature of human altruism. Nature, 425, 785-791.

*The views expressed in this arcle are those of the author (Silvia Quadrelli) 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.

Best Image Contest 2025 (3 of 3)

Central Airway Diseases

ENDOBRONCHIAL CRYO CLOT EXTRACTION

Credits / Image courtesy of

Dr Pree Vidyasagar , Dr Hemant Sharma, Dr Rowhit Y , Dr Ankur Gupta

Best Image Contest

P A G E 17

This image is 3 of 3 selected among 100+ submissions to our Best Image Contest held in late 2023. Our next

Image Contest will open later this year. We look forward to receiving your image submissions.

P A G E 18

WABIP News

WABIP 2025 Webinar: Advancing Bronchoscopy and Interventional Pulmonology

On September 13–14, 2025, WABIP convened a global community for its

webinar with 1349 total registrants, 32 chairs and speakers, 29 lectures, and

the support of 6 sponsors. The program delivered a focused forum for high-

impact knowledge exchange and candid, practice-shaping discussion.

The report that follows distills the most consequential insights and points of

convergence—where evidence is strong, where key uncertainties persist, and

where collaboration, training, and value-conscious adoption can most imme-

diately improve patient care. It is intended as a practical compass for clini-

cians and programs navigating rapid progress while staying anchored to out-

comes and access.

Day 1 of the WABIP webinar, "From Fiberoptic to Robotic Assisted Bronchoscopy," commenced with an introduction

honoring Dr. Shigeto Ikeda, a pioneer in bronchoscopy. The initial sessions focused on advancements in peripheral bron-

choscopy, highlighting techniques like airway mapping, radial EBUS, and fluoroscopic lung biopsy. Experts discussed

the nuances of driving ultrathin bronchoscopes, the importance of anatomical knowledge, and strategies for navigating

challenging peripheral lung nodules, often combining virtual bronchoscopy with real-time imaging and cryobiopsy for

improved diagnostic yield. The discussion also covered the critical evaluation of various robotic bronchoscopy systems

(ION, Monarch, Galaxy), comparing their navigation technologies, diagnostic performance, and the role of advanced im-

aging modalities such as augmented fluoroscopy and cone beam CT (CBCT). Strategies for patient selection, workflow

integration, and mitigating issues like CT-to-body divergence and atelectasis during procedures were also presented.

Later sessions shifted to the evolution of mediastinal staging and biopsy adequacy. Presenters underscored EBUS-TBNA

as the preferred first-line diagnostic tool for mediastinal evaluation over traditional mediastinoscopy, emphasizing its util-

ity in restaging and for obtaining tissue for molecular diagnostics (NGS, PD-L1), which are crucial for personalized lung

cancer treatment. The debate on optimizing tissue yield with needles versus cryobiopsy for various biomarkers was also

explored. A pathologist's perspective on "adequate" biopsy samples stressed the importance of tissue quality and tumor

cellularity over mere quantity, highlighting challenges in assessment and the critical role of multidisciplinary communica-

tion. The session concluded with a discussion on when to confidently trust benign biopsy results, outlining categories of

diagnostic outcomes and the necessity of prompt re-biopsy for suspicious or atypical findings.

The day culminated in a roundtable discussion addressing the challenge of balancing rapid technological advancements

with reasonability and pragmatism in interventional pulmonology. Key themes included the need for robust, randomized

controlled studies to provide evidence of real clinical advantages for new technologies, rather than relying solely on en-

thusiasm or marketing. Panelists, representing diverse global healthcare settings, emphasized the significant economic

barriers to adopting expensive new devices and the importance of patient-centered care. The discussion also touched upon

the critical need for accessible training in low- and middle-income countries and the ongoing efforts to foster global col-

laboration and knowledge sharing to ensure equitable access to effective diagnostic and therapeutic bronchoscopic proce-

dures.

Day 2 of the WABIP webinar, “From Rigid to Flexirigid Thoracoscopy”, focused on advancements in thoracoscopy, ad-

vanced bronchoscopic interventions, and benign lung disease management, concluding with a roundtable on global access

and training. The opening session provided a historical overview of thoracoscopy since Jacobaeus, highlighting its evolu-

tion from diagnostic to operative uses, the development of flexi-rigid scopes, and the ongoing need for training and stand-

ardization. The "Watch that Space!" session on pleural disease emphasized that thoracic ultrasound should be routinely

used for pleural effusions, often outperforming CT in diagnosing malignancy. It was noted that cytology for malignant

pleural effusion frequently lacks sufficient material for molecular markers, making direct biopsy crucial for high-risk pa-

tients. Thoracoscopy offers the highest diagnostic yield (93%) and best molecular marker sufficiency (95%).

P A G E 19

WABIP News

WABIP 2025 Webinar: Advancing Bronchoscopy and Interventional Pulmonology

(continued)

For pleural infections, new BTS guidelines introduced a traffic light system for pH to guide treatment, and the TPA+DNase

combination was shown to significantly improve drainage and reduce surgery. Indwelling pleural catheters (IPCs) were

presented as a first-line option for malignant pleural effusions, offering better symptom control, shorter hospital stays, and

lower re-intervention rates compared to talc pleurodesis.

The "Pushing the Envelope" session explored innovations in rigid bronchoscopy and airway stenting. New techniques for

rigid bronchoscopy included the Fantoni translaryngeal tracheostomy tube for distal ventilation during complex procedures

and the emerging field of robotic rigid bronchoscopy, aiming to improve maneuverability and safety with tactile feedback.

For airway stents, the discussion highlighted the development of custom-made and 3D-printed stents for complex anato-

mies, biodegradable stents, and amniotic tissue-coated stents, all aimed at improving fit and reducing complications. The

session also covered the management of malignant pulmonary nodules, comparing sublobar resection (segmentectomy/

wedge) with bronchoscopic ablative therapies. Sublobar resection was deemed non-inferior to lobectomy for small, early-

stage cancers, while bronchoscopic ablation, guided by intraoperative imaging like cone CT and navigational bronchosco-

py, offers a less invasive option for high-risk patients. In the "Bronchoscopy for Benign Lung Disease" session, advance-

ments in COPD treatment included polymer sealants to address incomplete fissures for endobronchial valve placement,

thermal vapor/liquid ablation for segmental volume reduction, and novel airway scaffolds to prevent small airway collapse.

For interstitial lung disease (ILD), cryobiopsy was presented as a robust alternative to surgical lung biopsy, offering larger,

higher-quality samples with lower morbidity, especially when guided by real-time imaging and complemented by molecu-

lar tests like the Invisia Genomic Classifier for UIP. Lastly, bronchial thermoplasty (BT) for severe refractory asthma was

discussed, with long-term studies demonstrating its sustained efficacy in reducing exacerbations and improving quality of

life, proving non-inferior to biologics, despite its current unavailability due to reimbursement issues.

The webinar concluded with a roundtable panel discussion on overcoming costs and access to technology, training, and ex-

pertise in interventional pulmonology (IP). WABIP's Interventional Pulmonology Institute (IPI) was presented as a model

program, offering free training and financial support to fellows from developing countries, with the aim of establishing IP

programs globally. Panelists from Morocco, Russia, Serbia, and Portugal shared local challenges, such as limited access to

advanced technology due to cost and sanctions, the need for structured training and mentorship, and the importance of ad-

vocating for IP as a public health priority. Key solutions proposed included a stepwise approach to technology adoption

(prioritizing high-impact, cost-effective tools like EBUS and pleuroscopy over more expensive robotics), developing hybrid

training models combining online education with simulation and supervised clinical practice, fostering international part-

nerships for scholarships and telemedicine, and ensuring sustained on-site support for new IP units to maintain competency.

The need for standardized terminology and protocols in bronchoscopy to improve consistency and facilitate research was

also emphasized.

In conclusion, this 2-day WABIP webinar underscored that the future of interventional pulmonology lies not just in adopt-

ing advanced technologies, but in judiciously integrating them based on robust evidence, cost-effectiveness, and patient-

specific needs. From optimizing diagnostic yields in peripheral and mediastinal disease to refining therapeutic interventions

for complex airway and pleural conditions, the discussions consistently highlighted the imperative of translating innovation

into tangible improvements in patient outcomes.

Ultimately, the event served as a powerful reminder of the shared global mission: to expand access to high-quality interven-

tional pulmonology care. Through initiatives like the IPI and continued international collaboration, the WABIP community

is actively addressing the disparities in technology, training, and expertise, fostering a future where cutting-edge bronchos-

copy is both effective and equitably accessible worldwide. Visit https://www.WABIP.com/webinar for agenda and Youtube

on-demand playback!

Roboc Assisted Bronchoscopy: The Gold Standard for Pulmonary Nodule

Sampling

Advanced diagnosc bronchoscopy technology, such as roboc-assisted bronchoscopy (RAB), has been transformaonal, in addion to naviga-

onal bronchoscopy, in diagnosing pulmonary nodules. However, there have only been small-scale trials which suggested the potenal to eval-

uate the safety, success, and diagnosc yield of RAB technology. The TARGET trial, the largest of its kind, oers robust prospecve mulcenter

data demonstrang that RAB is safe and eecve (1).

Several editorials and expert reviews have reected on the TARGET trial's ndings. In 2024 a Journal of Respiraon review acknowledged TAR-

GET as a pivotal study conrming the safety and ulity of RAB in broad clinical sengs, while also emphasizing the need for further direct com-

parisons with CT-guided and tradional navigaonal approaches (2).

A European Respiratory Society (ERS) editorial praised the real-world robustness of TARGET, highlighng high lesion access rates and safety (3).

Many other preceding reviews, including those in CHEST and Journal of Thoracic Disease, ancipated RAB’s benets, including superior distal

access and improved lesion localizaon, especially in comparison with ENB and standard bronchoscopy methods.

Conducted across 21 sites, the TARGET study involved 679 paents with lung lesions ranging from 8 to 50 mm, with the primary aim to assess

the safety of RAB (pneumothorax requiring intervenon, bleeding requiring intervenon, or respiratory failure). The secondary aim was to as-

sess outcomes, including all pneumothoraces, radial probe endobronchial ultrasound conrmaon, procedure duraon, unrelated complica-

ons, diagnosc yield, and infecons. The median lesion size was 21 mm, with most lesions being solid and located in the outer third of the

lungs. Notably, 37% of lesions were abung the pleural surface.

Editor-in-Chief: Dr. Kazuhiro Yasufuku

Research

Primary Business Address:

Kazuhiro Yasufuku, Editor-in-Chief WABIP Newsleer

c/o Judy McConnell

200 Elizabeth St, 9N-957

Toronto, ON M5G 2C4 Canada

E-mail: newsleer@wabip.com

P A G E 20

Associate editor:

Dr. Ali Musani

Associate editor:

Dr. Sepmiu Murgu

Ali Musani MD

Professor of Medicine and Surgery

Division Chief, Pulmonary Medicine

Director, Western Region Intervenonal

Pulmonology, Northwell Health

Lenox Hill Hospital

Nishil Dalsania, MD

Pulmonary and Crical Care,

AtlanCare Regional Medical Center,

Galloway, NJ

Research

P A G E 21

The primary safety endpoint occurred in 3.8% of paents. Pneumothorax requiring intervenon occurred in 2.8%, bleeding requiring

intervenon in 1%, and no instances of respiratory failure. This reects a low complicaon rate, especially compared to CT-guided biop-

sies, which have variable published pneumothorax rates from 15-49% (requiring intervenons from 5-15%). RAB was able to reach the

lesion in 98.7% of cases, and radial probe endobronchial ultrasound (R-EBUS) conrmed the lesion in 91.7%. The diagnosc yield varied

depending on the criteria. Using the ATS/CHEST strict denion, 61.6% and the invesgator reported yield 83.2%, with a 78.8% sensiv-

ity for malignancy. 64.1% of diagnosed lesions were malignant. The majority being non-small cell lung cancer. There was a higher diag-

nosc yield for lesions > 20 mm (68.8%), visible bronchus sign (66.7%), solid vs. subsolid (63.0% vs. 51.6%), and paents who had COPD.

Interesngly, the use of cone-beam CT did not signicantly improve diagnosc yield.

The low complicaon rates, high localizaon success, and diagnosc yield provide strong evidence and support for the use of RAB as the

rst-line diagnosc tool for evaluang PPLs.

References

1. Murgu S et al. Chest. 2025 Apr 27.

2. Bhandari BS et al. Journal of Respiraon. 2024 May 30;4(2):128-39.

3. Guiance IR et al. Breathe. 2025 Jul 15;21(3).

P A G E

WABIP ACADEMY- WEBCASTS

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 acquision 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

W A B I P N E W S L E T T E R

Links

www.chestnet.org Intervenonal Chest/Diagnosc Procedures (IC/DP)

NetWork

www.thoracic.org American Thoracic Society

www.ctsnet.org The leading online resource of educaonal and

scienc research informaon for cardiothoracic

surgeons.

www.jrs.or.jp The Japanese Respirology Society

sites.google.com/site/asendoscopiarespiratoria/

Asociación Sudamericana de Endoscopía Respiratoria

P A G E 22