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
Educaon 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 roboc-assisted
biopsy. There were no complicaons
and the overall diagnosc yield was
83%. A similar roboc plaorm
(Monarch) developed by Auris
Health has been shown to be able to
reach further out in the lung com-
pared to a convenonal thin bron-
choscope with an idencal 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 roboc plaorms
may be the ability to navigate out
into the distal airways under conn-
uous visualizaon and the ability to
maintain stac posion. These new
roboc plaorms will likely improve
the diagnosc yield but more inter-
esngly enable precise transbron-
chial therapeucs. The future of
guided bronchoscopy is bright, and I
look forward to the innovaons.
Editor-in-Chief
Kazuhiro Yasufuku
References
1. Wang Memoli et al. Chest 2012; 143;
385-93
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
paents with pulmonary nodules.
When ssue diagnosis is required,
transthoracic needle aspiraon
(TTNA) has been the standard of care
for the majority of paents. TTNA
has a high yield of 90% which is usu-
ally not limited to the locaon of the
nodule. However, TTNA also has a
pneumothorax rate of about 25%
and as such, may not be suitable for
some paents. Tradional exible
bronchoscopy has a relavely low
yield for the diagnosis of pulmonary
nodules depending on the size and
locaon of the nodule. Newer tech-
nologies to guide exible bronchos-
copy has emerged over the past 10-
20 years as a viable opon when the
bronchoscopist has the experse.
These technologies include virtual
bronchoscopy, electromagnec navi-
gaon 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 evaluaon of pul-
monary nodules showed a pool diag-
nosc yield of 70% which is sll low-
er than TTNA but signicantly higher
than tradional 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 publicaons as-
sessed in the meta-analysis were
from expert centers in the world,
data from clinical studies and the
numbers may not reect the real
world. A recent study looking at the
AQuIRE Registry for the diagnosc
yield and complicaons of bronchos-
copy for peripheral lung lesions
showed a slightly dierent result (2).
The overall diagnosc yield of bron-
choscopy was only 53.7%, although
the sensivity for lung cancer was
between 60-74%. Interesngly, 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
aspiraon (TBNA), larger lesion size
and non-upper lobe locaon was as-
sociated with increased diagnosc
yield on mulvariate analysis. Compli-
caons only occurred in 2.2% of pa-
ents. Aer over a decade of experi-
ence with guided bronchoscopy, are
we sll not geng any beer with
transbronchial biopsy of peripheral
lung nodules?
The introducon of robocs has
changed the landscape of minimally
invasive surgery. In parcular, retro-
specve studies published over the
past decade show that roboc sur-
gery for lung cancer has the ad-
vantages of minimally invasive sur-
gery for paents 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 dissecon may be more
radical. However, the high costs of
purchase, maintenance and consum-
ables are a concern. Nevertheless,
roboc thoracic surgery is widely be-
ing adopted into pracce, especially
in North America. What about ro-
bocs for bronchoscopy?
At least two companies are develop-
ing roboc bronchoscopy plaorms.
A rst in human study was presented
at the Chest 2017 annual meeng
using the Intuive Surgical roboc
assisted bronchoscopy system [3]. 30
paents 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
EXECUTIVE BOARD
Zsolt Papai MD
Székesfehérvár, Hun-
gary
Chair
Silvia Quadrelli MD
Buenos Aires, Argen-
na
Vice-chair
Hideo Saka MD
Nagoya, Japan
Secretary General
Hojoong Kim MD
Seoul, Korea
Treasurer
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
STAFF
Michael Mendoza
General Manager
Judy McConnell
Administrator
Kazuhiro Yasufuku
Newsleer Editor-in-
chief
P A G E 2
Future of Guided Bronchoscopy for Transbronchial Biopsy of Peripheral Lung Nodules
Technology Corner
Transcutaneous Microwave Ablaon for Inoperable Lung Cancer
Robert D. Suh, M.D.
Professor, Department of Radiological Sciences
Director, Thoracic Imaging and Intervenon
Vice Chair, Radiology Educaon
David Geen School of Medicine at UCLA
Introducon
With an esmated 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, accounng for an esmated 154,050 deaths, more than breast, prostate and colon cancers combined.
Despite relentless advances in surveillance and imaging and knowledge, the number of paents at inial presentaon with surgi-
cally resectable local disease remains soberly small at under 30%, compounded by the realizaon that many with resectable dis-
ease are rendered medically inoperable by comorbid disease. Over recent decades, most importantly the last, evoluonary inera
has rened local control measures on all fronts, surgical and nonsurgical, through improved technology and its applicaon and pa-
ent selecon. 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 stereotacc body radiotherapy (SBRT) and image-guided tumor
ablaon (IGTA), respecvely, have been increasingly accepted and ulized for local control and cure for both medically inoperable
and even medically operable lung cancer paents. To date, much of the medical literature has focused on radiofrequency ablaon
(RFA) in the “high-risk,” or medically inoperable populaon with NSCLC, but more recently, has featured microwave ablaon
(MWA), reecng the technologic shi and availability to more ecient heat energy delivery.
Background
Similar to RFA, MWA achieves cell injury and death through ssue heang and coagulaon necrosis and can be performed percuta-
neously, laparoscopically or via open surgical access; however, unlike RFA, MWA operates at higher frequencies on the electromag-
nec spectrum, and most importantly, the energy is not distributed through an electrical current, eliminang the need for ground-
ing pads. At the 2 most used microwave frequencies (915 MHz and 2450 MHz), electromagnec microwaves induce friconal heat
by inducing kinec energy in aected water molecules through oscillaon. The spinning water molecules interact and transfer ki-
nec energy into the surrounding ssues resulng in ssue heang. With more ecient heang compared to RFA, MWA oers
superb ssue penetraon, higher temperatures and less sensivity to potenal vascular and bronchial heat sinks, all of which con-
tribung to quicker and larger volume ablaons.
Clinical Applicaon
Although MWA has yet few 5-year results and the literature sll premature in terms of paent numbers and uniformity, MWA has
demonstrated comparable, if not improved, overall and cancer-specic survival and local control rates compared to RFA at 1-, 2-
and 3-years in some series with favorable complicaon proles. As comparison, the rst RFA 5-year data
1
, published in 2007,
showed overall survival rates of 78%, 57%, 36%, 27% and 27% at 1-, 2-, 3- , 4- and 5-years, respecvely. Although the results were
modest, it is important to realize that these results were achieved in stage I NSCLC paents who were medically inoperave. Over-
all survival and local tumor progression-free rates were signicantly beer for those paents with ≤ 3 cm tumors compared to
those paents with > 3 cm tumors. With rened paent and lesion selecon and technology and operator experience, results have
notably improved. The ACOSOG z4033 trial
2
(RFA of Stage IA NSCLC in Medically Inoperable Paents) reported overall survival at
86.3% and 69.8% at 1- and 2-years, respecvely, 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 mulcenter trials evaluang MWA, and most published reports are single center retrospecve series
which oen include the use of mulple MWA systems using variable powers and antennas and heterogeneous treated paent pop-
W A B I P N E W S L E T T E R
P A G E 3
ulaons with both early and advanced stage NSCLC and pulmonary metastases.
The rst large study of MWA
3
in the lung included 50 paents, 27 of whom with NSCLC, with overall 1-, 2- and 3-year survival rates of 83%,
73%, and 61%, respecvely. Survival in this series was not associated with tumor size, in contrast to previous RFA studies. Belore et al
4
ablated 69 unresectable lesions (44 lung cancers, 25 lung metastases) in 56 paents with cancer-specic survival rate of 69% at 1-year, 54%
at 2-years and 49% at 3-years, although did not report specically for early stage lung cancers. Lu et al
5
performed MWA on 69 medically
inoperable paents 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%, respecvely, and the recurrence-free survival rates at 1-, 2- and 3- years were 72.9%, 50.0% and 27.1%, respecvely. Yang et al
6
per-
formed MWA on 47 paents with stage I medically inoperable NSCLC with overall survival rates at 1-, 2-, 3- and 5- years of 89%, 63%, 43%
and 16 %, respecvely. The local control rates at 1-, 3- and 5- years were 96%, 64% and 48%, respecvely. The median cancer-specic and
median overall survivals were 47.4 months and 33.8 months. Zheng et al
7
performed MWA on 183 paents, 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
8
ablated 108 paents (82 NSCLC) and reported the actuarial sur-
vival rates at 1-, 2- and 3-years of 78%, 54% and 39%, respecvely. 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 aaining success in-
creased by 7%. Local tumor recurrence rates were 22%, 36% and 44% at 1, 2 and 3 years, respecvely. Finally, Yao et al
9
recently compared
propensity-matched 54 paents undergoing MWA to 108 paents undergoing lobectomy for the treatment of stage I NSCLC without signi-
cant dierence between the two groups in overall survival, disease free survival, local tumor progression or rate of distant metastases. The
complicaon rate was lower in the MWA group. While this data should not support MWA supplant surgical resecon, it idenes the need
for randomized controlled trials evaluang MWA versus other local therapies.
Conclusion
As a method for safe and eecve local therapy, image-guided tumor ablaon, including MWA, for NSCLC is parcularly 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 experienal use in the high-risk paent and other emerging paent populaons, much of which unfathomable a decade prior. When
crically compared to surgical resecon and SBRT, image-guided ablaon is an aracve opon with an acceptable threshold for local con-
trol balanced with risk and cost without detriment to survival.
References
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. Belore 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 inially posioned for ablaon and
conrmed on sagial (Figure C) and coronal (Figure D)
images relave to the cancer.
Figure E) Intraprocedural axial image displays charac-
terisc ground glass aenuaon beginning to encom-
pass the cancer and conrmed on sagial (Figure F)
and coronal (Figure G) images. The antenna was repo-
sioned twice (not shown) to cover the enre cancer;
total ablaon me at 3 staons = 10 minutes at 65
was.
Figure H) Postprocedure image demonstrates ex-
panding ground glass aenuaon now clearly encasing
the cancer in its enrety without pneumothorax.
Figure I) Single CT image shows retracon and now
well-margined ablaon zone, typically seen at 1
month, without visualizaon of the original cancer.
Figure J) 6 month CT demonstrates connued involu-
on of the expected ablaon zone.
Figure K) 12 month CT shows further contracon of
the expected ablaon 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 recanalizaon is generally aempted to provide palliaon for symptoms (1) due to lung volume loss and hypoxemia. It is also done
to decrease the likelihood of a signicant airway hemorrhage leading to blood loss or drowning. Relief of mechanical airway obstrucon also
reduces the likelihood of post obstrucve pneumonia. The majority of airway recanalizaons are done for malignant airway obstrucon.
However, paents with non-malignant airway obstrucons may also derive benet (2). Airway recanalizaon modalies broadly fall into two
categories: heat based and cold based. Examples of heat based recanalizaon devices include Laser and Argon plasma coagulaon. Exam-
ples of cold based recanalizaon devices include cryo spray ablaon and exible cryo probe. Mechanical debriders such as rigid bronchosco-
py and micro debrider bronchoscopy are also available. A combinaon of these modalies are used commonly to achieve palliave goals.
Heat based recanalizaons require the airway FiO2 to be less than 0.4 to avoid airway res. Gas embolism is also a potenal complicaon of
argon plasma coagulaon. It is beyond the scope of this arcle to discuss all modalies of airway recanalizaon. We will focus on cryo spray
ablaon for central airway obstrucon.
Spray cryotherapy (SCT) is a relavely new modality available to the trained intervenonal pulmonologist or thoracic surgeon as a reliable
tool in providing palliave airway recanalizaon to a carefully selected paent. The third generaon truFreeze system (CSA medical, Lexing-
ton, MA, USA) is approved for airway applicaons. This system uses liquid nitrogen as the cryogen and is delivered through a specialized
braided catheter that is compable with the working channel of a standard therapeuc bronchoscope. The liqueed gas is delivered through
the catheter at low pressure (2-4 PSI). The gas expands 700 fold aer exing the catheter and drops the temperature to -196⁰ C, thereby
providing the desired eect 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 eecve in the treatment of central airway obstrucon (CAO). It u-
lizes ash freezing of ssue at a temperature of approximately 196⁰ C, resulng in non-contact cell death of ssue with relavely high water
content (malignant cells, granulaon 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 recanalizaon (3). Regenerave growth of ssue is also not impaired. Targeted
delivery of low dose liquid nitrogen with 2 cycles of 5 second duraon has been shown to cause ssue damage of up to 1.5 mm in the hu-
man airway (4).
Paents with symptomac central airway obstrucon (CAO) due to malignant or non-malignant disease processes are candidates for Cryos-
pray ablaon (5). Paents should be able to tolerate general anesthesia. It is preferred that in most cases a rigid bronchoscope be used to
allow passive venng of nitrogen. However, a exible bronchoscope with an endotracheal tube can also be safely used in paents who are
unable to tolerate rigid bronchoscopy. In our instuon, we undertake specic precauons when we use a exible bronchoscope: we de-
ate the cu of the endotracheal tube during acvaon and use an endotracheal tube with a subgloc port connected to a sucon tubing
for acve venng of nitrogen. The endotracheal tube is stabilized with a mouth guard that holds the tube in posion when the cu is deat-
ed. In both situaons, the paent is disconnected from the venlator during acvaon. Airway FiO2 need not be adjusted for this proce-
dure. Transient desaturaons is not uncommon as nitrogen displaces oxygen from the pulmonary circuit but recovery is usually quick. We
recommend not more than ve to seven acvaons per site in the tracheobronchial tree. Visual and tacle vericaon of gas egress is im-
portant. The device is used as a noncontact form of ssue destrucon. The catheter is passed approximately a cenmeter distal to the work-
ing channel of the bronchoscope. Aer the nitrogen is acvated with a foot pedal, shortening of the catheter is observed followed by cir-
cumferenal ice formaon. The mer is started at this point for 5 seconds and counts as an acvaon. Two sengs, low and medium ow
are available to the operator. We strongly recommend having trained support sta. Palpaon of the chest wall and neck for crepitus aer
each acvaon will also allow early recognion of potenal complicaons. Gas embolism has not been reported with SCT.
Spray Cryotherapy
Ganesh Krishna, MD, FCCP.
Professor of Medicine,
University of California, San Francisco.
Intervenonal Pulmonologist,
Palo Alto Medical Foundaon.
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 specic challenge for airway recanalizaons in general and parcularly with SCT. Given the proximity of
the entrance of the gastrointesnal tract, there is a signicant 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 praccal. Access to physicians trained in suspension laryngoscopy and the equipment itself is not readily available in
most instuons. In our instuon, 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 paents with proximal airway obstrucon with laryngeal mask airway (accepted for publicaon, with re-
visions). We used a 5.5 cm esophageal balloon (Merit Medical Endotek, South Jordan, UT) and inated it to 12 mm at 8 ATM pressure to fully
occlude the esophagus to prevent nitrogen entry into the gastrointesnal tract. In addion, a dedicated sta member was asked to palpate
the abdomen for distension during acvaon as an extra precauon.
We view SCT as one of the myriad tools available for airway recanalizaon for malignant or non- malignant CAO. It can be used as a
standalone device or in conjuncon with other tools. Specialized training is necessary for the operator as well as support sta. In trained
hands and carefully selected paents, it is a valuable tool that provides long lasng palliaon of symptoms caused by airway obstrucon.
References
1. Mahmood et al. Respiraon. 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 ocially displaced from their homes by conict, violence and perse-
cuon. Since the Second World War such high gures had not been ever recorded by the United Naons.
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 deparng from Libya, Tunisia or Egypt, risking their lives in search of safety in
Italy.
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 desnaon 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 conict 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 hosng 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 connues to struggle with how to respond to the inux of more than a million refu-
gees and migrants. The overall proporon of children among arrivals remains being around 15%. Recepon condions re-
main of concern, parcularly on the Greek islands where the refugee and migrant populaon increased by 27 per cent in
2017, leading to overcrowding and lack of services in Recepon and Idencaon Centres. UNICEF has also shown a deep
concern about the increase in the number of unaccompanied and separated children (UASC) in protecve custody. It is
known that children and teen-agers traveling alone due to limited resources, as well as those showing the lower levels of
educaon, are highly vulnerable to exploitaon by smugglers and criminal groups over the course of their journeys.
The EU and its member states connue eorts to prevent arrivals and outsource responsibility for migraon control to coun-
tries outside the EU. In Libya the EU is pursuing a containment strategy in cooperaon with their authories, despite over-
whelming evidence of pervasive abuse against asylum seekers and other migrants arbitrarily detained in Libya. However, the
situaon is so dangerous mainly in Syria and Afghanistan, that no barrier, whether administrave 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 restricons have dramacally worsened the situaon 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 implementaon 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 condions 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 sanitaon.
As Filippo Grandi (UNHCR High Commissioner) told “Syria is the biggest humanitarian and refugee crisis of our me, a con-
nuing cause of suering for millions which should be garnering a groundswell of support around the world.”
Nongovernmental organizaons performed roughly 40 percent of rescues in the central Mediterranean in the rst half of
2017. However, many organisaons had to stop their acvies due to security concerns and increased intercepons, some-
mes reckless and accompanied by abuse, by Libyan coast guard forces.
Unfortunately, this increase in mass movement of people has been accompanied by hoslity and a cry of overpopulaon in
some of the countries in Europe. Most probably with no reasonable argumentaon, some of the recent terrorist aacks,
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 migraon has also created the con-
dions 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 condions 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 recepon 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 restricve discourse.
Displacement of peoples during hard mes has been constant along history. Europe itself is the product of migraons that
took place during the Middle Ages. There is no “pure” naonality anywhere. All the countries have been built on the dis-
placement of dierent peoples in the past, and they are what they are because of the work and the eorts of generaons of
people coming from remote lands, eeing from the dangers of the me. Beginning in 1845, nearly 2 million refugees from
Ireland crossed the Atlanc to the United States in the dismal wake of the Great Hunger. About 2 million Italians seled be-
tween 1880–1920, and just 1 million between 1900–1914 in Argenna. But even quite recently, during and aer Second
World War, Europeans were eeing. Most European Jewish who had survived concentraon camps or had been in hiding,
were unable or unwilling to return to eastern Europe because of postwar ansemism and the destrucon of their commu-
nies 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 waing 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 desnaon they had chosen (mostly in the Americas). And during those years (only one or two generaons
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 forgoen. The cur-
rent argumentaon is not about how to help but about how to avoid reselements of refugees in their constuencies.
It shows that the EU was never prepared for a large-scale migraon like Syria. Unprepared to the huge inow of asylum
seekers, the European Union strongest strategy has been to reform its immigraon policies and refugee laws making more
dicult the access. The new laws have altered the recepon of asylum seekers. Years ago migraon to countries like Greece
and Italy was signicantly easier than migrang to Germany or Switzerland. Now, the EU has set up oces at every border
displacing the main responsibility of control at the dierent entrance borders.
The situaon is polically complex, but mainly morally challenging not for the polical leaders but for every single cizen of
any country in posion 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 opportunies for the nave 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 connue 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 oce for the EU, Norway and Switzerland): “We’re talking about thousands of people that move out of desperaon.
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, cizens of every country must face the need of taking posion in front of this challenge,
avoiding the opinion clichés and the media manipulaon. 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 dierent
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 eciency and accountability standards. Now it is me to ask themselves for a beer job in terms of
assistance and to adherence to the laws that they have always defended and pushed for less developed countries to ob-
serve.
A large number of people have entered Europe with a desperate need of an asylum. These vulnerable people require inter-
naonal protecon and the EU is in the moral and legal posion to do provide it. Reacng to this crisis by rejecng and deny-
ing the humanitarian dimension of the problem is not an acceptable answer for a connent with a long tradion of respect
of the dignity of human beings and observaon of human rights.
It means that, just as ordinary cizens, it is our responsibility to learn about the origin, consequences and dimension of the
crisis and take posion about that. It is our personal decision if our polical 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
sll live in democracy and so, polical 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 arcle are those of the author and do not necessarily reect the ocial posions of the Execu-
ve Board or Internaonal 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 Introducon 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 educaon in Australia and New Zealand.
An excing new session included Anatomy of a Bronchoscopy Suite. Jon Williamson conducted this capivang, interacve session with parci-
pants as they discussed equipment, instruments, personnel, organizaon, and access to a dedicated emergency box in order to respond swily
and eecvely to bronchoscopy-related complicaons. Other mes during the course, simulators were employed to pracce step-by-step bron-
chial inspecon (including Laerdal, Symbionix, and TruCorp models). Two-to-one learner/teacher raos 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 condence that Aussies and Kiwi bronchoscopists
(Australia and New Zealand) are at the forefront of our mes, changing the educaonal paradigm and revoluonizing bronchoscopy training.
Not only are assessment tools and checklists being ocially introduced into naonal training programs and competency assessments, but new
guidelines are also being accepted regarding pleural disease educaon (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 Praccal Approach method are being used in many cen-
ters to eecvely 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 acquision of technical skills without endangering paents or
unnecessarily prolonging procedures.
And of course, a big thank you to Natasha Botvinik and the enre Olympus Australia team, and to our many Aussi and Kiwi trainers, and to all
the young people who enthusiascally contributed to the success of this program. Next stop…a Train-the-Trainer program in Auckland, New
Zealand!
*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-
board
Figure 2: Congratulaons to everyone who parcipated in the
Train-the-Trainer and Introducon to Flexible Bronchoscopy
course held in Melbourne, Australia, 2018.
WABIP Vising Scholar Grant – We are excited to announce the all new WABIP Vising Scholar Grant, whose rst recipient is Dr.
Omer Elhag, WABIP Regent from Sudan. This grant provided support to Dr. Elhag to complete EBUS and convenonal TBNA training
as part of a Sudanese naonally 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 credenals include a medical doctorate degree from the University
of Cluj, Romania. As part of the WABIP vising 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 Internaonal curriculum that included reading and
analysis of The Essenal cTBNA Bronchoscopist, the Essenal EBUS Bronchoscopist, coached
praccal approach exercises, analycal review of EBUS-related teaching videos available from
the BronchOrg YouTube channel, training in cytology and specimen/smear preparaon,
commentary of the WABIP podcast on small samples in lung cancer, and numerous hours of
hands-on training using models, then live clinical cases aer achieving 100 percent technical skill scores using assessment tools
such as EBUS-STAT.
Furthermore, Omer assisted with preparaons 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 mediasnal
staging, Bronchoscopy skills and techniques, anatomy, lung cancer classicaon
according to universally accepted IASLC guidelines, clinical case analyses, and EBUS-CT-
White light bronchoscopy correlaons.
Having returned to the Sudan, Dr. Elhag can share his new knowledge and experse with
his colleagues in his country, expanding clinical care and serving paents with greater
skill and competence. Many congratulaons to Dr. Elhag for building a strong foundaon
of knowledge and clinical experse that will help hundreds of paents and advance
intervenonal 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 Intervenonal Pulmonology Associaon (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.
WABIP NEWS
P A G E 11
The Marriage of Navigaon Bronchoscopy and Ablave Therapies for Peripheral Lung Cancers: You All Are Invited
Rapid progress in technologies to access peripheral pulmonary nodules including navigaon bronchoscopy, roboc navigaon, radial ultra-
sound, and trans parenchymal approach has made trans-bronchial biopsies much safer and more eecve and compared to just a few years
ago.
Ablave therapies have come a long way as well. Therapies with extensive experiences in other organs and newer modalies with a short but
robust track record of safety and ecacy 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 proporon of these paents are deemed poor surgical candidates due to severe co-morbidies despite having a good potenal
for “cure” by surgical resecon. Currently, the standard of care for such paents is stereotacc body radiaon therapy (SBRT).
Navigaon bronchoscopy combined with ablave therapies for the treatment of peripheral lung cancer has been undergoing extensive tesng
around the globe. It’s a conceivable that this combinaon might oer mulple therapeuc opons besides SBRT for non-surgical, early stage
lung cancer paents. These opons would be minimally invasive, single applicaon, 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 Ablaon (RFA) allowed progression-free survival in more than 80% of the paents at one year and median progression-
free survival of almost 3 years. No major early or delayed complicaons were reported. In this study, the navigaon and localizaon of the le-
sion were achieved by CT scanning.
Another such animal trial (2) was recently published describing the safety and ecacy of Photo Dynamic Therapy (PDT) in the treatment of
primary lung cancer in a canine model using navigaon bronchoscopy. Mulple dogs with biopsy-proven primary lung cancer were treated with
Diode laser in Photophyrin sensized tumors, PDT. The tumors were resected aer one week to study the eects of treatment on the tumor
and the surrounding healthy lung ssue. Authors reported no acute or chronic signicant side eects and success in the tumor ablaon in the
prescribed range of the laser from the p of the probe/catheter “kill zone.” Healthy lung showed mild inammaon easily treated with a short
course of steroids.
In another study (3), 50 paents with peripheral pulmonary malignancies were treated with percutaneous microwave ablaon using CT guid-
ance for locaon. The results of this study suggest that lesions less than 3 cm and more than 3 cm responded equally well to the microwave
ablaon technique with a 1-year survival of 83%, 2-year survival of 73%, and 3-year survival of 61%. Approximately 20% of the paents had re-
sidual disease aer the inial ablaon though.
Such studies show the relentless progress in Intervenonal Pulmonology carrying the promise to ulize cung-edge navigaonal and localiza-
on modalies with ablave 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. Sepmiu Murgu
Editor-in-Chief: Dr. Kazuhiro Yasufuku
Research
Primary Business Address:
Kazuhiro Yasufuku, Editor-in-Chief
WABIP Newsleer
c/o Judy McConnell
101 College St., TMDT 2-405
Toronto, Ontario M5G 1L7
Phone: 416-581-7486
E-mail: newsleer@wabip.com
P A G E 12
Research
P A G E 13
Figure 1: (A and B): Computer-generated images of the bronchial tree of Dog 1 developed by the electromagnec navigaonal system
(Veran Navigaon Systems). The images also show the tumor shape and locaon (in red in A). B shows the route taken by the bron-
choscopy probe and one of the nal locaons of the opcal ber used to irradiate the tumor. (C) Photograph taken during surgical
excision of the right caudal lobe of Dog 1 at 1 week aer PDT. The tumor is clearly visible.
References:
1. Xie et al. Respiraon. 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.
1ST INDONESIA PEDIATRIC INTERVENTIONAL
BRONCHOSCOPY SCIENTIFIC MEETING
P A G E 14
Pediatric intervenonal bronchoscopy in Indonesia is sll considered as a new procedure. In order to establish and improve skill and knowledge
on this eld, we held 1st Indonesian pediatric intervenonal bronchoscopy scienc meeng on March 22-24, 2018 in Jakarta. First acvity was
pediatric intervenonal bronchoscopy workshop which was conducted on March 22nd in Cipto Mangunkusumo Hospital, a naonal referral
hospital in Indonesia. Cipto Mangunkusumo hospital is an academic university based hospital in collaboraon with Faculty of Medicine Universi-
tas Indonesia and serve as a training and educaonal centre for medical students, residents and trainees. This workshop was endorsed by
World Associaon Bronchology and Intervenonal Bronchoscopy (WABIP), especially the pediatric secon. On March 23rd, The webinar (online
symposia) about integrated bronchoscopy services in Cipto mangunkusumo hospital was held. It was a collaboraon symposia of pediatric pul-
monologist, adult pulmonologist, Otorhinolaryngologist and guest speaker (chairman of pediatric secon 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 conjucon with Jakarta Internaonal Chest and Crical Care Medicine Congress, a topic of pediatric intervenonal bronchos-
copy was delivered in plenary session. In the aernoon, a pediatric hands on workshop of intervenonal bronchoscopy was performed.
Day 1 (March 22nd ,2018) : Pediatric Intervenonal Bronchoscopy Workshop
The workshop was opened by the representave of educaonal and training director of Cipto Mangunkusumo hospital, Dr Anwarul Amin. A
short introducon of the workshop was delivered by Dr Wahyuni Indawa as a course director then proceed to case presentaon for live
demonstraon procedure. Aer that, live demonstraon procedure of applicaon of cryotherapy and argon plasma coagulaon (APC) was per-
formed. A case of reccurent papilloma larynx in 7 years old girl who had fully obliterated supragloc, gloc and subgloc area above the tra-
cheostomy canule as well as in the trachea just below the tracheostomy canule was exrpated using cryotherapy and APC. The procedure was
done by Prof Mohammad Ashkan Moslehi which the audience saw it in realme 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
Aer the break, lecture sessions was began with “How to Develop Intervenonal
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 Extracon in Children”. The topic of “Anesthesia
technique in Pediatric Intervenonal Bronchoscopy“ was delivered by Dr Bintang
from Anaesthesiology Department. Aerwards Prof Moslehi gave enlightment
about “Cryotherapy in managing granulaon ssue and foreign body extracon in
Children” and proceed by lecture on “The role of ballooning in managing airway
stenosis”. The aendees were hospital sta from muldepartment 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. Aerwards Dr Ceva W Pitoyo, Head of Respirology and Crical Care of Department Internal Medicine
spoke about “Current Pracce of Adult Intervenonal Bronchoscopy”. Prof Moslehi as our honoured guest gave lecture on “The Present and
Future for Pediatric Intervenonal Bronchoscopy”. The
fourth topic about “Challenges of Foreign Body Extracon 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 acvely parcipated. Pediatric pulmonologist from
Jakarta, Palembang (South Sumatra), Padang (West Sumatra)
and so on were asking quesons interacvely during the
session.
Day 3 (March 24th ,2018) : Jakarta Internaonal Chest and Crical Care Medicine (JICCIM) Congress
In plenary session of the 6Th JICCIM in Raes hotel, Jakarta, Prof Moslehi Introduced “Pediatric Intervenonal Bronchoscopy : Where are we
now?”. In the aernoon session, Dr Wahyuni and Prof Moslehi conducted hands on session on pediatric intervenonal bronchoscopy. First Dr
Wahyuni started with Hands on session of “Praccal Points to Drive Flexible Bronchoscope” and then connued by Prof Moslehi about “The
Applicaon of Cryotherapy, APC and Balloning Procedures in Pediatric Seng”. The parcipants 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 parcipants were acvely involved and directly supervised during hands on using the bronchoscopy model. The session was
wrapped up with group photo and the spirit of connuing to elaborate and improve skills and knowledge on pediatric intervenonal 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 Seo Harto (Olympus Indonesia) and Erbe company for the support of this workshop.
P A G E 16
This 1st Indonesian Pediatric Intervenonal Bronchoscopy Scienc Meeng is the rst plaorm for Indonesian pediatric pulmonologist to
move forward in the future for beer pracces in respiratory medicine. Collaboraon with other society in the world and region will be ex-
pected to strengthen the scienc part as well as transfer of skill. ( Jakarta, March 31st 2018, WI)
1st Congress Of Asian Pediatric Interventional
Pulmonology Association（APIPA）
P A G E 17
1st Congress Of Asian Pediatric Intervenonal Pulmonology Associaon (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 exoc and beauful scene of dierent countries. Prof Liu Xicheng from
Beijing Children’s Hospital, the rst Chair of APIPA, read the rules and regulaons of APIAP.The aim of APIPA: To serve the world children
with bronchoscopy and intervenon. The mission of APIPA is to promote knowledge and understanding of pediatric intervenonal 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 plaorm for study and interacon. The aendees 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 intervenonal pulmonology.
Opening ceremony guests included Prof Mohammad AshkanMoslehi from Shiraz University School of Medicine, Iran and Chair of pediatric
secon of WABIP, Director Li Fang from Talent Exchange Service Center Of Endoscopic Diagnosc And Therapeuc Technology Project
Oce, China Naonal Health And Family Planning Commission, prof Liu Xicheng from Beijing Children’s Hospital and the rst Chair of APIPA,
prof Kopen Wang from Balmore Union Memorial Hospital,USA, prof Lorenzo Mirabile from Meyer Children’s Hospital, Italy, prof Hugo
Boo 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
Secon 1: Diagnosc And Therapeuc 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
aenon to standard training of pediatric intervenonal pulmonologists, this eld is very promising. Prof Hugo Boo spoke of " Diagnosc
And Therapeuc Development Of Pediatric Laryngomalacia", including pathogenesis, clinical manifestaons, the eects of growth and devel-
opment of children and intervenonal therapeuc methods, and he also showed the process of intervenonal therapy via real video. Prof
Lorenzo Mirabile gave a lecture of "Airway Stenng In Tracheobronchial Disease ", including updated status of children's airway disease in
Italy, implicaons and prevenons for complicaons of airway stenng, 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 intervenon full of challenge and was the inevitable direcon
of discipline development. Prof Kopen Wang introduced in detail about orientaon, puncture method and points for aenon when per-
forming TBNA, he also shared some ideas in equipment improvement. His presentaon fully reected connuous innovaon was very im-
portant in the work of intervenonal pulmonology.
Secon 2: Respiratory Endoscopy and Muldisciplinary Collaboraon
The development of pediatric pulmonary rehabilitaon is important for the psychosomac 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 dierent from adults in
physiology and anatomy, requiring more observaon, accumulaon of experience, cooperaon of children and parents, and completed lung
rehabilitaon therapy during playing. Prof Wen Hongmei from Third Hospital Aliated To Zhongshan University, showed the experience in
adult paents in her presentaon of "Endoscopic Evaluaon Of Pediatric Dysphagia", so that we could understand more about dysphagia in
pediatrics. Prof Wan Guifang from Third Hospital Aliated To Zhongshan University, gave a lecture of "Evaluaon And Management Of Dys-
phagia In Pediatrics", stressing the swallow involve mulple cooperave work of respiratory system, digesve system, et al, nding underly-
ing cause via evaluaon and prevenng aspiraon by regulated food.
P A G E 19
Muldisciplinary collaborave team from Qilu Children's Hos-
pital of Shandong University, consisng of respiratory inter-
venonal physician prof Meng, anesthest 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 deformies, dicult airway for in-
tubaon 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 malformaon of small
infants. Excellent cases report, unique teaching method and
visualized operaon video, made the parcipants fully realize
that muldisciplinary collaboraon has unlimited prospects.
Secon 3: Team Building Of Pediatric Respiratory Endoscopy
Prof Meng Chen, prof Hugo Boo, prof Lorenzo Mirabile and prof Mohammad
AshkanMoslehi, respecvely introduced pediatric respiratory endoscopic team
building in China, Argenna, Italy and Iran, made everybody know the develop-
ment of pediatric respiratory endoscopy in these countries.
Secon 4 : Clinical Applicaon Of Pediatric Respiratory Endoscopy
Airway foreign bodies are one of the most common work for pediatric respiratory endoscopy. In “Excing 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 Aenon To Pediatric Laryngopharyngeal Reux”, making the aendees under-
stand pediatric laryngeal diseases more. Prof Hugo Boo, spoke of "Rigid Bronchoscopy In Pediatrics". Prof Chen Dehui from First Hospital
Aliated To Guangzhou Medical University, stressed the importance of early endoscopic intervenon in her presentaon "Time Of Endo-
scopic Treatment For Severe Pneumonia Complicated With Atelectasis”. In the presentaon 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 aenon. Prof Huang Yan from Dalian
Children's Hospital suggested to standardize administraon of pediatric respiratory endoscopy so as to guarantee medical safety. Prof Zhou
Hongmei from Zhongshan Hospital Aliated To Guangdong Medical University, spoke of “Time Of Medical Thoracoscopy For Empyema And
Prevenon Of Complicaons”, indicated the importance of pediatric thoracoscopy.
P A G E 20
Secon 5: Case Reports
More than a dozen pediatricians shared their
wonderful cases of success or failure in their re-
specve hospitals. They are Dr. Mi Qing from
Taian Central Hospital, Dr. Niu Bo from Hebei
Children’s Hospital, Dr. Liu Xiangteng from
ZhongshanBoai Hospital Aliated To Southern
Medical University, Dr. Zhang Lei from Shanghai
Children's Medical Center, Dr. Zhang Han from
Shengjing Hospital Aliated To China Medical
University, Dr. Lin Xiaoliang from First Hospital
Aliated 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 connuously involved talent-
ed people!
P A G E 21
Secon 6: Hands-on Workshop
As one of the highlights of this session, there were many aendees in hands-on workshops. On the site, the teachers were full of energy in
instrucng, the leraners were very acve in learning. The content was very rich, including airway management, procedure of bronchoscopy,
bronchoalveolar lavage, clamping, minimally invasive thoracentesis and drainage, bronchoscopic balloon dilataon, cryotherapy, electrocau-
tery, argon plasma coagulaon, laser, medical thoracoscopy. The program of nurses included washing, disinfecon and maintenance of endo-
scope, cooperave work with praconer, equipment preparaon, applicaon of forceps, balloon and ablaon equipment. The aendees
were able to feel the charm of endoscopy and intervenon in silicone and animal models, live video transfer of operaons.
Asian Pediatric Intervenonal Pulmonology Associaon is the rst setup jointly by the pediatric intervenonal pulmonologists in the world. It’s
the window of the development of Asian Pediatric Intervenonal Pulmonology. The establishment of the plaorm will certainly promote fully
development of Asian Pediatric Intervenonal Pulmonology. We sincerely expect extensive exchanges and cooperaon with the world col-
leagues on this plaorm, and together make APIPA congress a high level pediatric respiratory intervenonal event with worldwide inuence.
P A G E
22
WABIP ACADEMY- WEBCASTS
The WABIP has started a new educaon project recently: THE WABIP ACADEMY. The WABIP Academy will pro-
vide free online webcasts with new and hot topics that will interest pulmonologists and intervenonalists.
Current webcast topic: Tissue acquision for biomarker directed therapy of NSCLC
You can reach these webcasts by using this link: hp://www.wabipacademy.com/webcast/
www.bronchology.com Home of the Journal of Bronchology
www.bronchoscopy.org Internaonal educaonal website for
bronchoscopy training with u-tube and
facebook interfaces, numerous teachiing
videos, and step by step tesng and assess
ment tools
www.aabronchology.org American Associaon for Bronchology and I
ntervenonal Pulmonology (AABIP)
www.eabip.org European Associaon for Bronchology and
Intervenonal Pulmonology
W A B I P N E W S L E T T E R
Links
www.chestnet.org Intervenonal Chest/Diagnosc Procedures (IC/DP)
NetWork
www.thoracic.org American Thoracic Society
www.ctsnet.org The leading online resource of educaonal and
scienc research informaon 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
P A G E
23
UPCOMING EVENTS
PLEURALITY 2018
When: June 2-3, 2018
Where: Narayana Health City, Bengaluru, India
Program Director: Dr. Ranganatha
Program Type: Educaonal seminar (postgraduate may include physicians in pracce and trainees), Hands-on workshop, Conference
(didacc lectures)
1st Internaonal and 3rd Iranian Naonal Congress of Lung Cancers and Intervenonal Pulmonology
When: June 20-22, 2018
Where: Milad Hospital, Isfahan, I.R.Iran
Program Director: Dr. Babak Amra, MD
Program Type: Educaonal seminar (for trainees only), Hands-on workshop, Conference (didacc lectures)
Website: hp://www.chestnet.ir
Intervenonal Pulmonology and Pathology Through Clinical Pracce
When: June 23, 2018
Where: Belgrade, Serbia
Program Director: Semra Bilaceroglu M.D., Marioara Simon M.D., Spasoje Popevic M.D.
Program Type: Educaonal seminar (postgraduate may include physicians in pracce and trainees)
Conference (didacc lectures)
Website: hp://www.srbrespiratory.org/meengs.html
Introducon 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: Educaonal 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: Educaon seminar, Hands-on workshop
Website: hps://www.facebook.com/lungcentre/
W A B I P N E W S L E T T E R
P A G E 23
P A G E
24
UPCOMING EVENTS
EBUS and Advanced Diagnosc 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: Educaonal seminar (postgraduate may include physicians in pracce and trainees), Hands-on workshop, Confer-
ence (didacc lectures)
Website: hps://hopkinscme.cloud-cme.com/aph.aspx?P=5&EID=11444
4th Annual Scienc Meeng of the Malaysian Associaon for Bronchology and Intervenonal Pulmonology
When: October 12-14, 2018
Where: MALAYSIA
Program Director: DR RAZUL MD NAZRI MD KASSIM
Program Type: Hands-on workshop, Conference (didacc lectures)
Website: hp://www.mabip.com
Fih Annual Percutaneous Tracheostomy and Advanced Airway Cadaver Course
When: October 22, 2018
Where: MISTC Lab, The Johns Hopkins Hospital, Balmore, MD
Program Director: Hans Lee, MD
Program Type: Hands-on workshop, Conference (didacc lectures)
Website: hps://hopkinscme.cloud-cme.com/aph.aspx?P=5&EID=13574
Ninth Annual Evaluaon and Management of Pleural Disease
When: January 21-22, 2019
Where: The Johns Hopkins Hospital, Balmore, MD
Program Director: David Feller-Kopman, MD, FCCP
Program Type: Hands-on workshop, Conference (didacc lectures)
Website: hps://hopkinscme.cloud-cme.com/aph.aspx?P=5&EID=14934
W A B I P N E W S L E T T E R
P A G E 24
P A G E
1
P A G E
2
