Interventional pulmonology

Interventional pulmonology (IP, also called interventional pulmonary medicine) is a maturing medical sub-specialty from its parent specialty of pulmonary medicine. It deals specifically with minimally invasive endoscopic and percutaneous procedures for diagnosis and treatment of neoplastic as well as non-neoplastic diseases of the airways, lungs, and pleura. Many IP procedures constitute efficacious yet less invasive alternatives to thoracic surgery.

Before the advent of optical fibers and advances in anesthesiology, interventional pulmonary procedures were mostly limited to foreign body retrieval via rigid bronchoscopy. Gustav Killian (June 2, 1860 – February 24, 1921), a German laryngologist, performed foreign body retrievals from bronchial passages using a rigid laryngoscope/bronchoscope whereas in the United States, Chevalier Jackson (1865 – 1958) was the first to use the rigid bronchoscope. Later, Swedish internist Hans-Christian Jacobaeus first introduced thoracoscopy in a 1910 paper published in the journal Münch med Wochenschr, before Japanese thoracic surgeon Shiketo Ikeda (1925 – 2001) introduced the fiberoptic bronchoscope in the late 20th century. Jean-Francois Dumon from France is credited with modernizing rigid bronchoscopy in the late 20th century by introducing a novel non-metallic airway stent made of silicone, appropriately named the Dumon stent. Together, these developments laid the foundation for most of today’s interventional pulmonary techniques.

In 1978, Kopen Wang and colleagues at Johns Hopkins Hospital described the use of transbronchial needle aspiration (TBNA) through a rigid bronchoscope to diagnose a paratracheal mediastinal mass. Following the advent of endobronchial ultrasound (EBUS), which first became available in the early 21st century, EBUS-TBNA swiftly replaced mediastinoscopy as the first-line in mediastinal staging for lung cancer. With these developments, interventional pulmonology became much more firmly established on the map of distinct subspecialties.

In 1992, the Association for Bronchology and Interventional Pulmonology (AABIP) was formed as a representative society of interventional pulmonologists based in North America. This organization also publishes a journal, namely the Journal of Bronchology and Interventional Pulmonology. The World Association for Bronchology was founded by Dr. Ikeda in 1978 and renamed as the World Association for Bronchology and Interventional Pulmonology (WABIP) in 2010. It holds a biennial scientific meeting known as the World Congress for Bronchology and Interventional Pulmonology. The Association for Interventional Pulmonology Program Directors (AIPPD), dedicated to the advancement of IP education in the United States, was created in 2012.

In addition to basic bronchoscopic and pleural procedures that are performed by a general pulmonologist, an interventional pulmonologist may perform the following advanced procedures:

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