Developments in Paediatric Interventional Pulmonology: Recent Experience in Turkiye With Broad Implications for the Field

摘要

Paediatric interventional pulmonology (IP) techniques have attracted increasing attention from paediatric pulmonologists due to their efficacy in treating respiratory problems, greater diagnostic convenience, and non-invasive methods. Due to the smaller working channels of paediatric flexible bronchoscopes, the application of interventional minimally invasive methods used successfully in adults since the 1990s has not coincided with similar progress in paediatric patients. Paediatric IP initially consisted of treating foreign body aspiration; the development of 1.1 mm cryoprobe catheters and their suitability for flexible bronchoscopy working channels (which are most commonly used in children) has opened the opportunity to perform many minimally invasive procedures [1, 2]. These procedures include balloon dilatation of the airway, cryoextraction, cryo-biopsy, cryo-devitalisation, electrocauterisation, argon plasma coagulation, stent placement, intralesional injections, rigid bronchoscopy, endobronchial ultrasound (EBUS) guided transbronchial lymph node biopsies, and robotic bronchoscopy. These procedures have a low complication rate and are very safe compared to open surgical interventions, as reported in an increasing number of publications in recent years [3]. A major challenge to global development of paediatric IP expertise is the limited inclusion of this subject in standard training programmes. Currently available paediatric IP training includes some specialised hands-on courses and pre-congress courses at international conferences [2]. A survey of paediatric pulmonologists in the United States on advanced diagnostic and interventional bronchoscopy practices indicated that the type of training received and the number and variety of procedures performed varied considerably between centres [4]. Another challenge is the difficulty in accessing the devices that need to be used during procedures, as many paediatric pulmonology centres do not yet have devices such as EBUS and cryotherapy. Paediatric IP has started to attract the attention of paediatric pulmonology physicians in Turkiye because these procedures are typically performed by thoracic surgeons in our country. To be able to perform these procedures as a paediatric pulmonologist in my country, I participated in the 1st hands-on course in paediatric IP held in Dusseldorf in April 2024 as part of an international training initiative. It was an exciting course with expert physicians from around the world as instructors. I had the opportunity to engage in numerous practical applications, try various devices not available at my centre, and network with many professionals. Later, at the 2nd INSPIRED Congress, I took a pre-congress course on cryotherapy for the removal of foreign body aspiration, transbronchial biopsy, and airway restoration, which included extensive practical applications on simulators and animal specimens. Although hands-on courses give the opportunity to practise on simulators and animal models, in centres where these procedures have never been performed before, more practice and the support of experienced clinicians are required for trainees to start applying these methods in their own patients. Through subsequent international collaboration, we were able to initiate IP procedures that had not previously been performed by paediatric pulmonary specialists in Turkiye. After obtaining official permissions and coordinating with the hospital administration, appropriate patients were identified and procedures were scheduled. Over 3 days, various interventional procedures using flexible bronchoscopy were performed at Konya City Hospital, including balloon dilation of airway stenosis, endobronchial forceps biopsy, transbronchial and endobronchial cryo-biopsy, cryo-extraction, and cryo-devitalization (Figure 1). There were no complications in our patients except for mild bleeding in the acute phase. This visit led to both an improved patient experience for Paedia