In the following, I aim to summarise my notes from Hyderabad. The text presents an absolutely independent viewpoint, written as a personal reflection that could be useful for other medical colleagues, and does not aspire to be a comprehensive journal of the meeting, nor to favour, praise or promote anyone in particular, person or company. I have no conflicts of interest in creating this material.
Let's talk first about the program. It was divided into plenary presentations and practical workshops. The presentations covered the current hot topics in interventional bronchoscopy, referring here to peripheral pulmonary lesion navigation and biopsy methods. There has recently been a proliferation of methods to navigate the periphery of the lung, from using a special computer tomography (CT cone beam) to software applications that overlap with the existing fluoroscopic technology (C arm) in many bronchoscopy rooms. All these techniques enable precise navigation with a thin endoscope to the proximity of a peripheral pulmonary lesion. The impression is that not all these technologies will succeed in being adopted in current clinical practice for various reasons, and discussions now and in previous conferences have not clarified which would be the best technique. It is still not clear what ideal characteristics the best navigation technique should have. However, repeatedly there was talk about the need for the best technique to provide a clear image of how the biopsy probe 'bites' the lesion (tool-in-lesion). An interesting analogy was made by one of the speakers from USA, who said that while a few years ago we had navigation technology similar to that which drove us in the neighbourhood of our destination and we had to find our way from there, now the technology drives us to the street where the destination is located, and some have the ability to drive us right into the garage of the location we want to reach. This is the navigation technology we need to choose. 'Car in the garage' or forceps in the lesion. Precision, therefore.
Another presentation that caught my attention was about the detection of pulmonary nodes with AI on CT scans. Hyderabad is a technological hub and has a company that works with many centres around the world to perfect this method. There are already technologies on the market, including in the UK, for the automatic detection of lung lesions, but their adoption in current clinical practice is not currently widespread. It seems that this will soon change.
As a presentation style I appreciated the combination of discussions with traditional PowerPoint presentations. In general, I believe that our medical presentation style with PowerPoint at conferences is outdated. The classic format is very tedious. For some presentations, I didn't even leave my hotel room and watched the transmission online, as I could do other things at the same time. These presentations and conferences must evolve into a media and educational show, otherwise the audience becomes bored and leaves the room or spends the rest of the time browsing the phone.
One of the US colleagues showed me the Paper app to illustrate the presentations in a more interesting way. In general, I can say that the organizers and moderators, especially those from US, tried to enliven the discussions both as moderators and as participants in the room, with pertinent and interesting questions.
Overall, I felt that the presentation style and content of US speakers was of a higher standard than those of European speakers. Interventional bronchoscopy in the US is superior in terms of training organization and equipment compared to Europe, which was evident. The US has a standardized training program in interventional bronchoscopy for the past 10 years, while Europe only offers courses and workshops, with only one excellent master course in Florence. Americans have been using bronchoscopic robots for years, while Europeans are still trying to approve it. There is a funding issue in Europe as well, with American hospitals likely having more money to easily purchase new technology, but it is also a mentality issue, with many European centres being tied to a single individual and organizational activities sometimes conflicting with these individuals' interests. Although significant progress has been made at both ERS and EABIP levels, I believe that EABIP, of which I am the Executive Secretary, still has much to learn from its American counterpart, AABIP.
We had many participants at the practical workshops. At the chest ultrasound workshop that I attended, we had twice as many participants as available places, and had to run it twice to accommodate all 120 registered doctors. We had 10 practical stations and simulators of all types. I was impressed by the Indian doctors' eagerness to learn, as they were very specific about the technical elements they needed. In fact, an interesting discussion occurred during one of the presentations, where someone from Europe suggested that in medicine, one needs talent, similar to music, in order to be good at bronchoscopy, while the following speaker from US, showed how any procedure can be learned and performed at a decent level, if specific learning techniques such as deconstructing complex elements into simple ones and deliberate practice (repeated practice with appropriate feedback) are used. I personally agree with the Americans, and as I mentioned earlier, I believe Europe lags behind in both bronchoscopy training methods and educational philosophy and structured programs.
The networking opportunities were noteworthy. Someone said that we don't even know how important it is for boosting the motivation of a junior Indian doctor participating at Bronchus 2023 even to be able to take a selfie with one of the speakers. Intense discussions were held both “horizontally” and “vertically”, including with the many companies present, who had the opportunity to meet with international opinion leaders, and between groups of doctors from various parts of India. The plethora of photos and posts on Facebook is proof of this.
The food was excellent, and the city was wild. I didn't have much time to see more of the city as the traffic was congested and any journey took a long time, but the organizers made sure to show us one of the former residences of the region's first prime minister which was impressive.
It took me 20 hours to get from my hotel room in Hyderabad to my doorstep in London, but I believe it was worth it. Regarding travel, I have again great respect for my colleagues in the USA for whom just the flight was of minimum 20 hours. From their hotel door to their doorstep, they probably did even more.
And in 2024, if I'm invited, I will go again.
Tudor Toma, FRCP, PhD, London