The history of interventional pulmonology is marked by a continuous drive to improve the diagnosis and treatment of lung, airway, and pleural disorders through minimally invasive techniques. From the early days of rigid bronchoscopy and thoracoscopy to the current era of robotic-assisted procedures, augmented reality, fusion imaging, and personalized therapies, interventional pulmonology has evolved into a dynamic and essential component of modern respiratory care. As the field continues to innovate, it promises to further transform the landscapes of pulmonary medicine and thoracic surgery. 

This gradual transformation is at the root of a potential identity crisis for the field’s practitioners. This is partly because it is in our human nature to want to delineate ourselves from others, as in the adage, “we are all equal, but some are more equal than others.” It is also because not everyone incorporates all types of airway and pleural procedures into their daily practices. Indeed, several terms are used to describe the field’s practitioners or their area of focus, which can be confusing to medical colleagues as well as patients. These include terms such as bronchoscopy, advanced bronchoscopy, interventional pulmonology, interventional bronchoscopy, and endoluminal airway surgery. 

An identity crisis can lead to factions, which breed division rather than unification. This is the real danger of the looming identity crisis for practitioners defined by what they do rather than what they are. For example, can those who perform airway procedures but do not perform thoracoscopy call themselves interventional pulmonologists? And what of those who are not formally trained in pulmonary or pleural procedures, but gain technical skills solely from national meetings and workshops? Or, as in the United States, those who perform interventional procedures but are not board-certified? What of pulmonary specialists who perform diagnostic flexible bronchoscopy but only rarely intervene therapeutically, or those who perform flexible bronchoscopy but do not perform rigid? Are “advanced bronchoscopists” also interventional pulmonologists (by no means do I believe the term ‘advanced’ is meant to be used in its hierarchical sense, but rather only as it applies to specific technologies, which by the way, may not seem as advanced ten years from now)?  And, how is the newly fashionable term “endoluminal airway surgery” different from other diagnostic and therapeutic airway procedures?

According to the National Cancer Institute (www.cancer.gov), “intervention” is a treatment, procedure, or other action taken to prevent or treat disease, or improve health in other ways. If we accept this definition, everything we do is “interventional,” but isn’t that also what we are?