tion to the classic forceps used by Killian and Jackson. These newer therapies include laser, stents, electrocautery, cryotherapy, and others and can be applied through either rigid or flexible bronchoscopes [4] . On the other hand, thoracoscopy had been advocated by Jacobaeus [5] in 1910 for the exploration of serous cavities. According to the excellent historical review by Moisiuc and Colt [6] , the first thoracoscopy was performed in Dublin in 1865 by the Irish physician Francis Richard Cruise [7] and it was reported in 1866 by Dr. Samuel Gordon [8] at the end of the case presentation of an 11-yearold girl with empyema. In spite of this, Jacobaeus still deserves the honor to be considered as the father of thoracoscopy, because he overcame the problems involved in collapsing the lung to obtain a better endoscopic view by inducing pneumothorax and he used thoracoscopy both as a diagnostic and therapeutic tool. Nowadays, thoracoscopy is usually performed by pulmonologists in the endoscopic suite under local anesthesia and with intravenous conscious sedation/analgesia; it is mainly used for diagnostic purposes (especially in pleural effusions) and for talc pleurodesis (‘poudrage’) to prevent recurrence of persistent pleural effusions or pneumothorax. Unfortunately the number of procedures has decreased worldwide and is increasingly replaced by video-assisted thoracoscopic surgery, although this technique requires general anesthesia and double lumen tracheal intubation, and is performed almost exclusively in the operating room [9] . The first bronchoscopy was performed by Gustav Killian [1] in Freiburg, Germany, in 1887. During the early years of the development of bronchoscopy, the indications for the procedure were primarily therapeutic: removal of foreign bodies and dilation of strictures from tuberculosis and diphtheria. In the early part of the 20th century, Chevalier Jackson [2] , the father of American bronchoesophagology, further advanced bronchoscopic techniques and designed modern rigid bronchoscopes. Again, the primary indication was often therapeutic. In the 1970s, Dr. Shiketo Ikeda introduced the flexible fiberoptic bronchoscope primarily as a diagnostic instrument. Bronchoscopy soon shifted from being a therapeutic procedure performed by thoracic surgeons and otolaryngologists to a primarily diagnostic procedure performed by pulmonologists [3] . Currently, apart from thoracentesis and pulmonary function testing interpretation, bronchoscopy is the most commonly performed procedure by pulmonologists. As pulmonologists have gained expertise within the field of bronchology, the diagnostic use of the flexible bronchoscope has expanded and there has been a growing interest in the use of the instrument for therapeutic purposes. The worldwide epidemic of lung cancer, which often leads to airway obstruction by malignant neoplasm, but also the stenoses due to benign disorders have replaced foreign body removal as the main indications for therapeutic bronchoscopy. Modern technology has given bronchoscopists numerous adjunctive therapies in addiPublished online: November 5, 2009