Videolaryngoscopy is associated with a lower rate of double-lumen endotracheal tube malposition in thoracic surgery procedures, retrospective single-center study

<bold>Introduction:</bold> Double-lumen endotracheal tube (DLET) placement is critical in thoracic surgery for lung isolation. Malpositioning can cause ventilation issues, hypoxia, and airway damage. While direct laryngoscopy was standard, video laryngoscopy offers better glottis visualization and enhances intubation precision, prompting technique reevaluation. <bold>Aims:</bold> Our hypothesis is that the utilization of video laryngoscopy during the placement of double-lumen endotracheal tubes will result in a decreased incidence of malposition compared to the conventional direct laryngoscopy approach. <bold>Methods:</bold> Data from thoracic surgery patients treated between May 2023 and December 2023 were analyzed. The study grouped patients based on the intubation method: video laryngoscopy (VL) or direct laryngoscopy (DL). Characteristics, anesthesia onset to incision time, DLET positioning, and tube-related issues were compared between groups. Fiberoptic bronchoscopy confirmed DLET placement post-intubation and after positioning changes. <bold>Results:</bold> From June 2023 to February 2024 a total of 89 patients were included in the study. The mean age was 55.4 ± 15.8 years. There were 68 male and 21 female patients. The rate of double-lumen endotracheal tube malposition was significantly lower in the VL group compared to the DL group (n=6, 13.3% vs n=14, 31.8%, p=0.037). Additionally, the anesthesia induction to incision interval was found to be significantly shorter in the VL group (25.2±6.1 min. vs 28.3±6.5 min., p=0.02). <bold>Conclusions:</bold> We found that video laryngoscopy offers better visualization, leading to more precise tube placement and potentially fewer malposition.