Endoscopic control for bronchial blockers: Experimental evaluation of single-lung ventilation strategies in simulation-based models

ABSTRACT Background: One-lung ventilation (OLV) is essential in thoracic anesthesia and is commonly achieved using double-lumen tubes or bronchial blockers (BBs). Recent visualization-integrated systems, such as VivaSight™, may improve procedural efficiency and safety, particularly for clinicians with limited BB experience. Methods: A preclinical simulation-based evaluation was conducted in a randomized crossover design using two experimental simulation models. In the first experimental model, a randomized crossover simulation manikin study was conducted that involved 21 anesthesiologists with minimal BB experience, comparing two BB-based lung isolation strategies: a visualization-integrated approach using VivaSight-EB™ and a conventional approach using EZ-Blocker™ with bronchoscopic guidance. In addition, the second experimental model involved a mixed-model randomized crossover simulation study that evaluated procedural workflow, operator experience, and cost-related outcomes. Twenty anesthesiologists with experience in lung-isolation performed two BB-based lung isolation strategies: blind placement of the EZ-Blocker™ and placement of the EZ-Blocker™ through a VivaSight™ single-lumen endotracheal tube. The primary outcome in the two simulation-based experiments was time to achieve left-lung exclusion. Results: In the simulation manikin experiment, 21 anesthesiologists with limited experience in lung isolation were involved and the visualization-integrated strategy achieved significantly faster left-lung exclusion compared with the conventional approach (32.1 ± 5.3 s vs 134.8 ± 56.6 s; P < 0.001). While in the mixed-model simulation experiment, 20 thoracic anesthesiologists with experience in lung-isolation techniques were involved and similar time advantages were observed, favoring the visualization-integrated strategy (34.6 ± 8.1 s vs 68.5 ± 19.5 s). Moreover, secondary outcomes consistently favored the visualization-integrated strategy, including higher operator satisfaction, fewer procedural failures, and lower procedure-related costs. Conclusion: The VivaSight-EB™ system demonstrated superior efficiency and workflow performance across both simulation environments. These findings support the potential clinical advantage of integrated visualization systems, particularly for operators with limited BB experience, and warrant further clinical evaluation.