Video-guided Versus Conventional Right-sided Double-Lumen Tubes for One-Lung Ventilation in Thoracoscopic Surgery

Right-sided double-lumen tubes are used to achieve lung isolation and one-lung ventilation during thoracoscopic surgery. Correct positioning is important for adequate ventilation, lung collapse, and surgical exposure. However, placement of a conventional right-sided double-lumen tube can be challenging because of the short right main bronchus and the need to align the ventilation slot with the right upper-lobe bronchial opening. Tube displacement during positioning or surgery may require repositioning or fibreoptic bronchoscopy.

This prospective, multicentre, parallel-group randomised controlled superiority trial will enrol 566 adult participants scheduled for elective thoracoscopic surgery requiring one-lung ventilation with a right-sided double-lumen tube. Participants will be allocated in a 1:1 ratio to receive either a video-guided right-sided double-lumen tube or a conventional right-sided double-lumen tube. The video-guided device incorporates an integrated visualisation system that provides continuous airway visual feedback during initial placement and intraoperative monitoring. In the conventional group, tube placement and position assessment will follow standard clinical practice; fibreoptic bronchoscopy may be used when clinically indicated or as rescue.

The primary outcome is successful initial right-sided double-lumen tube placement. Successful placement requires successful first insertion, correct tube position, adequate lung isolation, acceptable surgical exposure, no withdrawal and reinsertion, and no tube exchange. Secondary outcomes include right upper-lobe bronchial obstruction; intraoperative tube displacement and repositioning; fibreoptic bronchoscopy utilisation; airway management time; lung collapse and surgical exposure quality; and airway-related complications through 24 hours after surgery.

Participants will be unaware of their allocated tube. Because of the distinct visual and operational features of the devices, the anaesthesiologist performing intubation and other intraoperative clinical personnel cannot be blinded. Outcome data will be collected according to the prespecified protocol.

Inclusion criteria

• Adults aged 18 years or older.
• American Society of Anesthesiologists physical status I-III.
• Scheduled for elective thoracoscopic surgery requiring lung isolation with a right-sided double-lumen tube for one-lung ventilation.
• Able to provide written informed consent.

Exclusion criteria

• Contraindication to placement of a right-sided double-lumen tube, including a lesion involving the right main bronchus that precludes its use.
• Known tracheobronchial anatomical abnormality.
• Known or anticipated difficult airway.
• Requirement for rapid-sequence induction.
• Emergency surgery.
• Previous thoracic surgery within 4 weeks before enrolment.
• Active systemic infection or known/suspected pulmonary tuberculosis within 4 weeks before enrolment.
• Severe respiratory instability that, in the investigator's judgement, makes trial participation unsafe.
• Concurrent participation in another interventional clinical trial that could interfere with this study.