Video laryngoscope-guided double-lumen tube tracheal intubation in the left-lateral position for thoracoscopic surgery: an open-label randomized non-inferiority trial

OBJECTIVE: To evaluate whether double-lumen tube (DLT) intubation guided by video laryngoscope in the left-lateral position is superior to that in the supine position. METHODS: A prospective, single-center, open-label, randomized, non-inferiority trial included 94 patients (aged 18-75 years) undergoing thoracoscopic right lung surgery in the left position from July 2022 to September 2025. Patients were randomized to receive DLT intubation in the lateral or supine position. The primary outcome was total intubation time (TNI), with a non-inferiority margin (δ) of 10s. Secondary outcomes included first-attempt intubation success, Cormack-Lehane score, number of DLT adjustments, preparation time for patient positioning, number of medical staff required for positioning, and number of facilitating maneuvers. Safety outcomes were also recorded. RESULTS: All patients were successfully intubated on the first attempt. TNI in the lateral position was 7 s (97.5% CI, 3 to 10) longer than that in the supine position. Compared with the supine group, the lateral group required fewer intubation adjustments, had a shorter preparation time for postural placement, had fewer medical staff personnel for postural placement, and intubation misplacement of the DLT was more common in the lateral group (P = 0.006). Furthermore, serial postoperative assessment revealed that airway discomfort (measured by NRS) peaked at 6 hours after extubation in both groups. Comprehensive clinical evaluation demonstrated that the lateral position significantly reduced the airway management difficulty score, while maintaining a comparable procedure smoothness index, confirming its clinical efficiency and feasibility. CONCLUSION: Video laryngoscope-guided DLT intubation in the left lateral position was non-inferior to the supine position in terms of operational feasibility.