Clinical efficacy of video double-lumen tube for one-lung ventilation in thoracic surgery: a meta-analysis of randomized controlled trials

Background Double-lumen tube (DLT) is generally regarded as the gold standard for one-lung ventilation during thoracic surgery. Compared with DLT, video double-lumen tube (VDLT) has an integrated camera, allowing continuous visualization of its position in the trachea. However, the clinical efficacy of VDLT for one-lung ventilation in thoracic surgery is unclear. This meta-analysis aims to evaluate the clinical efficacy of VDLT for one-lung ventilation in thoracic surgery. Methods The PubMed, EMBASE, Web of Science, the Cochrane Library, CNKI, WanFang, and CBM databases were searched for relevant studies from inception to July 2025. This meta-analysis used RevMan and Stata software to implement statistical analysis. The primary outcome was the intubation time. Sensitivity analysis and Egger’s test were performed to evaluate the stability of the results and the publication bias. Results Eighteen studies involving 1,332 patients were included. For the primary outcome intubation time, extreme and unexplained between-study heterogeneity was observed (I 2 = 99%). A random-effects model was applied, and the pooled result suggested a trend toward shorter intubation time in the VDLT group (MD = −102.68 [95% CI: −123.71 to −81.66], p < 0.00001). Meta-analysis also revealed that the VDLT group exerted a higher first-attempt success rate (OR = 8.04, 95% CI [2.17 to 29.74], p = 0.002), lower mean arterial pressure (MD = −16.85 [95% CI: −21.67 to −12.02], p < 0.00001) and heart rate (MD = −11.32 [95% CI: −19.80 to −2.85], p = 0.009) after intubation, a shorter repositioning time after dislodgement (MD = −50.91 [95% CI: −67.30 to −34.52], p < 0.00001), and a lower incidence of sore throat (OR = 0.62, 95% CI [0.39 to 0.98], p = 0.04). No significant differences regarding the incidence of dislodgement during positioning and surgery, quality of lung collapse, or the incidence of hoarseness after surgery were noted between the 2 group. Conclusion Compared with the DLT, VDLT may provide modest clinical advantages of a shorter intubation time, higher first-attempt success rate, lower mean arterial pressure and heart rate after intubation, shorter repositioning time after dislodgement, and lower incidence of sore throat. However, the primary outcome of intubation time is limited by extreme between-study heterogeneity that could not be explained. Standardized multicenter international randomized trials are warranted to confirm the clinical efficacy of VDLT. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251138139 , Identifier: CRD420251138139.