Video double-lumen tube intubation in a modified lateral position for unilateral video-assisted thoracoscopic surgery: a randomized controlled trial

PURPOSE: We aimed to evaluate and report a protocol for video double-lumen tube (VDLT) intubation in a modified lateral position and evaluate whether it shortens in-room to cut time (IRCT; defined as the time from patient entry to incision) compared with conventional supine intubation in patients undergoing elective unilateral video-assisted thoracoscopic surgery (VATS). Participants were randomized 1:1 to modified-lateral-position (Group L) or supine-position (Group S) VDLT intubation using a computer-generated sequence with sealed-envelope allocation concealment. Operators were unblinded; nonoperator staff collecting postoperative data and the outcome analyst were blinded to allocation. The primary outcome was IRCT. RESULTS: Sixty-two patients were randomized (Group L, N = 31; Group S, N = 31), and all were analyzed for the primary outcome. Mean (standard deviation [SD]) IRCT was shorter in Group L (18.1 [2.0] min) than in Group S (31.1 [3.3] min), with a mean difference (L-S) of -13.0 min (95% confidence interval [CI], -14.4 to -11.6; P < 0.001). Intubation time was similar (mean [SD], 103 [15] sec vs 97 [15] sec; P = 0.10). Video double-lumen tube malpositioning occurred in 1/31 (3%) cases in Group L vs 15/31 (48%) cases in Group S (relative risk [RR], 0.067; 95% CI, 0.009 to 0.474; P < 0.001). Sore throat within 48 h occurred in 9/31 (29%) patients in Group L vs 18/31 (58%) patients in Group S (RR, 0.50; 95% CI, 0.27 to 0.94; P = 0.02). CONCLUSIONS: In patients undergoing unilateral VATS, VDLT intubation in a modified lateral position shortened IRCT. In exploratory analyses, several secondary outcomes favoured this approach. Intubation in a modified lateral position may be a feasible alternative to conventional supine position intubation in these patients. TRIAL REGISTRATION: ChiCTR.org.cn ( ChiCTR2500112254 ); first posted 21 October 2025.