Clinical benefits of right-lumen fiberoptic bronchoscope-guided double-lumen tube placement in thoracic surgery: a randomized controlled trial.

Background: Single-lung ventilation is frequently required in thoracic surgery, with double-lumen tubes (DLTs) serving as the standard device for lung isolation. However, DLT placement and accurate positioning remain technically challenging, and may cause airway trauma and postoperative discomfort that affect patient satisfaction. This study aims to compare the clinical efficacy of a novel fiberoptic bronchoscope (FOB)-guided intubation technique via the right lumen of left-sided DLTs with conventional blind intubation and left-lumen FOB-guided placement. Methods: This prospective study enrolled 120 patients [aged 18-79 years, American Society of Anesthesiologists (ASA) physical status II-III] undergoing elective thoracic surgery requiring right one-lung ventilation. Participants were randomized into Group C (n=40) undergoing conventional blind intubation, Group R (n=40) receiving FOB-guided placement through the right lumen of left-sided DLTs (L-DLTs) and Group L (n=40) receiving FOB-guided placement via the left lumen of DLTs. The primary outcome of this study was the total DLT placement time (T-total), defined as the interval from insertion of the DLT through the lips to confirmation of correct anatomical positioning by fiberoptic bronchoscopy. Secondary efficacy outcomes included the final positioning time (T3), the other procedural time components (T1 and T2), and the first-attempt success rate of DLT placement. Safety outcomes comprised peri-intubation hemodynamic changes and airway mucosal injury assessed bronchoscopically, while patient-reported outcomes included postoperative throat symptoms (hoarseness, postoperative pharyngalgia, and odynophagia) and patient satisfaction. Results: The primary outcome, total DLT placement time (T-total), was significantly shorter in Group R than in Groups L and C (P<0.05). Group R also showed a significantly reduced T3 compared with the other two groups (P<0.05). No significant differences were observed among the three groups for T1 and T2. The tracheal injury score and the severity of airway mucosal injury in Group R were markedly lower than those in Group C (P<0.05). On postoperative day 1, both the incidence and severity of postoperative pharyngalgia in Group R were significantly reduced compared to Group C (P<0.05). Additionally, Group R exhibited a statistically significant decrease in the incidence and severity of postoperative pharyngalgia compared with Group C, and patients in Group R also reported the highest satisfaction scores among the three groups (P<0.01). Conclusions: Compared to conventional blind intubation and FOB-guided placement through the left lumen of L-DLTs, the right-lumen FOB-guided DLT positioning technique not only simplified the intubation process and significantly reduced the total DLT placement time, but also decreased patient-reported postoperative discomfort (postoperative pharyngalgia and hoarseness), minimized airway mucosal injury, and enhanced overall recovery experience. These findings suggest that the right-lumen technique may be considered a feasible alternative in selected clinical settings when performed by experienced anesthesiologists. However, further multicenter studies are required to validate these results and to determine their generalizability to broader patient populations and routine clinical practice. Trial Registration: The study was registered at Chinese Clinical Trial Registry (www.chictr.org.cn; 21/06/2021; ChiCTR2100047678).