[Pros/Cons: Airway Management for Separate-side Ventilation: Always Use a Video Laryngoscope?]

The optimal technique for airway management during intubation with a double-lumen tube (DLT) in thoracic anesthesia remains unclear. While efforts are now being made to use a video laryngoscope for routine use with single-lumen tubes, its use with DLTs remains a topic of debate. This article presents an analysis from two perspectives in the style of a debate, in this case with a slight wink as a plea in court, comparing video laryngoscopy (VL) with direct laryngoscopy (DL) for routine use. The "defense position" highlights evidence demonstrating improved visibility of the glottis, higher success rates on the first attempt, less mucosal trauma, lower DLT misplacement rates, and educational advantages associated with VL, especially when using Macintosh blades. In contrast, the "prosecution" emphasizes the limitations of VL, including longer intubation times, difficulty advancing the DLT due to anatomical conditions and the rigidity of the DLT, increased misplacement rates in certain studies, variability between VL devices, and the potential for dental injuries associated with certain blades. A comprehensive evaluation of randomized trials, meta-analyses, and observational studies shows that while VL offers clear advantages in difficult airway situations, DL can provide faster and more reliable results under routine conditions. This comparison is intended to encourage critical evaluation of the current evidence and support informed clinical decision-making regarding the standard of care in thoracic anesthesia.