Fiberoptic Bronchoscopy-Guided Bronchial Blocker Placement in Lateral Versus Supine Positions in Video-Assisted...

Bronchial blockers (BBs) are widely used for one-lung ventilation during video-assisted thoracic surgery (VATS), but malposition remains a common cause of repeated fiberoptic bronchoscopy (FOB) examinations and procedural inefficiency. Whether BB placement performed directly in the lateral decubitus position improves device stability and perioperative outcomes remains unclear. Clinical data from adult patients undergoing elective unilateral VATS with BB-assisted one-lung ventilation were analyzed to compare lateral-position BB placement with the conventional supine approach followed by repositioning. Patients were categorized according to the position used during BB deployment. BB malposition occurred less frequently in the lateral group than in the supine group (12.5% vs 30.8%; relative risk [RR] 0.41, 95% confidence interval [CI]: 0.23-0.72; p = 0.001). Lateral placement was associated with shorter BB placement time (3.8 ± 0.9 vs 5.6 ± 1.2 min; p < 0.001), fewer FOB examinations (1.3 ± 0.3 vs 2.1 ± 0.5; p < 0.001), and a shorter anesthesia-to-incision interval (18.4 ± 3.5 vs 24.7 ± 4.2 min; p < 0.001). Intraoperative oxygenation was improved (arterial partial pressure of oxygen [PaO2]: 186.5 ± 22.4 vs 158.3 ± 25.1 mmHg; p < 0.001), accompanied by lower peak airway pressures (23.4 ± 3.1 vs 26.8 ± 3.6 cmH2O; p < 0.001) and fewer hypoxemic events. Postoperative sore throat, hoarseness, hypoxemia, and airway mucosal injury occurred less frequently in the lateral group (all p < 0.05). In conclusion, BB placement in the lateral decubitus position was associated with greater device stability, improved procedural efficiency, and fewer airway-related complications. Aligning BB deployment with the final surgical position may provide a practical strategy to optimize lung isolation during minimally invasive thoracic surgery.