Airway Management in Robotic Thoracic Surgery: A Narrative Review and Clinical Insight on Camera-Integrated Double Lumen Tube Use

Background: Robotic-assisted thoracic surgery (RATS) presents unique anesthetic chal-lenges, particularly in airway management due to patient inaccessibility after docking. The VivaSight™ double-lumen endotracheal tube (VDLT), which integrates real-time airway visualization, has been proposed as a potential solution in this setting. Methods: This article examines the literature on VivaSight™ in thoracic surgery, com-paring it to conventional double-lumen tubes (cDLT) in terms of safety, efficiency, and clinical outcomes. We also present a retrospective analysis of 31 patients undergoing RATS between September 2024 and February 2025, all intubated with the VivaSight™ tube. Results: In our experience, VivaSight™ intubation was successful on the first attempt in 52% of cases. Issues with camera fogging or secretions required fiberoptic bronchoscopy (FOB) in 48% of cases. Application of anti-fog spray (SilkoSpray®) and continuous suction improved outcomes. No major complications or device overheating were recorded. Lit-erature supports shorter intubation times, reduced need for FOB, and improved safety due to continuous visualization. Conclusions: VivaSight™ offers significant advantages for airway management in RATS, including faster intubation, better intraoperative monitoring, and potentially reduced contamination risk. Optimization strategies, such as anti-fog measures and suction in-tegration, can enhance its performance. More evidence is needed to standardize its ap-plication and validate its cost-effectiveness in high-risk surgeries.