Styletubation-The Ultimate Holy Grail for Endotracheal Intubation?

Laryngoscopy technique for endotracheal intubation has been developed and evolved for many decades. Among various conventional laryngoscopes and blades, videolaryngoscopes (VL) have been applied in a variety of patient populations, including certain difficult airways. The safety and effectiveness of VL have been repeatedly and extensively studied in both normal and difficult airways scenarios. The superiority of VL then has been observed, reported, and is advocated as a standard of care and possibly for routine first-line application. In contrast to laryngoscopy, the development of video intubating stylet (VS, also named as styletubation) has been noticed two decades ago. Since then, sporadic clinical experiences of clinical use have appeared in literature. In this review article, we presented our vast use experiences of the styletubation (more than 63,537 patients from 2016 to 2024). We found this technique is swift (the time to intubate: from 3 s to 10 s), smooth (first-attempt success rate: 100%), safe (no airway complications), and easy (high subjective satisfaction and fast learning curve for the novice trainees) in the majority of normal airway scanrios. Even in seemingly and identified difficult airway scenarios, the intubating time is acceptable (e.g., 30 s) with first-pass success. We therefore propose styletubation technique can be feasibly applied as universal routine use for endotracheal intubation.