A novel SaCoVLM™ video laryngeal mask airway in airway management for morbidly obese patients in bariatric surgery: a single-arm prospective study

Objective: The SaCoVLM™ video laryngeal mask is a novel video-assisted device that integrates the functions of both a dual-channel laryngeal mask airway (LMA) and an intubating laryngeal mask airway (ILMA). Theoretically, it can provide reliable awake airway management for obese patients undergoing laparoscopic sleeve gastrectomy (LSG). Methods: This single-arm prospective study evaluated the efficacy and safety of the SaCoVLM™ video laryngeal mask airway in 57 morbidly obese patients (BMI ≥35 kg/m²) undergoing LSG. Results: The primary outcome, first-attempt intubation success rate, was 93.0%（53/57）, with a median intubation time of 30 seconds. Secondary outcomes included an 89.5% first-attempt insertion success rate for the SaCoVLM™, a median airway seal pressure of 32.0 cmH₂O, and frequent intraoperative adjustments (e.g., up-down maneuver in 78.9%% of cases). Postoperative sore throat occurred in 89.5% of patients (mostly mild), and hoarseness in 21.1%, though all resolved within 72 hours. Significant correlations were observed between intubation time and BMI, neck circumference (p<0.05). No as-piration, airway trauma, or device failures occurred. Conclusion: The SaCoVLM™ demonstrated feasibility and safety in this high-risk cohort, attributed to real-time visualization and robust sealing, but postoperative mucosal irritation highlights areas for refinement. Trial Registration: ClinicalTrials.gov NCT05386979; first submitted May 10, 2022.