During thoracic surgery, double-lumen endotracheal intubation with one-lung ventilation is routinely performed to optimize surgical exposure, facilitate operative manipulation, and prevent iatrogenic lung injury. In patients undergoing repeat pulmonary surgery, prior lung resection may lead to pleural adhesions and tracheobronchial distortion, which substantially increase the difficulty of bronchial intubation. Even with experienced operators, the malposition rate of conventional double-lumen tubes remains high. The video double-lumen tube enables continuous visualization of the trachea and carina during insertion, positioning, and one-lung ventilation, allowing real-time airway monitoring. However, no clinical studies have specifically investigated airway management in patients undergoing redo pulmonary surgery. This study aimed to evaluate the efficacy and safety of the video double-lumen tube during anesthesia in patients undergoing secondary pulmonary resection.

Inclusion Criteria:

• Age ≥18 years.
• History of previous pulmonary resection.
• Scheduled for elective pulmonary surgery.
• Planned to receive a left-sided double-lumen tube.
• ASA physical status I-III.
• Patients have signed the informed consent form.

Exclusion Criteria:

• Preoperatively predicted difficult airway (Mallampati ≥ III, Cormack-Lehane ≥ III).
• Acute respiratory distress syndrome (ARDS) or respiratory failure within the past 3 months.
• Uncontrolled asthma.
• Confirmed pregnancy or current breastfeeding.
• Multiple traumatic injuries.
• Current participation in another clinical trial.
• Other conditions deemed unsuitable by the investigator.