SURGICAL PROCEDURES performed in the thoracic cavity, such as pulmonary resection, lung transplantation, spine surgery, descending aorta repair, and esophagectomy, require collapse of the lung on the ipsilateral side of the surgery to facilitate exposure and create optimal surgical conditions. 1-6 As a consequence, anesthesiologists need to be furnished with proper devices (lung isolation devices) and equipment (fiberoptic bronchoscopy) necessary to create conditions feasible for surgery with one-lung ventilation (OLV). Major technologic advances have been made in airway devices to facilitate lung isolation and OLV such as the bronchial blocker, the conventional double-lumen tracheobronchial tube (DLT), and the VivaSight video DLT (ETView Ltd, Misgav, Israel). 7-12 There still is much debate and controversy as to choice of airway device to create OLV and size of device, particularly as it pertains to DLTs. 13-15 In contemporary anesthesia practice, however, the conventional left-sided DLT (LDLT) is the preferred device for lung isolation and OLV because of its ease of insertion, reliability, better efficacy of lung isolation, and cost efficiency. 1-7 In all practical matters, the LDLT is safe for lung isolation, with less than 1% incidence of major complications, mainly from incorrect selection of size. 15 Nevertheless, it has been associated with malposition and dislodgement, which are influenced by multiple factors attributed to the patient (sex, height, and weight); surgery (patient positioning, right or left surgery); operator (experience and equipment used); and the DLT itself (depth of insertion, DLT size, and cuff inflation). 2-7,15 The LDLT is an airway device composed of a proximal endotracheal lumen and a distal endobronchial lumen in a sideby-side fashion. Commonly used LDLTs in adults are sizes 35 French (Fr), 37 Fr, 39 Fr, and 41 Fr, which have external bronchial diameters of 11.7 mm, 12.3 mm, 13.0 mm, and 13.7 mm, respectively. 9 Traditionally, the LDLT is placed in a blind fashion using direct laryngoscopy. After the LDLT is
