From “Can’t See” to “Can’t Deliver”: Our Tracheal Access Webinar Clip Series
Following our webinar, Tracheal Access Geometry in the Video Laryngoscope Era, Pentland Medical has shared a series of short educational clips exploring some of the key themes raised during the session.
The webinar featured Dr Sean Runnells, anaesthetist, inventor of the Total Control Introducer and founder of Through The Cords. It examined how the widespread adoption of video laryngoscopy is changing both the practical challenges and the underlying geometry of tracheal intubation.
Rather than asking clinicians to revisit the entire webinar at once, the short-clip series allowed us to explore its main themes individually, from serpentine airway geometry and equipment choice to cadaver footage, current evidence and specialist applications of the TCI.
From visualisation to tracheal access
Direct laryngoscopy is built around alignment. Force is used to lift and flatten the airway’s natural curves, creating a more direct line of sight and a relatively linear route to the trachea.
Video laryngoscopy changes this relationship. It allows clinicians to see around the airway’s curves without necessarily flattening them. This can provide an excellent view of the glottis, particularly with a hyperangulated blade, while leaving the tube or introducer to navigate the airway’s natural serpentine geometry.
This helps explain an increasingly familiar challenge: the vocal cords are clearly visible, but delivering the tube remains difficult.
Throughout the series, we explored the shift from the traditional problem of “can’t see” towards the modern challenge of “can’t deliver”. We also looked at intubation as a complete system involving three interdependent components: the operator, the visualisation equipment and the tracheal access equipment.
The blade and access equipment both matter
The geometry created during intubation depends partly on the laryngoscope blade being used.
Direct laryngoscopy creates a comparatively linear access route. A Macintosh-shaped video laryngoscope blade generally creates a less demanding, semi-serpentine route, balancing improved visualisation with relatively straightforward tube delivery. A hyperangulated blade can provide the best view while preserving more of the airway’s natural curves, creating a fully serpentine route to the trachea.
The series then considered how effectively different tracheal access tools can adapt to these changing routes.
Static devices retain a fixed or pre-shaped curve. Semi-dynamic devices provide some control at the tip but cannot continually adapt across their full length. Fully dynamic equipment allows the operator to adjust its direction throughout intubation, enabling it to follow the individual patient’s anatomy.
Looking below the vocal cords
One of the most striking parts of the series used footage from a cadaver study in which a camera was positioned at the carina, looking upwards towards the vocal cords.
The first clip showed intubation using a static stylet. Once the tube passed beyond the view of the video laryngoscope, its fixed shape directed force against the anterior tracheal wall as it was advanced.
The second clip repeated the same view using fully dynamic tracheal access. The introducer was able to adapt to the airway’s geometry and guide the endotracheal tube along the same path, with a notable difference in the movement of the trachea during tube delivery.
We also examined a peer-reviewed manikin study comparing five introducers and stylets during hyperangulated video laryngoscopy. The results demonstrated differences in first-attempt success when intubation was made difficult.
As discussed during the series, manikin evidence has important limitations. Manikins do not react to applied force like human tissue and cannot reproduce tissue movement, injury or clinical outcomes. Further research is now examining the forces applied by different tracheal access tools to help build a fuller evidence base.
From theory to clinical application
The later clips introduced the Total Control Introducer as a purpose-designed, fully dynamic tracheal access device for use alongside video laryngoscopy.
We explored the complete TCI range and its applications across adult and paediatric airway management, double-lumen and microlaryngeal tubes, awake intubation and nasal intubation.
The series concluded with two questions from the webinar Q&A. The first examined how the TCI differs from a flexible fibreoptic scope. The second addressed the challenges of demonstrating a reduction in rare outcomes such as tracheal trauma, and why research often needs to examine upstream indicators including force, hoarseness and near misses.
Together, the clips reinforce one central point: an excellent view is only one part of a successful intubation. The route to the trachea and the equipment used to navigate it matter too.
Watch the complete short-clip series
The changing challenge
- The age of video laryngoscopy is here to stay
- Video laryngoscopy has changed the challenge
- The failure mode has shifted
- The airway is not a straight line
- Successful intubation depends on more than the view
- Direct laryngoscopy is built around alignment. Video laryngoscopy is built around navigation
- The blade determines more than the view
Understanding tracheal access equipment
- Static, semi-dynamic and fully dynamic tracheal access
- What happens below the vocal cords?
- What fully dynamic tracheal access looks like from below the cords
- What does the evidence show?
From theory to practice
- Welcome to the precision tracheal access era
- Precision tracheal access is not one size fits all
- Awake intubation: keeping the airway and tube in view
- Nasal intubation adds another curve to navigate
Final Q&A
Watch the full webinar
The complete webinar remains available to watch on demand:
Watch Tracheal Access Geometry in the Video Laryngoscope Era
Thank you to everyone who watched, commented and contributed to the discussion throughout the series.
For further information about the Total Control Introducer, or to arrange a demonstration, evaluation or departmental training session, please contact the Pentland Medical team or visit our Total Control Introducer product page.
