Taboada, ManuelFernández, JorgeBermúdez, MaríaEstany-Gestal, AnaMolins, NievesOrallo, María de los ÁngelesMosquera, EvaAmor, MarcosDíaz, CoraMirón, PaulaDos Santos, LauraSoto-Jove, RosaAlonso, María ConcepciónAmate Pena, Juan JoséVarela, SergioTaboada, CristinaAlcántara, Jorge MiguelSeoane-Pillado, Teresa2026-01-292026-01-292025-05-25Taboada M, Fernández J, Bermúdez M, Estany-Gestal A, Molins N, de Los Ángeles Orallo M, Mosquera E, Amor M, Díaz C, Mirón P, Dos Santos L, Soto-Jove R, Alonso MC, Amate JJ, Varela S, Taboada C, Alcántara JM, Seoane-Pillado T; VIDEOLAR‐SURGERY Trial Investigators Group. Universal videolaryngoscopy for tracheal intubation in the operating theatre: a prospective non-randomised clinical trial. Anaesthesia. 2025 Sep;80(9):1045-1056.0003-2409https://hdl.handle.net/2183/47147Clinical trial[Abstract] Introduction: Multiple trials have shown the advantages of videolaryngoscopy over direct laryngoscopy for tracheal intubation in the operating theatre. However, the effectiveness of universal videolaryngoscopy in real-world operating theatre settings remains uncertain. Methods: We conducted a prospective, multicentre, quasi-experimental study, to evaluate the effectiveness of universal videolaryngoscopy compared with direct laryngoscopy for tracheal intubation in a real-world operating theatre setting. During the non-interventional phase, anaesthetists performed tracheal intubation using the Macintosh laryngoscope as their primary tool. In the interventional phase, the same anaesthetists employed a videolaryngoscope as the first-choice device. The primary outcome was 'easy tracheal intubation', defined as a composite of successful tracheal intubation on the first attempt; easy laryngoscopic view; and absence of the need for adjunct airway devices. Results: Of the 5135 patients included in the study, easy tracheal intubation occurred in 1909/2568 patients (74.3%) during the non-interventional phase compared with 2216/2567 patients (86.3%) during the interventional phase (absolute difference 12%, 95%CI 9.8-14.1, p < 0.001). The interventional phase showed higher rates of successful first-attempt tracheal intubation (absolute risk difference 5.8%, 95%CI 4.1-7.5, p < 0.001); easy laryngoscopy (absolute risk difference 9.9%, 95%CI 8.2-11.7, p < 0.001); and a lower need for adjunct airway devices (absolute risk difference -5.2%, 95%CI -6.7 to -3.7, p < 0.001). Additionally, complications related to tracheal intubation were reduced significantly in the interventional phase (absolute risk difference -4.3%, 95%CI -5.7 to -2.8, p < 0.001). Discussion: In a real-world operating theatre setting, universal videolaryngoscopy was effective at increasing the rate of easy tracheal intubation and successful first-attempt tracheal intubation, while reducing the incidence of difficult laryngoscopy and complications related to tracheal intubation.engThis is the peer reviewed version of the article https://doi.org/10.1111/anae.16643, which has been published in final form at Wiley Online Library. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibitedAirwayComplicationsOperating theatreTracheal intubationVideolaryngoscopyjournal articleembargoed access10.1111/anae.16643