Development of a dynamically adjustable video-laryngoscope for endotracheal intubation (DAVE)

Abstract

Endotracheal intubation is a routine yet safety-critical procedure in anaesthesiology and emergency medicine. Although videolaryngoscopes have substantially improved airway management, established systems are still based on fixed blade geometries that do not allow patient-specific adjustment during use. This work describes the development and prototypical implementation of a dynamically adjustable videolaryngoscope for endotracheal intubation (DAVE). The device was developed through an interdisciplinary product development process based on VDI 2221, integrating engineering and clinical expertise. Based on clinical and technical requirements, a concept featuring an articulated blade with two mechanically coupled movable segments, a cable-driven actuation mechanism, and an integrated camera system was developed and iteratively refined over fourteen prototype versions. The final prototype was manufactured using multimaterial additive manufacturing based on polylactide and thermoplastic polyurethane and enables controlled adjustment of the articulated blade geometry while preserving sufficient rigidity for tissue retraction and lifting. Within the iterative development process, qualitative tests were used to assess distal blade angulation, camera-view angle, and passive camera alignment through movement of the middle segment. The resulting observations were used for prototype refinement and to evaluate their potential influence on glottis exposure and laryngoscopic view. These observations indicate that the developed concept is fundamentally suitable for dynamically adapting blade curvature and camera orientation to the individual requirements of the patient and user. The effect of these adjustments on glottic visualisation and clinical performance was not systematically quantified in the present work. The present work demonstrates the fundamental technical feasibility of a dynamically adjustable videolaryngoscope.