From mirrors to monitors: the historical evolution of laryngoscopy toward universal videolaryngoscopy.

Abstract

Introduction: Tracheal intubation is a critical intervention in anaesthesia, emergency medicine, and critical care. Videolaryngoscopy has transformed airway management by improving glottic visualisation and enabling shared team performance.

Areas covered: This narrative review reviews the historical evolution of laryngoscopy, from mirror-based indirect techniques to contemporary videolaryngoscopy. A narrative literature search was conducted in PubMed/MEDLINE and Embase for articles published up to 2025, using terms related to videolaryngoscopy, tracheal intubation, airway management, difficult airway, implementation, and patient safety. The review focuses on technological development, clinical evidence, educational implications, and the implementation-oriented 2025 international guidelines for universal videolaryngoscopy adoption.

Expert opinion: Videolaryngoscopy should no longer be regarded as a specialised rescue device but as the logical standard for tracheal intubation. Achieving universal adoption will require structured training, organisational alignment, and sustained cultural change to translate strong evidence into consistent clinical practice.