Background <p>The optimal positioned double-lumen endotracheal tubes (DLT) is crucial in thoracic surgery requiring lung isolation. This study aims to compare the accuracy and complication rates of DLT placement using videolaryngoscopy (VL) versus conventional direct laryngoscopy (DL).</p> Methods <p>This retrospective single-center study included 89 patients who underwent thoracic surgery with DLT placement between July 2023 and May 2024. Patients were divided into two groups: VL (<i>n</i> = 45) and DL (<i>n</i> = 44). Patient characteristics, intubation times, malposition rates, and complications were recorded. DLT position was confirmed using fiberoptic bronchoscopy.</p> Results <p>The incidence of DLT malposition was significantly lower in the VL group (13.3%) compared to the DL group (31.8%) (<i>p</i> = 0.037). The overall complication rate was also lower in the VL group (4.4%) compared to the DL group (11.4%) (<i>p</i> = 0.024). The mean time from anesthesia induction to the first incision was shorter in the VL group (25.2 ± 6.1&#xa0;min) than in the DL group (28.3 ± 6.5&#xa0;min) (<i>p</i> = 0.02).</p> Conclusions <p>VL significantly reduces the incidence of DLT malposition and associated complications in thoracic surgery compared to DL. The improved visualization and multiple blade options of the C-MAC videolaryngoscopy set likely contribute to these findings. Further research is warranted to confirm these results in larger, multicenter studies.</p> Trial registration <p>Institutional Review Board (Registration number: 80576354-050-99/437, 27.06.2024).</p>