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The clinician places a Wilson intubator (the pink piece advanced into the mouth) to help keep the scope midline and guide it to the posterior pharynx. An assistant manually distracts the jaw anteriorly to provide viewing and maneuvering space for the scope. The scope is advanced carefully to identify the epiglottis and vocal cords before advancing into the trachea. Once the carina has been identified, the ETT is unlocked from the scope and gently advanced while keeping the carina in view so as not to mainstem the scope. After the ETT is positioned, the scope is advanced to the carina, and the clinican then pinches/holds the scope just at the proximal end of the ETT. By slowly withdrawing the scope until the distal end of the ETT is visible on the monitor, the distance from carina to ETT can be measured (by looking at the distance between where the scope is being pinched/held on the proximal end and the proximal end of the ETT). Ideally, this distance will be 2-4 cm and assures the ETT tip is in the mid-tracheal position. Next, the cuff is inflated, the rigid Wilson Intubator removed and the patient ventilated.

The fiberoptic bronchoscope (FOB) is a flexible device and as such cannot be used to move tissues.  An expensive device, it is re-used after sterilization but there have been reports of infection caused by improper sterilization of FOBs.  FOBs are also fragile (especially the glass fiber).  It has traditionally been the gold standard for management of the difficult airway   It requires a different grip (dagger grip) from direct laryngoscopy and the steering is complex.  It cannot be used instantly because it requires set-up (focus, view orientation and camera) and is not universally available.  The learning curve is prolonged requiring 45 uses to achieve expert skill status.