The endoscopic vision of the anatomic structures after DLET placement would be limited to the trachea because the fiber-optic bronchoscopy channel of the DLET does not allow any endoscopic tip flexure; in this way, possible lesions, anomalies, and decubiti could be missed. In addition, we believe that the procedure reduces or prevents the endoscopic vision of the surgical field because of the lack of air in the closed chamber created in the trachea. We believe that the reduced endoscopic vision increases the risk of complications. Our technique3,5 allows for wide endoscopic vision during the entire procedure without interfering with the ventilation and surgical equipment (Fig 1) and might be safer than the one suggested by Vargas et al.1 Finally, contrary to our continuous ventilation technique, cannula insertion occurred with the withdrawn DLET without any endoscopic vision, thus exposing patients to the same complications of a withdrawn ETT. For these reasons, we strongly believe that the use of the DLET should not be encouraged.