Design, Development, and Mechanical Stress Testing of a 3D-printed, Low-Cost, Modular, Smartphone-Based Video Laryngoscope

Design, Development, and Mechanical Stress Testing of a 3D-printed, Low-Cost, Modular, Smartphone-Based Video Laryngoscope | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Design, Development, and Mechanical Stress Testing of a 3D-printed, Low-Cost, Modular, Smartphone-Based Video Laryngoscope Matthew Gue, Raymond Gue This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8504721/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Videolaryngoscopes provide many key advantages over direct laryngoscopy, including an improved view of the glottis and a greater first-attempt success rate. However, videolaryngoscopy systems are costly and not as accessible in lower-income countries and hospital systems. 3D printing has revolutionized medical tools by allowing for rapid prototyping and low-cost devices. In particular, 3D-printed videolaryngoscopes have already demonstrated their clinical viability as many anesthesia providers have implemented these devices on their medical missions around the world. Methods The GHAVL was designed with a computer-aided design software and 3D-printed from polylactic acid filament. A low-cost device was developed with the goal of containing excess wires and enabling single-operator use. Finite element analysis was conducted to determine the mechanical performance under incremental loads at the tip of the blade. Results The GHAVL consists of two main components: the blade/handle unit and the phone mount. The blade/handle unit was designed with a hollow handle to contain excess wires, and the two components connect via a snap-twist mechanism for rapid, reliable joining. Finite element analysis demonstrated the GHAVL blade tip displacements of 1.5mm, 3mm, 4.5mm, and 9mm under a load of 50N, 100N, 150N, and 300N, respectively. Conclusion The GHAVL is a modular system that integrates with an industrial endoscope and smartphone to create a low-cost, single-operator videolaryngoscope. Stress testing suggests the GHAVL’s structural integrity and ability to withstand forces of up to 150N with minimal blade deformation. The GHAVL demonstrates great promise, but it still requires extensive testing to determine its clinical applicability. Videolaryngoscope 3D-printing airway management low-cost medical devices global health Figures Figure 1 Figure 2 Figure 3 Background Videolaryngoscopes are an extremely valuable tool for tracheal intubation. Through a small camera at the tip of their curved blade, videolaryngoscopes (VLs) can provide live video footage and thus improved visualization of airway structures. Compared to direct laryngoscopy, VLs have been shown to improve the view of the glottis and reduce the number of failed intubations (Lewis et al., 2016 ). They were also found to help increase the rate of successful first attempt intubations and intubations on known difficult airways (Hansel et al., 2022 ). The advantages of VLs were especially evident during the COVID-19 pandemic. Clinician guidelines for intubating patients with COVID-19 recommended VLs for their improved visibility, especially with PPE possibly hindering a clear view of the airway, a greater success rate upon the first attempt, and an increased distance between the operator and the airway, decreasing aerosol exposure (Cook et al., 2020 ). As a result, videolaryngoscope use greatly increased during the COVID-19 pandemic. Nevertheless, current models, such as the McGrath MAC videolaryngoscope and the Verathon Glidescope Core System, can cost thousands of dollars. Thus, many low and middle-income countries still have limited access to these devices. A novel approach to improving accessibility is through 3D-printed videolaryngoscopes. A 3D-printed model paired with an industrial borescope camera that connects to a smartphone provides the same key advantages as commercially available VLs at a fraction of the cost. TANSEN, a 3D-printed and smartphone-compatible VL, exhibited a greater intubation success rate, time to intubation, and Cormack-Lehane grade compared to the Macintosh laryngoscope (Lambert et al., 2020 ). Many 3D-printed VLs, such as the AirAngel, are currently being used by clinicians on medical missions and in low-resource areas around the world. Another 3D model, the VLG3DUFF, costs around $ 30 including the reusable camera and can be sterilized via peracetic acid through the Sterrad technique (Silva et al., 2025 ). These models each offer innovations in reducing costs while maintaining functionality, though they still have practical limitations. Many models consist of a laryngoscope blade with a camera that connects to a smartphone or external monitor. However, because these cameras are often used for more industrial purposes, the wire connecting the camera to the smartphone or monitor is often much longer than needed. The two main drawbacks to this system are the need for an additional person to hold the smartphone or monitor and the excess wires, which can increase clutter and introduce additional non-sterile surfaces near the airway. Thus, there is a need for a 3D-printed VL that can contain excess wires and mount the smartphone, allowing for one-handed device operation. This paper describes the design, development, and mechanical stress testing of the Great Hearts Anesthesia Video Laryngoscope (GHAVL). Methods Materials and Equipment Used Autodesk Fusion360 was the computer-aided design software used for the design and revision of the GHAVL. The Bambu Labs P2S Printer and AMS 2 Pro system with a 0.4mm nozzle were used for printing (Bambu Labs). Polylactic Acid (PLA) filament was chosen for its toughness and stiffness, along with its biodegradable nature and potential for sterilization under low heat conditions. Specifically, Bambu Labs PLA basic filament was used. For the camera, a 7.9 mm industrial endoscope with an integrated light, 1m cable, and smartphone connection was used (Daxiongmao). No other outside materials were required in the production or assembly of the GHAVL. Costs The industrial endoscope camera was $ 18, and the total cost of the filament for the blade/handle unit and the phone mount was $ 3.83. Design Process The primary objectives for the design of the GHAVL were to maintain the advantages of the previous 3D-printed videolaryngoscopes while addressing the practical limitations of excess camera wires and the lack of an integrated phone mount for single-operator use. Thus, it was essential to preserve the device's low cost and maintain a general structure consistent with clinically established designs. Another objective was to not require any additional components, such as screws, springs, or adhesives. Strength Test A strength test was conducted in SimScale, a free tool for finite element analysis. The GHAVL file was imported, and the respective properties of the filament were added, including a Young’s Modulus of 2.58e + 9 Pa and a density of 1240 kg/m³ (Bambu Labs). Forces of 50N, 100N, 150N, and 300N were applied to the tip of the blade, and the resulting Von Mises results and displacements were recorded. Results Final Design The final design consists of two components: a joined blade/handle unit and a phone mount (Fig. 1 ). The blade/handle unit consists of a curved blade and a cylindrical handle. Along the path of the blade is a lowered plane where the camera and wire will rest. This plane contains a compartment to contain and guide the camera and three protruding features. These protrusions function to clip the wire to hold the camera in place and allow the operator to customize the depth of the camera relative to the blade. This lowered plane extends to a hole that connects to a hollow handle, where the excess wire can be coiled and stored. The top of the cylindrical handle contains four protrusions, which are part of the snap-twist connection that joins the blade/handle unit and phone mount together. The phone mount was adapted from an open-source model by user Jakejake (Thingiverse). It consists of a cylindrical base, which contains the corresponding part of the snap-twist connection. The cylindrical base contains an opening where the camera wire can exit and connect to a smartphone. This component utilizes two other 3D printed pieces that allow for a threaded mechanism to secure the smartphone in place. The two components join together through a snap-twist connection adapted from Joseph Willis’ design that ensures a quick and consistent joining with proper alignment. The protrusions on the blade/handle unit are inserted into the cutouts on the phone mount. After a slight twist of the phone mount counter-clockwise, the two components snap into position. This locked position ensures that the blade is opposite to where the phone will be inserted, ensuring proper orientation for use. GHAVL components (left) and fully assembled device (right). Components are shown from left to right as the phone mount, industrial endoscope, handle and blade, and smartphone. Dimensions The handle has a length of 100m and a radius of 17.88mm. The blade was modeled after a standard Macintosh laryngoscope blade with a width of 19mm, tip to heel length of 103mm, and inner arc length of 134mm. Operational Workflow As shown in Fig. 2 , the camera wire is first inserted into the hollow handle and through the opening that extends to the blade. The camera is then positioned into the camera compartment. Once in the desired position, the wire is clamped between the three raised protruding features to lock the camera in place. The excess wire is coiled and stored in the handle. The free end of the camera wire is passed through the opening on the phone mount. Using the snap-twist mechanism, the phone mount is attached to the blade/handle unit. The smartphone is placed onto the mount and secured through the threading mechanism. Finally, the free end of the camera wire is connected to the smartphone. Once connected to the smartphone, the camera can be rotated to ensure the proper orientation. Strength Test Figure 3 below displays the Von Mises results and respective displacements. In response to an applied force of 50N, the blade was displaced 1.5mm at the tip. In response to an applied force of 100N, the blade was displaced 3mm at the tip. In response to an applied force of 150N, the blade was displaced 4.5mm at the tip. In response to an applied force of 300N, the blade was displaced 9mm at the tip, indicating possible deformation or structural damage. Von Mises Results (Left) and Tip Displacement (Right) for a force of (a) 50N (b) 100N (c) 150N and (d) 300N on the tip of the blade. Discussion This study aimed to describe the design, development, and mechanical stress testing of a low-cost, modular, smartphone-based videolaryngoscope that addresses limitations of current 3D-printed VLs. To maintain the low cost of VLs, many 3D-printed models, including the GHAVL, utilize an industrial endoscope, which often has wires that can range anywhere from 1m to 3m. These cameras also require an external smartphone or monitor. Thus, the two main drawbacks to current 3D-printed VL systems are the need for an additional person to hold the smartphone or monitor and the excess wires, which are often wrapped around the handle. The GHAVL addresses this first concern by creating a modular blade/handle and phone mount system. Using the snap-twist mechanism, the phone mount can be quickly attached to the blade/handle unit and properly aligned so the smartphone is in the correct viewing position relative to the blade. This design parallels the McGrath videolaryngoscope, allowing a single operator to seamlessly view the live video footage while controlling the laryngoscope. Another benefit of this modular design is the ability to use the blade/handle unit as a standard laryngoscope without the other components. If a smartphone or external monitor is unavailable or videolaryngoscopy is not needed, the GHAVL remains functional, although an external light source is required. The GHAVL also addresses the excess wires by integrating a hollow handle. Existing 3D-printed VLs, such as the AirAngel, contain an indentation on the back of the handle to guide the wire. Nevertheless, the wire must still be secured to the handle, and the excess cable length is often wrapped multiple times around the handle or repositioned away from the airway. The GHAVL builds upon these designs by guiding the wire into the handle, where excess cable can be coiled and stored. The modular phone mount and hollow-blade/handle unit create a single-operator system that manages excess wires. Preliminary stress testing through finite element analysis demonstrates the GHAVL’s ability to withstand forces up to 150N at the tip with minor displacement. At this load, the tip of the blade demonstrated a maximum displacement of 4.5mm, suggesting moderate structural integrity. Laryngoscope blades are subject to rigorous mechanical standards (ISO 7376:2020), one of which is withstanding a tensile force of 150N. These findings support the GHAVL’s ability to withstand a force ranging from 50N to 150N and suggest the need for further performance testing to determine the GHAVL’s potential applicability in a clinical setting. The GHAVL’s low-cost, single-operator, and smartphone-compatible nature demonstrates promise for its usability in environments that do not have access to commercial videolaryngoscopes. This study has several limitations in the design and testing of the GHAVL. The snap-twist mechanism must be tested for its long-term durability. Although initial use has shown no signs of functional loss, the mechanism may be subject to gradual mechanical wear. The use of PLA filament also introduces limitations for sterilization. Since PLA filament has low heat resistance, alternative methods of sterilization outside of the standard autoclaving method is required. Previous research has suggested PLA sterilization using hydrogen peroxide gas plasma or peracetic acid (Davila et al., 2021), although further testing is required to determine if repeated use of these techniques compromises key features of the GHAVL. The finite element analysis suggests preliminary load resistance, but real-world strength tests are needed for validation. Future experiments are needed to draw more reliable conclusions on the GHAVL’s clinical applicability. Simulation tests on airway manikins are needed to determine speed and ease of use. Specifically, comparing the GHAVL to other 3D-printed and commercial videolaryngoscopes based on time to intubation, success rate, and Cormack-Lehane grading can provide valuable information on its applicability in a clinical setting. Incorporating feedback from practicing anesthesia providers is also needed to make further improvements. Conclusion The GHAVL’s modular system and hollow handle to store excess wires addresses key limitations of current 3D-printed VL systems while still maintaining a low-cost and smartphone compatible system. Together, these features allow a single operator to use the GHAVL, requiring only the two 3D-printed parts, an industrial endoscope, and a smartphone. Furthermore, finite element analysis stress testing demonstrates the GHAVL’s potential to withstand forces up to 150N. This study details design features of the GHAVL aimed to increase the efficiency and feasibility of utilizing 3D-printed videolaryngoscopes in low-income hospital envionments. Nevertheeless, additional physical, sterilization, and simulation-based testing are required to fully evaluate the GHAVL’s clinical applicability. Abbreviations VL : videolaryngoscope GHAVL : Great Hearts Anesthesia Videolaryngoscope PLA : polylactic acid Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Availability of data and materials All data generated or analysed during this study are included in this published article. Competing interests The authors declare that they have no competing interests. Funding None. Authors’ contributions Matthew Gue and Raymond Gue contributed equally to this work and share first authorship. MG and RG were involved in study design, device design, mechanical analysis, figure design, and manuscript preparation. Both authors read and approved the final manuscript. Acknowledgements The authors independently conducted this work. No institutional funding, facilities, or oversight were provided by Midwestern University Arizona College of Osteopathic Medicine or the University of California, Los Angeles. References Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19: Guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists. Anaesthesia. 2020. 10.1111/anae.15054 . Hansel J, Rogers AM, Lewis SR, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adults undergoing tracheal intubation: a Cochrane systematic review and meta-analysis update. Br J Anaesth. 2022. 10.1016/j.bja.2022.05.027 . Lambert CT, John SC, John AV. Development and performance testing of the low-cost, 3D-printed, smartphone-compatible 'Tansen Videolaryngoscope' vs. Pentax-AWS videolaryngoscope vs. direct Macintosh laryngoscope: A manikin study. Eur J Anaesthesiol. 2020; 10.1097/EJA.0000000000001264 . PMID. Lewis SR, Butler AR, Parker J, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation. Cochrane Database Syst Rev. 2016; 10.1002/14651858.CD011136.pub2 . Update in: Cochrane Database Syst Rev. 2022; doi: 10.1002/14651858.CD011136.pub3. Pérez Davila S, González Rodríguez L, Chiussi S, Serra J, González P. How to Sterilize Polylactic Acid Based Medical Devices? Polymers (Basel). 2021; 10.3390/polym13132115 Silva AJ, Verçosa N, Lima LG, et al. 3D printing of a low-cost videolaryngoscope for tracheal intubation. Sci Rep. 2025. 10.1038/s41598-025-10332-3 . Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":192959,"visible":true,"origin":"","legend":"\u003cp\u003eGreat Hearts Anesthesia Video Laryngosocope (GHAVL)\u003c/p\u003e\n\u003cp\u003eGHAVL components (left) and fully assembled device (right). Components are shown from left to right as the phone mount, industrial endoscope, handle and blade, and smartphone.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8504721/v1/3a8e86acc3cef7a2d6c5cf49.png"},{"id":100735539,"identity":"94b00375-2b30-40b6-996e-af3e6e7eec37","added_by":"auto","created_at":"2026-01-20 22:26:25","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":356826,"visible":true,"origin":"","legend":"\u003cp\u003eGreat Hearts Anesthesia Video Laryngosocope (GHAVL) Operational Workflow Steps\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8504721/v1/ab577cbf78b9ecf40dac4e19.png"},{"id":100735342,"identity":"deedfffc-b7e0-4202-aaf4-ec0521a6852a","added_by":"auto","created_at":"2026-01-20 22:23:57","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":462428,"visible":true,"origin":"","legend":"\u003cp\u003eSimScale Finite Element Analysis\u003c/p\u003e\n\u003cp\u003eVon Mises Results (Left) and Tip Displacement (Right) for a force of (a) 50N (b) 100N (c) 150N and (d) 300N on the tip of the blade.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8504721/v1/7f73eb2cd300f4bd5e4bf362.png"},{"id":106403045,"identity":"49b92084-079d-4314-a2d7-bf374d0ea2a5","added_by":"auto","created_at":"2026-04-08 09:13:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1300681,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8504721/v1/da141a62-3fc0-45f0-939a-0c400f5a0902.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Design, Development, and Mechanical Stress Testing of a 3D-printed, Low-Cost, Modular, Smartphone-Based Video Laryngoscope","fulltext":[{"header":"Background","content":"\u003cp\u003eVideolaryngoscopes are an extremely valuable tool for tracheal intubation. Through a small camera at the tip of their curved blade, videolaryngoscopes (VLs) can provide live video footage and thus improved visualization of airway structures. Compared to direct laryngoscopy, VLs have been shown to improve the view of the glottis and reduce the number of failed intubations (Lewis et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). They were also found to help increase the rate of successful first attempt intubations and intubations on known difficult airways (Hansel et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The advantages of VLs were especially evident during the COVID-19 pandemic. Clinician guidelines for intubating patients with COVID-19 recommended VLs for their improved visibility, especially with PPE possibly hindering a clear view of the airway, a greater success rate upon the first attempt, and an increased distance between the operator and the airway, decreasing aerosol exposure (Cook et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). As a result, videolaryngoscope use greatly increased during the COVID-19 pandemic.\u003c/p\u003e \u003cp\u003eNevertheless, current models, such as the McGrath MAC videolaryngoscope and the Verathon Glidescope Core System, can cost thousands of dollars. Thus, many low and middle-income countries still have limited access to these devices. A novel approach to improving accessibility is through 3D-printed videolaryngoscopes. A 3D-printed model paired with an industrial borescope camera that connects to a smartphone provides the same key advantages as commercially available VLs at a fraction of the cost. TANSEN, a 3D-printed and smartphone-compatible VL, exhibited a greater intubation success rate, time to intubation, and Cormack-Lehane grade compared to the Macintosh laryngoscope (Lambert et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMany 3D-printed VLs, such as the AirAngel, are currently being used by clinicians on medical missions and in low-resource areas around the world. Another 3D model, the VLG3DUFF, costs around \u003cspan\u003e$\u003c/span\u003e30 including the reusable camera and can be sterilized via peracetic acid through the Sterrad technique (Silva et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). These models each offer innovations in reducing costs while maintaining functionality, though they still have practical limitations. Many models consist of a laryngoscope blade with a camera that connects to a smartphone or external monitor. However, because these cameras are often used for more industrial purposes, the wire connecting the camera to the smartphone or monitor is often much longer than needed. The two main drawbacks to this system are the need for an additional person to hold the smartphone or monitor and the excess wires, which can increase clutter and introduce additional non-sterile surfaces near the airway. Thus, there is a need for a 3D-printed VL that can contain excess wires and mount the smartphone, allowing for one-handed device operation. This paper describes the design, development, and mechanical stress testing of the Great Hearts Anesthesia Video Laryngoscope (GHAVL).\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eMaterials and Equipment Used\u003c/p\u003e \u003cp\u003eAutodesk Fusion360 was the computer-aided design software used for the design and revision of the GHAVL. The Bambu Labs P2S Printer and AMS 2 Pro system with a 0.4mm nozzle were used for printing (Bambu Labs). Polylactic Acid (PLA) filament was chosen for its toughness and stiffness, along with its biodegradable nature and potential for sterilization under low heat conditions. Specifically, Bambu Labs PLA basic filament was used. For the camera, a 7.9 mm industrial endoscope with an integrated light, 1m cable, and smartphone connection was used (Daxiongmao). No other outside materials were required in the production or assembly of the GHAVL.\u003c/p\u003e \u003cp\u003eCosts\u003c/p\u003e \u003cp\u003eThe industrial endoscope camera was \u003cspan\u003e$\u003c/span\u003e18, and the total cost of the filament for the blade/handle unit and the phone mount was \u003cspan\u003e$\u003c/span\u003e3.83.\u003c/p\u003e \u003cp\u003eDesign Process\u003c/p\u003e \u003cp\u003eThe primary objectives for the design of the GHAVL were to maintain the advantages of the previous 3D-printed videolaryngoscopes while addressing the practical limitations of excess camera wires and the lack of an integrated phone mount for single-operator use. Thus, it was essential to preserve the device's low cost and maintain a general structure consistent with clinically established designs. Another objective was to not require any additional components, such as screws, springs, or adhesives.\u003c/p\u003e \u003cp\u003eStrength Test\u003c/p\u003e \u003cp\u003eA strength test was conducted in SimScale, a free tool for finite element analysis. The GHAVL file was imported, and the respective properties of the filament were added, including a Young\u0026rsquo;s Modulus of 2.58e\u0026thinsp;+\u0026thinsp;9 Pa and a density of 1240 kg/m\u0026sup3; (Bambu Labs). Forces of 50N, 100N, 150N, and 300N were applied to the tip of the blade, and the resulting Von Mises results and displacements were recorded.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eFinal Design\u003c/p\u003e \u003cp\u003eThe final design consists of two components: a joined blade/handle unit and a phone mount (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe blade/handle unit consists of a curved blade and a cylindrical handle. Along the path of the blade is a lowered plane where the camera and wire will rest. This plane contains a compartment to contain and guide the camera and three protruding features. These protrusions function to clip the wire to hold the camera in place and allow the operator to customize the depth of the camera relative to the blade. This lowered plane extends to a hole that connects to a hollow handle, where the excess wire can be coiled and stored. The top of the cylindrical handle contains four protrusions, which are part of the snap-twist connection that joins the blade/handle unit and phone mount together.\u003c/p\u003e \u003cp\u003eThe phone mount was adapted from an open-source model by user Jakejake (Thingiverse). It consists of a cylindrical base, which contains the corresponding part of the snap-twist connection. The cylindrical base contains an opening where the camera wire can exit and connect to a smartphone. This component utilizes two other 3D printed pieces that allow for a threaded mechanism to secure the smartphone in place.\u003c/p\u003e \u003cp\u003eThe two components join together through a snap-twist connection adapted from Joseph Willis\u0026rsquo; design that ensures a quick and consistent joining with proper alignment. The protrusions on the blade/handle unit are inserted into the cutouts on the phone mount. After a slight twist of the phone mount counter-clockwise, the two components snap into position. This locked position ensures that the blade is opposite to where the phone will be inserted, ensuring proper orientation for use.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eGHAVL components (left) and fully assembled device (right). Components are shown from left to right as the phone mount, industrial endoscope, handle and blade, and smartphone.\u003c/p\u003e \u003cp\u003eDimensions\u003c/p\u003e \u003cp\u003eThe handle has a length of 100m and a radius of 17.88mm. The blade was modeled after a standard Macintosh laryngoscope blade with a width of 19mm, tip to heel length of 103mm, and inner arc length of 134mm.\u003c/p\u003e \u003cp\u003eOperational Workflow\u003c/p\u003e \u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the camera wire is first inserted into the hollow handle and through the opening that extends to the blade. The camera is then positioned into the camera compartment. Once in the desired position, the wire is clamped between the three raised protruding features to lock the camera in place. The excess wire is coiled and stored in the handle. The free end of the camera wire is passed through the opening on the phone mount. Using the snap-twist mechanism, the phone mount is attached to the blade/handle unit. The smartphone is placed onto the mount and secured through the threading mechanism. Finally, the free end of the camera wire is connected to the smartphone. Once connected to the smartphone, the camera can be rotated to ensure the proper orientation.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eStrength Test\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e below displays the Von Mises results and respective displacements. In response to an applied force of 50N, the blade was displaced 1.5mm at the tip. In response to an applied force of 100N, the blade was displaced 3mm at the tip. In response to an applied force of 150N, the blade was displaced 4.5mm at the tip. In response to an applied force of 300N, the blade was displaced 9mm at the tip, indicating possible deformation or structural damage.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eVon Mises Results (Left) and Tip Displacement (Right) for a force of (a) 50N (b) 100N (c) 150N and (d) 300N on the tip of the blade.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to describe the design, development, and mechanical stress testing of a low-cost, modular, smartphone-based videolaryngoscope that addresses limitations of current 3D-printed VLs. To maintain the low cost of VLs, many 3D-printed models, including the GHAVL, utilize an industrial endoscope, which often has wires that can range anywhere from 1m to 3m. These cameras also require an external smartphone or monitor. Thus, the two main drawbacks to current 3D-printed VL systems are the need for an additional person to hold the smartphone or monitor and the excess wires, which are often wrapped around the handle.\u003c/p\u003e \u003cp\u003eThe GHAVL addresses this first concern by creating a modular blade/handle and phone mount system. Using the snap-twist mechanism, the phone mount can be quickly attached to the blade/handle unit and properly aligned so the smartphone is in the correct viewing position relative to the blade. This design parallels the McGrath videolaryngoscope, allowing a single operator to seamlessly view the live video footage while controlling the laryngoscope. Another benefit of this modular design is the ability to use the blade/handle unit as a standard laryngoscope without the other components. If a smartphone or external monitor is unavailable or videolaryngoscopy is not needed, the GHAVL remains functional, although an external light source is required.\u003c/p\u003e \u003cp\u003eThe GHAVL also addresses the excess wires by integrating a hollow handle. Existing 3D-printed VLs, such as the AirAngel, contain an indentation on the back of the handle to guide the wire. Nevertheless, the wire must still be secured to the handle, and the excess cable length is often wrapped multiple times around the handle or repositioned away from the airway. The GHAVL builds upon these designs by guiding the wire into the handle, where excess cable can be coiled and stored. The modular phone mount and hollow-blade/handle unit create a single-operator system that manages excess wires.\u003c/p\u003e \u003cp\u003ePreliminary stress testing through finite element analysis demonstrates the GHAVL\u0026rsquo;s ability to withstand forces up to 150N at the tip with minor displacement. At this load, the tip of the blade demonstrated a maximum displacement of 4.5mm, suggesting moderate structural integrity. Laryngoscope blades are subject to rigorous mechanical standards (ISO 7376:2020), one of which is withstanding a tensile force of 150N. These findings support the GHAVL\u0026rsquo;s ability to withstand a force ranging from 50N to 150N and suggest the need for further performance testing to determine the GHAVL\u0026rsquo;s potential applicability in a clinical setting. The GHAVL\u0026rsquo;s low-cost, single-operator, and smartphone-compatible nature demonstrates promise for its usability in environments that do not have access to commercial videolaryngoscopes.\u003c/p\u003e \u003cp\u003eThis study has several limitations in the design and testing of the GHAVL. The snap-twist mechanism must be tested for its long-term durability. Although initial use has shown no signs of functional loss, the mechanism may be subject to gradual mechanical wear. The use of PLA filament also introduces limitations for sterilization. Since PLA filament has low heat resistance, alternative methods of sterilization outside of the standard autoclaving method is required. Previous research has suggested PLA sterilization using hydrogen peroxide gas plasma or peracetic acid (Davila et al., 2021), although further testing is required to determine if repeated use of these techniques compromises key features of the GHAVL. The finite element analysis suggests preliminary load resistance, but real-world strength tests are needed for validation.\u003c/p\u003e \u003cp\u003eFuture experiments are needed to draw more reliable conclusions on the GHAVL\u0026rsquo;s clinical applicability. Simulation tests on airway manikins are needed to determine speed and ease of use. Specifically, comparing the GHAVL to other 3D-printed and commercial videolaryngoscopes based on time to intubation, success rate, and Cormack-Lehane grading can provide valuable information on its applicability in a clinical setting. Incorporating feedback from practicing anesthesia providers is also needed to make further improvements.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe GHAVL\u0026rsquo;s modular system and hollow handle to store excess wires addresses key limitations of current 3D-printed VL systems while still maintaining a low-cost and smartphone compatible system. Together, these features allow a single operator to use the GHAVL, requiring only the two 3D-printed parts, an industrial endoscope, and a smartphone. Furthermore, finite element analysis stress testing demonstrates the GHAVL\u0026rsquo;s potential to withstand forces up to 150N. This study details design features of the GHAVL aimed to increase the efficiency and feasibility of utilizing 3D-printed videolaryngoscopes in low-income hospital envionments. Nevertheeless, additional physical, sterilization, and simulation-based testing are required to fully evaluate the GHAVL\u0026rsquo;s clinical applicability.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eVL\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003evideolaryngoscope\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eGHAVL\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eGreat Hearts Anesthesia Videolaryngoscope\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePLA\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e polylactic acid\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable. \u003c/p\u003e\n\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article.\u003c/p\u003e\n\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\n\u003cp\u003eAuthors\u0026rsquo; contributions\u003c/p\u003e\n\u003cp\u003eMatthew Gue and Raymond Gue contributed equally to this work and share first authorship. MG and RG were involved in study design, device design, mechanical analysis, figure design, and manuscript preparation. Both authors read and approved the final manuscript. \u003c/p\u003e\n\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors independently conducted this work. No institutional funding, facilities, or oversight were provided by Midwestern University Arizona College of Osteopathic Medicine or the University of California, Los Angeles. \u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19: Guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists. Anaesthesia. 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/anae.15054\u003c/span\u003e\u003cspan address=\"10.1111/anae.15054\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHansel J, Rogers AM, Lewis SR, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adults undergoing tracheal intubation: a Cochrane systematic review and meta-analysis update. Br J Anaesth. 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.bja.2022.05.027\u003c/span\u003e\u003cspan address=\"10.1016/j.bja.2022.05.027\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLambert CT, John SC, John AV. Development and performance testing of the low-cost, 3D-printed, smartphone-compatible 'Tansen Videolaryngoscope' vs. Pentax-AWS videolaryngoscope vs. direct Macintosh laryngoscope: A manikin study. Eur J Anaesthesiol. 2020; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/EJA.0000000000001264\u003c/span\u003e\u003cspan address=\"10.1097/EJA.0000000000001264\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLewis SR, Butler AR, Parker J, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation. Cochrane Database Syst Rev. 2016;\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/14651858.CD011136.pub2\u003c/span\u003e\u003cspan address=\"10.1002/14651858.CD011136.pub2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Update in: Cochrane Database Syst Rev. 2022; doi: 10.1002/14651858.CD011136.pub3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eP\u0026eacute;rez Davila S, Gonz\u0026aacute;lez Rodr\u0026iacute;guez L, Chiussi S, Serra J, Gonz\u0026aacute;lez P. How to Sterilize Polylactic Acid Based Medical Devices? Polymers (Basel). 2021; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/polym13132115\u003c/span\u003e\u003cspan address=\"10.3390/polym13132115\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSilva AJ, Ver\u0026ccedil;osa N, Lima LG, et al. 3D printing of a low-cost videolaryngoscope for tracheal intubation. Sci Rep. 2025. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41598-025-10332-3\u003c/span\u003e\u003cspan address=\"10.1038/s41598-025-10332-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Videolaryngoscope, 3D-printing, airway management, low-cost medical devices, global health","lastPublishedDoi":"10.21203/rs.3.rs-8504721/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8504721/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eVideolaryngoscopes provide many key advantages over direct laryngoscopy, including an improved view of the glottis and a greater first-attempt success rate. However, videolaryngoscopy systems are costly and not as accessible in lower-income countries and hospital systems. 3D printing has revolutionized medical tools by allowing for rapid prototyping and low-cost devices. In particular, 3D-printed videolaryngoscopes have already demonstrated their clinical viability as many anesthesia providers have implemented these devices on their medical missions around the world.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe GHAVL was designed with a computer-aided design software and 3D-printed from polylactic acid filament. A low-cost device was developed with the goal of containing excess wires and enabling single-operator use. Finite element analysis was conducted to determine the mechanical performance under incremental loads at the tip of the blade.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe GHAVL consists of two main components: the blade/handle unit and the phone mount. The blade/handle unit was designed with a hollow handle to contain excess wires, and the two components connect via a snap-twist mechanism for rapid, reliable joining. Finite element analysis demonstrated the GHAVL blade tip displacements of 1.5mm, 3mm, 4.5mm, and 9mm under a load of 50N, 100N, 150N, and 300N, respectively.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe GHAVL is a modular system that integrates with an industrial endoscope and smartphone to create a low-cost, single-operator videolaryngoscope. Stress testing suggests the GHAVL\u0026rsquo;s structural integrity and ability to withstand forces of up to 150N with minimal blade deformation. The GHAVL demonstrates great promise, but it still requires extensive testing to determine its clinical applicability.\u003c/p\u003e","manuscriptTitle":"Design, Development, and Mechanical Stress Testing of a 3D-printed, Low-Cost, Modular, Smartphone-Based Video Laryngoscope","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-20 21:23:52","doi":"10.21203/rs.3.rs-8504721/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c299fe6b-5909-40dd-a0f7-24d459b96187","owner":[],"postedDate":"January 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-06T10:12:27+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-20 21:23:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8504721","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8504721","identity":"rs-8504721","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}