The distance from the carina to the tip of the tracheal tube was measu
red with a fibreoptic bronchoscope in 21 consecutive patients undergoi
ng elective laparoscopic cholecystectomy. After placement of an Eschma
nn tracheal tube with a printed intubation guide mark at the vocal cor
ds, the distance was 28 (15) [5-54]mm (mean (SD) [range]). The tube wa
s then repositioned so that the distance was 34 (3) [30-40]mm from tip
of the tube to the carina. After creation of pneumoperitoneum, the di
stance was significantly decreased to 26 (5) [17-35]mm (p < 0.005), wh
ich was not significantly altered by subsequent moving of the patient
to the reverse Trendelenburg and left lateral tilt position. The maxim
um distance of tube migration was 8 (4) [0-15]mm. Four out of 21 patie
nts would have been at risk of bronchial intubation after pneumoperito
neum if the tube had not been repositioned. Placement of the tube acco
rding to the guide mark is not recommended for laparoscopic cholecyste
ctomy.