I would like to thank to Marshall for their response [1] on the topic of usability between videolaryngoscopy and direct laryngoscopy [2], as well as for an extended analysis of the system usability scale including its limitations when comparing medical devices. However, I would like to clarify that the focus on usability is not intended to question the complexity of the devices themselves. Rather, the emphasis is on the perceived complexity associated with using videolaryngoscopes as compared with direct laryngoscopes. The essence of usability studies lies in understanding the user's perspective – how they perceive the ease or difficulty of using a particular system. This approach does not challenge the established superiority of videolaryngoscopy but seeks to understand why this clearly superior device has not yet been universally adopted, despite overwhelming evidence and expert consensus supporting its use [3].

The analogy drawn between desk and cellular telephones and may also be apt in this regard. The rapid adoption of cellular telephones and shift from analogue devices was largely driven by substantial investments in communication infrastructure and network upgrades. Likewise, although we can continuously promote the use of videolaryngoscopy by emphasising its obvious clinical and procedural advantages, this approach appears to be inadequate. This is evident from the continued underuse of videolaryngoscopes even many years after their integration into clinical practice [4].

We already have good accounts on how strategic changes at the institutional level can facilitate this transition [5], including standardisation of device use or type locally. The challenge now is to scale such strategies to a broader, perhaps national or international level. Investing in the necessary infrastructure and simplifying the perceived complexity of using videolaryngoscopes can promote their broader adoption as a superior tool.

我要感谢 Marshall 对视频喉镜和直接喉镜之间的可用性主题的回应 [ 1 ]，以及对系统可用性量表的扩展分析，包括比较医疗设备时的局限性。然而，我想澄清的是，对可用性的关注并不是为了质疑设备本身的复杂性。相反，重点在于与直接喉镜相比，使用视频喉镜所带来的感知复杂性。可用性研究的本质在于理解用户的观点——他们如何看待使用特定系统的难易程度。这种方法并不挑战视频喉镜既定的优越性，而是试图了解为什么这种明显优越的设备尚未被普遍采用，尽管压倒性的证据和专家共识支持其使用[ 3 ]。

台式电话和移动电话之间的类比在这方面也可能是恰当的。蜂窝电话的快速普及和模拟设备的转变很大程度上是由通信基础设施和网络升级方面的大量投资推动的。同样，尽管我们可以通过强调其明显的临床和操作优势来不断推广视频喉镜的使用，但这种方法似乎还不够。即使在视频喉镜融入临床实践多年后，其使用仍然不足，这一点就很明显[ 4 ]。

我们已经很好地了解了机构层面的战略变革如何促进这一转变[ 5 ]，包括本地设备使用或类型的标准化。现在的挑战是将此类战略扩展到更广泛的层面，也许是国家或国际层面。投资必要的基础设施并简化使用视频喉镜的复杂性可以促进其作为优质工具的更广泛采用。