Dr. Asai appears to be discussing a slightly different, yet intriguing concept that he has previously published.

  It is important to clarify, as he mentioned in his letter, that depending on the patient, the endotracheal tube could extend beyond the glottis, surpassing the grille of the laryngeal mask airway. However, due to the limit of 250 words, we were unable to provide complete clarity, although that may not have been the primary focus. Removing the laryngeal mask airway while the tube is in place would require the use of a device referred to as a “pusher” in our description or, as Dr. Asai suggests, a “stabilizer.” Naturally, there are numerous clinical scenarios where these related techniques could be used. Our aim was simply to describe a situation where direct laryngoscopy was ineffective for intubating a premature neonate. The patient was stabilized using a laryngeal mask airway and required definitive airway management before being transferred to the intensive care unit, necessitating the removal of the laryngeal mask airway. Although stabilizer rods are available for adult airway devices, there is no Food and Drug Administration–approved device for such purposes in the realm of premature neonate airways. Our technique differs from what Dr. Asai described in his case report. He used a second endotracheal tube as a “stabilizer,” which we referred to as a “pusher” to hold the primary tube in place when he removed the laryngeal mask airway and reconfirmed the correct placement of the primary tube. In our approach, we used the “pusher” to hold the primary tube in place when we removed the laryngeal mask airway without losing the view of the carina and ensuring the primary tube remained in the correct position during the removal of the laryngeal mask airway. We believe this is critical for managing difficult airways in neonates. Therefore, the innovative approach of using a second endotracheal tube serves this purpose effectively.