BACKGROUND Video laryngoscopes have been introduced in recent years as an alternative choice to facilitate tracheal intubation. We conducted a meta-analysis to assess their value when compared with direct laryngoscopy. METHODS PubMed and EMBASE were searched up until 24 September 2010. Randomised trials that reported data on the comparison of video laryngoscopes with direct laryngoscopy for tracheal intubation were included. RESULTS Eleven trials with a total of 1196 participants were identified. During tracheal intubation, video laryngoscopes can achieve a better view of the glottis and have a similar success rate [rate ratio 1.0; 95% confidence interval (CI) 0.99-1.01]. Overall, the time to tracheal intubation was not different between the video laryngoscopes and direct laryngoscopy (standardised mean difference 0.19; 95% CI -0.37-0.75). However, in a subgroup analysis, video laryngoscopes shortened the time taken for difficult intubation (standardised mean difference, -0.75; 95% CI -1.24 to -0.25). CONCLUSIONS Video laryngoscopes are a good alternative to direct laryngoscopy during tracheal intubation. The advantage seems to be more prominent when difficult intubation is encountered.