Open surgical tracheotomy is a procedure used to create an opening in the front wall of the trachea. Over the years, percutaneous tracheotomy techniques have been developed, allowing for the placement of the tube at the bedside. Surgical tracheotomy may be necessary in emergency situations or performed electively to assist with mechanical ventilation. The typical procedure begins with positioning the patient in a way that optimizes neck extension. During this time, the surgeon should feel for the neck landmarks to locate the midline and laryngeal cartilages. Usually, a transverse incision is made between the sternal notch and the cricoid cartilage (approximately two fingers above the sternal notch). The next step involves dissecting the subcutaneous tissues and fasciae and moving the strap muscles to the sides. This action exposes the thyroid isthmus, which is then divided and tied off. The trachea is now exposed with only visible, with only the thin pretracheal fascia remaining intact. A window is created in the trachea, at least 0.5 cm below the cricoid cartilage. The final step is removing the endotracheal tube, performing suction if necessary, and inserting the desired tracheostomy tube. The tube is connected to the ventilator, and proper ventilation and end-tidal CO2 levels are used to confirm correct placement.