Tritube® is an ultrathin ventilation tube for the peri-operative management of a stenosed laryngeal or tracheal airway. It is used in combination with an Evone® ventilator which provides flow-controlled ventilation (FCV). A stenosed airway can be passed easier compared to an endotracheal tube or a microlarynx (MLT) tube. It provides excellent ventilation conditions. There is no need for cross field intubation (CFI) and the surgeon is able to work around the Tritube®. Compared to jet ventilation there are less aerosols because of presence of a cuff. Positioning a Tritube® behind a stenosis or tumor in the distal trachea can be problematic, because the considerable length of the cuff (35 mm) and the distal end (30 mm). The presence of the cuff impedes resection of the trachea. Shortness of distance between the process and the main carina result in obstruction of the Tritube®. Furthermore, distal tracheal surgery is often performed by a right-sided thoracotomy and therefore one-lung-ventilation is required. To solve these problems, we modified the Tritube® so that it can fit the left main bronchus. It was successfully used for simple and complex distal tracheal surgery with the possibility to avoid CFI or even ECMO.