The method of open tracheostomy, which was originally standardized by Jackson1 in 1909, was the mainstay of "interventional" airway management for more than 40 years. In 1955, Shelden et al2 described a percutaneous approach in which a cutting trocar was used to form the tracheostomy. This approach was modified later using a Seldinger technique,3 which in turn was refined by Ciaglia et al4 and Griggs et al5 using a system of serial dilators and dilator forceps, respectively.