Horizontal incision is made through skin of anterior neck. Fat below skin is removed. Strap muscles are divided along midline muscular raphe. Isthmus of thyroid gland is divided, and trachea is exposed. Two polypropylene stay sutures are placed vertically on each side of planned tracheotomy. Stoma is matured by suturing skin edges directly to trachea. Vertical incision is made in trachea, and tracheostomy tube is inserted. Tube is secured with twill ties around neck. Video courtesy of Ravindhra G Elluru, MD, PhD.

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