Since 1985, when Ciaglia introduced his percutaneous dilational tracheostomy technique, a separate operator has been used to maintain the placement of the withdrawn endotracheal tube with the cuff just above the vocal cords. This way of airway management is risky because accidental extubation2–, transfixation of the tube, and deflation of the cuff can happen. Serious complications, including emphysema, pneumothorax, and death, can result from the loss of the airway,3–6 but this technique has been used successfully by Cuvelier et al. Further, there is much evidence in the literature about the dangers of interference between bronchoscopy and ventilation.2,7–9 For this reason, Cuvelier et al use “intermittent endoscopic monitoring” to protect against hypoventilation. There is then a real risk of tracheal damage during the dilation phase and tracheostomy tube placement phase, which are both carried out without the aid of an endoscopic view.