Translaryngeal tracheotomy

Translaryngeal tracheotomy (TLT) is a retrograde, one-step technique of percutaneous tracheotomy, creating a stoma from inside the trachea to the outside by means of a special cone cannula. After tracheal puncture, a guidewire is inserted and advanced cephalad. Thereafter, the cone cannula is connected to the guidewire and, by pulling the neck end of the wire, advanced through pharynx and larynx into the trachea. The sharp metal cone penetrates the anterior tracheal wall, soft tissues, and skin. The final steps comprise cutting off the cone, straightening and rotating the cannula by 180°, then pushing it down the trachea. Although a meta-analysis did not favor a specific percutaneous tracheotomy technique in terms of overall complications, TLT has specific advantages in high-risk intensive care unit patients, such as in those with critical coagulopathy or severe respiratory failure. Pediatric TLT sets are available; however, clinical experience with TLT in children and infants is still very limited.