A recent innovation in the technique of tracheostomy is now available as a commercial kit. A standard tracheostomy tube is inserted using a guidewire and dilator as in the Seldinger technique. The kit was used in nine cases in a unit with a head and neck oncology interest. Two failures were experienced but no serious or fatal complications. The technique is limited when applied to necks which are not anatomically ‘ideal’, and hence will have application in head and neck surgery only after careful patient selection