Open surgical access allows dissection, exposure and identification
of key structures, diathermy and management of large vessels, all under
direct vision
Percutaneous dilation through a scar from previous tracheostomy
risks tearing the trachea
Percutaneous tracheostomy has been described awake in elective and
emergency situations but the blind nature without bronchoscopy means
its safety is considered inferior to a surgical procedure under local
anaesthesia
Minimum times to safely change a tracheostomy tube are probably 3
days for surgical and 7-10 days for percutaneous tracheostomy
Bronchoscopy makes a percutaneous tracheostomy safer and is
recommended by a number of guidelines and authors