Surgical removal of the larynx is usually a treatment for cancer of the larynx. Surgery is invasive, prolonged, and carries risks of bleeding and airway difficulties throughout.

One of the most hazardous points in the operation is the exchange between the oral endotracheal tube and the new tracheostomy tube, which is inserted under direct vision by the surgical team. This manoeuvre calls for very careful communication and close cooperation with the surgical team.

Assessment of the airway is particularly important. Many patients have had radiotherapy to the neck. The fibrosis this causes may reduce normal neck movement and mandibular protrusion, making intubation difficult or impossible.

There is often a history of smoking and poor nutritional status, plus cardiovascular and respiratory disease.