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and submission of the manuscript. SAN critically reviewed the manuscript. Both authors read and approved the final manuscript submission.”
“Introduction Tracheostomy is one of the most frequently performed surgical procedures in intensive care unit (ICU) patients [1]. Percutaneous tracheostomy has gained widespread acceptance as an alternative to open surgical tracheostomy with the advantage of “”bedside”" performance and minimal morbidity [2–4]. Most percutaneous tracheostomy

methods incorporate the Seldinger technique to gain initial access to the tracheal lumen. However, after that initial step, a number of variations have been described [2, 4–10]. The method introduced by Ciaglia and colleagues in 1985, has become the most popular technique for percutaneous tracheostomy [2]. Different strategies to dilate the tracheal breach are utilized in the Percu Twist™technique (Rüsch, Kernen, Germany) and in the Griggs method Verteporfin (Portex® Smiths Medical International Ltd., Hythe, Kent, UK) [5, 10–12]. In the Percu Twist™technique a tracheal stoma is created by a screwlike dilating device, whereas in the method introduced by Griggs a pair of forceps are used to dilate the tracheal breach [5, 9–14]. Compression of the anterior tracheal wall is minimal in both methods potentially reducing injury to the posterior wall [12, 13]. The aim of this study is to describe a technical modification of percutaneous tracheostomy that combines the principles of the Percu Twist™ and the Griggs-Portex® methods. Materials and methods This prospective case series study was approved by the Research Ethics Committee of the Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (resolution number: ETIC 0392.0.203.