Percutaneous
Surgical
Advantages
- Relatively quick in experienced hands 1
- Avoids need for transfer of unstable patients 1
- Does not require involvement of surgeons 1
- Cheaper 1
- Smaller scar 1
- Tighter stoma that decreases stomal bleeding and provides better fit 1
- Can be performed when percutaneous contraindicated:
- Short or thick neck, obese 1
- Coagulopathy 1
- Unstable spine 1
- Previous neck / thyroid surgery 1
- Abnormal vessels 1
- Resources available to control bleeding 1
- Potentially easier management in event of early tube dislodgment or tube exchange: 1
- Stoma stitched open
- May have stay sutures to elevate the trachea
Disadvantages
- Suboptimal conditions for management of bleeding, especially if major vessel injured
- Blind techniques can be incorrectly positioned
- Tracheal ring fracture can occur
- Late tracheal stenosis (as per surgical tracheostomy)
- Lack of surgical dissection can increase risk of vascular or thyroid injury
- Potentially more difficult management in event of early tube dislodgment or tube exchange:
- Tissues will tend to ‘spring’ closed when tube removed in first 7–10 days
- Requires operating theatre leading to delays in insertion
- Requires patient transfer
- More expensive