BACKGROUND: To test validity, safety, costs and healing-outcome of surgical minitracheotomy after cannula removing. METHODS: Design: Opened, perspective. Site: Polyvalent ICU. Patients: 40 patients underwent surgical minitracheotomy, in a year. Traditional surgical technique was adopted. Minitracheotomy was performed by intravenous general anesthesia with curarization and in mechanical ventilation. Intra-operative monitoring: ECG, non-invasive blood pressure and SaO2 by digital pulse oximetry. If a bleeding appeared, hemorrhage was stopped by vessel binding. RESULTS: Technical difficulty was the same in every tracheotomy carried out. Complications appeared in 7 patients. There were 2 infectious cases for stoma, resolved in 7 and 12 days respectively by local disinfection and antibiotic therapy. There were 5 cases with moderate bleeding; in one patient only a surgical procedure was necessary. CONCLUSIONS: Surgical tracheotomy represents a good and safe method in ICU; complications are few, if safety conditions are observed. Tracheotomy made in ICU reduced the use of medical and paramedical staff and operative rooms; unlike percutaneous procedure, in the surgical technique an always the same set after simple sterilization is used. Healing-outcome of surgical tracheotomy, after cannula removing, is the same with both techniques.