After standardizing surgical procedures around 1900 Shelden, Toye, Weinstein and Ciaglia developed the percutaneous dilational tracheotomy (PDT). At present it is recognized that about 50% of the anestesiological Intensive care Units (ICU) in Germany are using the PDT while favorizing the Ciaglia-technique in the majority of cases. Further techniques are known as Griggs-, Fantoni-, Percu-Twist- and Blue-Rhino-method. Some of these are relatively new, therefore making critical comparison with other methods almost impossible due to lack of experience. The most feared complications of PDT are injury of the cricoid cartilage or of the rear tracheal wall as well as paratracheal positioning of a tracheotomy tube. Comparison between PDT and surgical techniques are difficult due to certain contraindications for PDT which are not valid for surgical procedures. Consecutively PDT will not be able to substitute surgical tracheotomy in the future. It furthermore can't be advocated as an alternative therapeutic option for mobile in-patients outside the ICU.