This is the first report of the novel surgical procedure to maintain the tracheal blood supply in anterior mediastinal tracheostomy.

The longer tracheal stump makes easier to create a tracheostomy, but has a disadvantage for its blood supply.

The unaffected-sided tracheal sheath was preserved in a state of connecting with the ipsilateral lobe of the thyroid gland and the tracheal stump.

The trachea was cut diagonally, leaving the unaffected tracheal wall longer.

This technique enables to secure the blood supply of the tracheal stump and to prevent postoperative fatal complications.