Neonatal tracheostomy is a complex procedure associated with significant morbidity due to the small size and medical condition of the patient. Standard techniques have been well described and depend on palpation and visual identification of the trachea in the wound. This can at times be exceedingly difficult depending on the anatomical configuration of the neck. The potential for damage to adjacent neurovascular structures increases as dissection strays away from the midline. We describe a new technique that restricts dissection strictly to the midline and ensures accurate placement of the tracheostomy below the first tracheal ring. We feel that this technique will significantly shorten the operative time for the procedure and also reduce the morbidity associated with it.