Elective conventional open tracheostomy is routinely performed by dividing the isthmus of the thyroid gland. An isthmus retraction hook is introduced that allows the isthmus to be preserved during open tracheostomy by retracting the isthmus cranially or caudally of the chosen tracheostomy site. The hook has been used in over 350 planned open tracheostomies; the isthmus was preserved in all cases.