The aim of this study was to demonstrate that performance of percutaneous dilatational tracheostomy (PDT) associated with a self-drive control technique lowers the incidence of complications. A case-control, before-and-after, retrospective study. Place of study: A major teaching hospital in the Department of Emergency, Intensive Care Unit. we studied 128 patients who underwent fiberoptic-guided PDT over an 18 month period of time. Thirty-nine patients were assisted by conventional fiberoptic bronchoscopy, while 89 video-assisted fiberoptic procedures were performed in which the operator controlled his own actions on a screen. We defined perioperative complications as accidental extubation, perioperative hemorrhage, tracheal ring rupture, lesions of the tracheal wall, and abnormal insertion of the cannula. A Chi-square test, Student's t-test and U Mann Whitney test were used to compare the incidence of complications and the duration of procedure in the traditional fiberoptic PDT group and in the video-guided group. Procedure time was significantly shorter in the group with the self-drive control technique. There was also a reduction of the number of perioperative complications. Fiberoptic bronchoscopy associated with a video system seems effective in reducing the risk of perioperative complications.