Objective To analyze the clinical key points of minimally invasive tracheostomy with percutaneous horn expansion applicated in ICU,and to discuss the problems encountered in minimally invasive surgery and the solutions.Methods The clinical data of 25 patients of minimally invasive tracheostomy with percutaneous horn expansion in ICU were analyzed retrospectively.Results Twenty-one patients with minimally invasive tracheostomy with percutaneous horn expansion were successfully performed in 25 patients of ICU (no incision sputum,subcutaneous emphysema,pneumothorax and other complications),2 patients had more postoperative bleeding,2 patients were difficult to imbedding catheter,of which 1 case abandoned the catheter and received conventional tracheotomy.Conclusion Percutaneous horn expansion minimally invasive tracheostomy has the advantages of small incision,less injury,less operative time,less blood loss and low incidence of complications.However,ICU patients are in severe condition and easy to change.Adequate preoperative preparation,controlling the key steps in the operation can find a solution to the problme.