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Primary tracheal carcinoid presenting as an endoluminal mass is rare and its asthma-like symptoms commonly delay diagnosis. Complete surgical resection is the treatment of choice. We report a young man with a distal tracheal carcinoid in whom transoral rigid bronchoscopic resection was attempted but limited by tumour location in the lower third of the trachea, broad posterior-wall implantation and significant intra-operative bleeding. A low temporary tracheostomy was performed intra-operatively to provide a more direct and stable access route, allowing simultaneous use of a rigid endoscope and bipolar cautery for complete excision under single-lung ventilation. The tracheostomy was retained for 2 weeks for surveillance bronchoscopy after which the patient was decannulated. We discuss this modified access route as a pragmatic adjunct in carefully selected distal tracheal lesions where standard transoral or transbronchoscopic resection is constrained by access, instrumentation or haemorrhage.