Placement of a tracheal tube can result in significant complications if the tube is positioned incorrectly. The tracheal tube cuff must be placed distal to the glottic opening to seal the airway reliably and avoid direct damage to the vocal cords, nerve compression and accidental extubation (1,2). Endobronchial intubation may occur if the tip of the tracheal tube is too close to the carina, particularly with pneumoperitoneum, Trendelenburg positioning3 or movement of the head and neck (4,5). Unfortunately, there is considerable variation in vocal cords-carina distances (VCD) between individuals and there is no good bedside predictor of a short trachea (6). Formulae have been suggested to guide depth of insertion of the tracheal tube (7-9) and some tracheal tube manufacturers also place one or two black marks proximal to the cuff as a guide to correct depth of insertion. In a recent study comparing several methods of tracheal tube placement, although marking the tube proximal to the cuff resulted in the lowest number of tube malpositions, there were still a number of endobronchial intubations (10).