Objective: To assess efficacy of bedside fibro optic bronchoscope to assist percutaneous tracheostomy in selected patients at our center. Patients and Methods: This study was conducted at King Hussein Medical Center, Amman, Jordan from December 2008 to November 2010. It included 22 patients who underwent fibro optic bronchoscope-assisted percutaneous tracheostomy. These patients had a previous tracheostomy, abnormal neck anatomy due to previous surgery or radiotherapy, risk of difficult airway or bleeding or existing tracheal stents. Results: Successful tracheostomy was performed in each patient without complication. The duration of the procedure was 20–30 (median 25) min. The fibro optic bronchoscope-guided percutaneous tracheostomy technique provided excellent visibility and support protecting the tracheal stents from displacement or damage during the procedure. Conclusion: The fibro optic bronchoscope-guided percutaneous tracheostomy technique provided excellent visibility and was successful in all difficult patients.