This chapter aims to provide an overview of the ultra-thin cuffed endotracheal tube (ETT), starting with the concept that inspired its design and a detailed description of the tube’s specifications. This chapter also covers the clinical uses of ultra-thin ETT in upper airway surgeries as well as using it in combination with other airway equipment such as a conventional ETT, laryngeal mask airway (LMA), and flexible fibre-optic bronchoscope to tackle challenging airway management scenarios. A brief description of flow-controlled ventilation (FCV), the novel ventilatory mode used with straw-size ETT is also touched upon. Additionally, practical points for preparing the tube for usage and troubleshooting commonly encountered issues are discussed. Finally, a brief discussion of the role of ultra-thin ETT in elective as well as emergent difficult airway scenarios requiring surgical access to the front of the neck is provided.