A female infant with CHARGE syndrome and a long type IV cleft extending to within 5 mm of the carina underwent transcervical repair at 5 weeks of age. The trachea was transected from the cricoid cartilage and was peeled off the esophagus. The front of the esophagus and the back of the trachea were repaired while still ventilating the patient. The trachea was reconnected to the cricoid cartilage. This technique obviated the need for a sternal split, thoracotomy, cardiopulmonary bypass, or extracorporeal membrane oxygenation. It improved visibility, access, airway stability, and coverage of the anastomosis with periosteum permitting a three-layer closure. Laryngoscope, 2013.