Objective

We present technique details of a case of carina resection/reconstruction using a combination of VATS under spontaneous breathing without endotracheal intubation in a 45 year-old man. Patient had a 1.7x1.4cm biopsy-proven adenoid cystic carcinoma located at distal trachea 1 cm away from carina. Traditionally, such procedure would require endotracheal intubation with cross-field ventilation. Thoracotomy and more recently VATS approach have been used. However, exposure is often not optimal because of the interference by the airway tubings in the operative fields. Based on this centre's experience in VATS and spontaneous breathing techniques, we successfully carried out carinal resection/reconstruction by combining both techniques. This not only offers the patient both the benefits of both techniques, but more importantly, it also provides better operative field of view as no airway tubing is in the way.