: Patients with compromised lung function undergoing uniportal video-assisted thoracoscopic surgeries (VATS) are at high risk for postoperative pulmonary complications. Ventilation technique for these patients should attempt to minimize the potential lung injury as well as to obtain a satisfactory surgical field and provide adequate intraoperative oxygenation. Non-intubated thoracic surgery has been reported to be associated with less ventilatory impairment compared to general anesthesia with double lumen tube intubation. However, this technique in complex surgeries such as sleeve lobectomy is not standardized yet. We described a 71-year-old male with severe chronic obstructive pulmonary disease (COPD) and primary carcinoma obstructing the right upper lobe. Uniportal VATS right upper sleeve lobectomy was performed under non-intubated anesthesia. A cross-field bronchial suction catheter was inserted through the open end of the right main bronchus to provide left lung oxygen delivery during the anastomosis maneuvers. Satisfactory operative conditions as well as adequate oxygenation was achieved using this technique. No signs of pulmonary complications or any other discomfort was observed during the patient’s hospital stay. Thus, we suggest that non-intubated anesthesia could be a safe or even better option in the case of a patient with reduced lung function for complex uniportal VATS surgeries like sleeve lobectomy.