We present an innovative method using uniportal video-assisted thoracoscopic surgery under spontaneous ventilation anaesthesia (SVA) to perform tracheal surgery in a 46-year-old man with distal tracheal squamous cell carcinoma. SVA offered better exposure of the surgical field and facilitated anastomosis following a single incision. Such simplification of the ventilation strategy and uniportal incision accelerated the postoperative recovery and reduced the side effects of conventional anaesthesia.