Background Video-assisted thoracoscopic surgery (VATS) which is conventionally performed under tracheal intubation with double lumen tube to achieve single lung ventilation has many complications and adverse effects following intubated general anesthesia and one-lung ventilation are inevitable, including intubation-related airway trauma ventilation-induced lung injury etc, affecting the recovery and quality of life of those patients .Recently, VATS without tracheal intubation has been extensively performed and evaluated . Objective To promote the cognition and application of non-intubated anesthesia during VATS in recent years.Content Review the clinical researches and applications of nonintubated VATS in thoracic diseases, evaluate the safety, feasibility and advantages compared to the traditional approach.Trend As a new technology in the VATS, non-intubated anesthesia is in urgent need for more clinical research, its long-term prospects needs greater number of clinical studies to be confirmed.