Anesthesiologists in thoracic surgery need to know how to use all manner of instruments to deal with all kinds of difficulties. Techniques for one-lung ventilation can be accomplished in two different ways. The first involves the use of a double-lumen endotracheal tube (DLT) and second method involves bronchial blockers. Video-assisted thoracoscopic procedures (VATS) are essentially impossible without lung isolation. One-lung ventilation and isolation can be performed using a double-lumen endotracheal tube or one of several alternative airway devices. In this presentation, we report a case in which sequential lung isolation was performed by placing DLT through a traceotomi stoma. A 68-yr-old-72-kg man presented with right pleural effusion. The surgeons planned diagnostic VATS and biopsy. His medical history revealed he had an operation which is total laryngectomi because of larynx Ca, 5 years ago. Lung isolation ivas achieved with left DLT (left, RobertShaw endobronchial tube) via traceotomi stoma without any difficulty or complication. The surgery was performed successfully. In conclusion, this technique may be useful for total- laryngectomized patients and sequential one-lung ventilation or true lung isolation.