The authors reported the first patient who underwent non-intubated video assisted thoracic surgery (NIVATS) in Thailand. She was 66 years old when she had primary treatment for lung cancer 1 year ago. Left upper lung lobectomy and systematic lymph node dissection were performed without any adjuvant therapy.  She was doing well until 1 year later when a new pulmonary nodule at right lower lung lobe (RLL) was incidentally found during her follow-up computed tomographic imaging (CT scan) of chest including upper abdomen. The imaging showed an 8-mm sub-solid nodule without any bony involvement, adrenal metastasis nor regional lymphadenopathy. Curative uniportal NIVATS wedge resection of RLL was performed after pre-operative CT-guided localization of the nodule using isosulfan blue.  The operation was performed under intravenous anesthetic drug and nasal high flow oxygen without endotracheal intubation. The total operative time was 60 minutes: 25 mins for anesthetic induction process and 35 mins for actual operation. No Foley catheter nor intercostal drainage tube were inserted. Blood loss was negligible without any peri-operative complications. The patients was discharged 2 days after surgery and was doing well 2 months after surgery.