【Abstract】 Objective: To explore the technical feasibility and clinical value of Uni-VATS (Uniportal Video-Assisted Thoracoscopic Surgery) in complex airway reconstruction. Methods: A 71-year-old patient presented with an isolated bronchial lesion in the posterior segment of the left lower lobe, with no significant invasion observed in either lung. After comprehensive risk assessment and perioperative preparation, the patient underwent a Uni-VATS thoracoscopic left lower lobe posterior segment sleeve resection combined with secondary carina reconstruction. Upon pathological confirmation of malignancy, a systematic lymphadenectomy was performed. To prevent postoperative complications, the anastomotic site was circumferentially wrapped using autologous tissue. Postoperative evaluation of therapeutic efficacy was conducted using bronchoscopy and imaging studies. Results: The surgical procedure was successfully completed with an operative time of 150 minutes and an intraoperative blood loss of 50 ml. Postoperative bronchoscopy showed good secondary carina reconstruction, and no anastomotic fistula occurred. The postoperative pathology confirmed negative margins, and the patient was extubated on the 5th day after the operation and discharged smoothly on the 6th day. This was confirmed as the first case of similar surgery in Jiangsu Province. Conclusion: Uni-VATS enables safe and efficient segmental sleeve resection and secondary carina reconstruction, demonstrating feasibility in complex airway reconstruction. Compared with conventional surgical approaches, Uni-VATS balances oncological radicality with lung function preservation, offering an innovative and minimally invasive solution for localized airway tumors. This case provides critical practical evidence for the extension of Uni-VATS to highly complex procedures, supporting its role in facilitating rapid patient recovery. Given these advantages, Uni-VATS holds clinical value for broader application and dissemination. Key words：Secondary carina reconstruction; Sleeve resection; Uniportal video-assisted thoracic surgery