OLV is essential in video-assisted thoracoscopic surgery (VATS) to provide a clear operative field by deflating the lung on the surgical side while preserving ventilation and oxygenation in the contralateral lung [1]. In most cases, OLV is achieved using double-lumen endotracheal tubes (DLTs), which allow independent ventilation of each lung.

However, airway management in tracheostomized patients is significantly more complex due to anatomical alterations, including restricted stoma dimensions and distorted tracheal anatomy. This complexity is especially pronounced in individuals with a history of total laryngectomy— a procedure involving complete resection of the larynx and creation of a permanent tracheostomy [2]. The resulting structural changes substantially restrict the range of suitable airway devices and increase the technical complexity of their placement, particularly when one-lung ventilation is required.

The case report describes a different approach to OLV in a tracheostomized patient with a history of total laryngectomy, who underwent VATS for right inferior lobectomy. Given the anatomical challenges, various airway management strategies were explored. An initial attempt with a 7Fr Arndt Endobronchial Blocker was unsuccessful due to inadequate cuff volume. A conventional EZ-Blocker® technique provided only partial lung isolation, prompting a modified approach in which both cuffs were positioned within the right main bronchus, ensuring complete exclusion of the right lung. This report emphasizes the importance of selecting appropriate devices and techniques for OLV in patients with end tracheostomies, demonstrating an unconventional use of the EZ-Blocker® for complete right lung exclusion.