Summary Video-assisted thoracoscopic surgery (VATS) has become a common and globally accepted mode of resection of pulmonary tumors. One-lung isolation using double-lumen endobronchial tubes or endobronchial blockers has been traditionally considered mandatory for VATS. However, recent reports showed that VATS pulmonary resections can also be performed safely using regional anesthesia without tracheal intubation. Mostly, nonintubated VATS pulmonary resections are performed using regional anesthesia, either a thoracic epidural anesthesia or intercostal blocks, in a spontaneously breathing state after an iatrogenic open pneumothorax. Conscious sedation is usually necessary for longer and intensively manipulating procedures. Intraoperative cough reflex can be effectively inhibited by ipsilateral intrathoracic vagal blockade to facilitate major pulmonary resections. The early outcomes of nonintubated VATS pulmonary resections include a faster postoperative recovery and a lower complication rate as compared with its counterpart of intubated general anesthesia, which may be translated into a fast track VATS program. The future directions of nonintubated VATS should focus on its long-term outcomes, especially on oncological perspectives and overall survival in lung cancer patients.