We report a case of successful one-lung ventilation with a spiral-tipped double lumen tube for resection and reconstruction of the tracheal bifurcation. A 71-year-old woman with lung cancer developed its invasion to the right bronchus near the tracheal bifurcation. Right lung total pneumonectomy or reconstruction with resection of the tracheal bifurcation was planned. In order to secure the tracheal tube and cuff around the tracheal bifurcation non-surgically, we first inserted air-Q while confirming the distorted anatomy around the bifurcation. She then underwent left bronchial intubation with a short-cuffed, long-length spiral tracheal tube under bronchofiberscopy, but effective ventilation was not achieved. The tracheal tube was exchanged with a spiral-tipped double lumen tube under bronchofiberscopy and one-lung ventilation was achieved. Total pneumonectomy and reconstruction of the tracheal bifurcation proceeded uneventfully. One-lung ventilation with a spiral-tipped double lumen tube may be useful in tumor resection that involves distorted anatomy, such as at tracheal bifurcation.