Background: Surgery for patients with left central bronchogenic carcinoma invading the carina is challenging due to the complexity of left sleeve pneumonectomy, carinal resection, and airway reconstruction and management. Here we describe a modified approach to overcome this problem. Case presentation: Between March 2011 and September 2012, two patients with left central bronchogenic carcinoma invading the carina underwent single-stage bilateral thoracic surgery via a combined approach incorporating video-assisted thoracic surgery (VATS) and thoracotomy in our hospital. We reviewed our experience with this type of surgery and analyze its outcomes. Conclusions: Single-stage, bilateral thoracic surgery incorporating video assisted thoracic surgery (VATS) and thoracotomy provides optimal exposure of the operative field, reduces surgical trauma, and ensures the integrity of tumor excision and exactness of tracheobronchial anastomosis. This may be a safe and feasible alternative for left carinal pneumonectomy.