Advances in extracorporeal membrane oxygenation (ECMO) have allowed safe performance of complex thoracic surgical procedures that were impossible before. Application of ECMO in general thoracic surgery is extremely rare, but allows life-saving procedures in patients in whom one-lung ventilation cannot be carried out safely. We present the case of a 66 year old man who underwent a challenging veno-venous ECMO assisted segmentectomy for a second primary lung cancer. One-lung ventilation was not feasible due to previous lobectomy on the contralateral side and consequent lack of respiratory function. After the surgical procedure was completed the ECMO was removed and under stable conditions followed the immediate tracheal extubation.