Small pulmonary nodules with CT-guided Hook-wire localization thoracoscopic resection technique Small pulmonary nodules are hyperdense shadows in the lung parenchyma that can develop from a variety of causes. With the development of imaging technology, more and more pulmonary nodules are being detected. The literature reports that approximately 50% of pulmonary nodules are malignant, so it is essential to obtain an accurate pathological diagnosis as soon as possible. Puncture biopsy is one of the common options for obtaining a pathologic diagnosis, but the overall diagnostic benefit rate is not high. With the development of thoracoscopic techniques, small pulmonary nodules can be excised for examination with minimal trauma and await on the operating table for immediate surgical treatment if the pathology turns out to be malignant. The diagnosis and treatment of small pulmonary nodules has been greatly developed. However, the thoracoscopic technique also has its limitations. Since it is difficult for the operator to directly touch the lung tissue, when the lung nodules are deeper, smaller or less dense, it is difficult for the operator to accurately locate the small lung nodules, and it is often forced to turn the lung open or even forced to perform lobectomy directly, which increases the pain and unnecessary trauma of the patient. Therefore, many clinicians can only passively adopt a regular observation method for smaller nodules, which is likely to miss a good opportunity for treatment. Many scholars have designed a series of methods such as preoperative localization under CT guidance of Melanoma and intraoperative ultrasound localization, but the results are not satisfactory. Recently, there are reports in the literature that preoperative thoracoscopic resection was performed after the tumor was anchored by puncture with Hook-wire localization system under CT guidance, and better results were achieved. We have recently pioneered the CT-guided Hook-wire localization followed by thoracoscopic resection of small pulmonary nodules in South China, and achieved a successful outcome. This technique is particularly valuable for small pulmonary nodules less than one centimeter, especially those with deep location and low density, enabling the most timely and appropriate treatment for such patients.