Indeterminate pulmonary nodules are common findings in clinical practice, especially after widespread use of high-resolution computed tomographic scans for cancer screening. To determine whether the nodule is malignant or not, surgery is usually required for either diagnostic or therapeutic purposes in the early stages. Current development in minimally invasive surgery and anesthesia using video-assisted thoracoscopic surgery without tracheal intubation (nonintubated VATS) are feasible and safe for resection of peripheral lung nodules, including nonintubated needlescopic or uniportal approaches. In addition, nonintubated VATS may offer high-risk patients for intubated general anesthesia opportunities to receive surgery. Therefore, nonintubated VATS can provide an attractive alternative for early diagnosis and treatment of indeterminate lung nodules.