The detection rate of pulmonary nodules in modern medical conditions is increasing year by year, and the diagnosis and treatment of pulmonary nodules is another challenge for thoracic surgeons. It is still challenging to identify and treat small lung lesions in surgery, and the difficulty is how to integrate surgical and oncology principles with lung preservation surgery which should be more minimally-invasive and appropriate. In order to meet the increasing demand for pulmonary nodules and the transformation of surgical treatment modes, there have been many developments and innovations in the field of video-assisted thoracoscopic surgery (VATS). In recent years, the emergence of single-hole VATS and non-intubated VATS has significantly reduced the invasive injury of VATS. The emergence of glass-free 3D display system, image-guided VATS, hybrid operating theatre and fluorescence thoracoscopy have all contributed to improving the precision of VATS, and are becoming important auxiliary means to diagnose and treat pulmonary nodules. This article will discuss some key points of the recent developments of VATS technology and their important roles in the management of pulmonary nodules.