BACKGROUND: Identifying small pulmonary nodules during sublobar resection via video-assisted thoracoscopic surgery (VATS) poses certain challenges. Although preoperative computed tomography (CT)-guided localization is common, it is invasive and may lead to complications. This study aims to develop a novel, non-invasive technique for improving the accuracy of pulmonary nodule localization during VATS, with the goal of reducing complications associated with traditional methods. METHODS: We developed the longitude-latitude-depth (LLD) localization method, a novel intraoperative approach for localizing small pulmonary nodules. The LLD method uses anatomical reference points derived from the lung's natural structure to guide nodule localization during surgery. This retrospective study compared patients with small pulmonary nodules (≤2 cm in diameter, consolidation tumor ratio ≤0.5, and outer one-third of the pulmonary parenchyma) undergoing either intraoperative LLD localization or preoperative CT-guided hook-and-wire localization followed by VATS at Qilu Hospital of Shandong University from March 2020 to November 2023. Propensity score matching (PSM) analysis was used to the compare clinical information and perioperative outcomes, with 176 patients in each group after matching was performed. RESULTS: Compared to the CT-guided localization, the LLD method achieved higher accuracy (96.59%) during surgery and had a significantly reduced localization duration (5 CONCLUSIONS: LLD localization is noninvasive, time-saving, and cost-effective and may be a feasible, safe, and effective technique for localizing small pulmonary nodules during surgery.