Small indeterminate lung nodules are increasingly detected because of the extensive use of chest x-rays and of computed tomography scans. In evaluating a small solitary pulmonary nodule the main concern is whether the nodule is benign or malignant. Resection by video-assisted thoracic surgery is the standard treatment for solitary pulmonary nodules, especially if they are small and not accessible by bronchoscopy or by percutaneous transthoracic needle aspiration. In this prospective study the personal experience in the diagnosis and treatment of lung nodules by video-assisted thoracic surgery and its implications in early diagnosis of lung cancer, are illustrated In the reported series video-assisted lung wedge resection was carried out successfully in (94%) of lung nodules, with low morbidity and no mortality. A definitive pathologic diagnosis was achieved in all cases. These findings indicate that indeterminate lung nodules > 1 cm in diameter have a high probability (65%) of being malignant and therefore need to be resected to establish a definitive diagnosis.