Background: Using the non-intubated video-assisted thoracoscopic surgery (VATS) approach for small pulmonary nodules (SPNs) can accelerate patients' postoperative recovery. However, locating the SPNs intraoperatively by palpation can be difficult for thoracic surgeons. The advantages of using different preoperative positioning materials are different, especially for pulmonary-nodule-location-needle (P-N -L-N) and the microcoil. This retrospective study analyzed the advantages of two preoperative positioning techniques for VATS under non-intubation anesthesia. Methods: The data were collected for a total of 150 patients with pulmonary nodules who underwent non-intubated VATS at the First People's Hospital of Yunnan Province from January 2018 to January 2021. The patients were divided into a preoperative positioning group (including a P-N-L-N group and microcoil group) and an unlocalized group. These included patients were all compliant with surgical guidelines and were suitable for preoperative localization. Their intraoperative and postoperative indicators were compared, and among these indicators, the operative time, number of postoperative drainage days, postoperative total drainage volume, postoperative discharge time was efficacy group and the intraoperative blood loss was safety group. Results: Preoperative localization helped surgeons to explore nodules faster intraoperatively and remove SPNs precisely under non-intubated VATS. But the advantages of using different preoperative positioning materials are different. Positioning with either microcoil or P-N-L-N resulted in less operation time (P-N -L-N group: 94.90 +/- 28.42 min, microcoil group: 112.80 +/- 28.6 min, P<0.05), less intraoperative blood loss (P-N-L-N group: 35.80 +/- 21.17 mL, microcoil group: 75.00 +/- 65.22 mL, P<0.001) and less postoperative thoracic drainage volume (P-N-L-N group: 64.90 +/- 181.96 mL, microcoil group: 648.52 +/- 708.81 mL, P<0.001). However, the postoperative discharge time (P-N-L-N group: 5.02 +/- 1.35 days, microcoil group: 5.40 +/- 2.79 days, P=0.38) and postoperative drainage time(P-N-L-N group: 2.58 +/- 1.70 days, microcoil group: 3.18 +/- 2.49 days, P=0.16) was not statistically significant. Positioning with P-N-L-N seemed to have a better auxiliary effect for non-intubated VATS, suggesting its use can assist surgeons to determine the location of the lesion more accuracy intraoperatively. There was no significant difference in the pathological results among the groups. Conclusions: Localization of SPNs is beneficial in non-intubated VATS, and the use of P-N-L-N was more effective than the microcoil in reducing operative time, intraoperative blood loss, postoperative total drainage volume, and postoperative discharge time.