Of late, small-sized lung cancers have become much more often found with the development of diagnostic image techniques. This article reviews the current status of radical sublobar resection such as segmentectomy and wide wedge resection for a peripheral clinical NO lung cancer tumor 2 cm or less in diameter in patients able to tolerate a lobectomy, with emphasis on its invasiveness as well as techniques and results. Several recent reports suggest that clinical results of sublobar resection in such highly selected patients is not worse than those of standard lobectomy. In addition to preservation of pulmonary function, this lung-saving surgery must provide a second chance to patients who have a higher risk of metachronous disease after surviving a first disease. Also, with the great interest in minimally invasive techniques for treating various pathologies, we have widely applied an integrated surgical approach that combines muscle-sparing minithoracotomy (incision, 4-8 cm) and video-assistance using mainly direct visualization of the lung resection, which we have called hybrid video-assisted thoracic surgery (VATS). The combination of sublobar resection and hybrid VATS might be an alternative as a much less invasive standard operation for patients with small peripheral lung cancers.