During video-assisted thoracic surgery (VATS), localization is sometimes needed to detect a target lesion that is too small and/or too far from the pleura. In 1995, Kanazawa et al. developed short hookwire and suture system. Since then, this system has been placed often for selected targets before VATS in Japan. This short hookwire and suture system is a representative preoperative localization method and the placement procedure is well-established. Its placement success rates are very high (range: 97.6%–99.6%), and dislodgement of this short hookwire rarely occurs with an incidence of 0.4%–2.5%. The most common complication of short hookwire placement is pneumothorax (incidence: 32.1%–68.1%), followed by pulmonary hemorrhage (incidence: 8.9%–41.6%). Complications are frequent; however, most complications are minor and asymptomatic.