Increased public health awareness and expanded low-dose computed tomography (CT) utilization, accelerated by the COVID-19 pandemic, have elevated detection rates of pulmonary ground-glass nodules (GGNs). Patients with multiple primary lung cancer (MPLC) often present with multiple GGNs, posing challenges for precise treatment and prognostic assessment. Current therapies including stereotactic body radiation therapy (SBRT), chemotherapy, and immunotherapy face efficacy and safety limitations. While video-assisted thoracic surgery (VATS) is the primary treatment for high-risk GGNs, the sole reliance on surgery may cause excessive loss of lung function. Image-guided thermal ablation techniques can effectively treat smaller lesions with lung preservation. This review explores molecular mechanisms of ablation, VATS-ablation synergy, and the potential value of this approach in combination with immunotherapy. The clinical application prospects, including advancements in navigation techniques and equipment, are also discussed. Overall, this hybrid surgical strategy represents a promising option for patients with multiple lesions, minimizing lung function loss and the psychological burden.