This study reports our experience, diagnostic accuracy and safety of surgical lung biopsy in patients with interstitial lung diseases. From January 1998 - December 2007 surgical lung biopsy was performed in 53 patients (22 female [41.5%]; age 47.2+/-13 years). A total of 37 patients (69.8%) underwent videothoracoscopic lung biopsy and minithoracotomy was performed in 16 patients (30.2%). Right lung was the choice in 47 patients (88.7%). Postoperative complications were rare (9.4%) and included three prolonged air leaks (5.7%), one pneumothorax requiring a chest drain (1.9%), and one haemothorax requiring reoperation (1.9%). One patient died of cardiac arrest of unknown cause. Average chest tube duration was 4.4+/-3 days and average hospital stay 5.4+/-4 days. Lung biopsy contributed to the diagnosis in 50 patients (94.3%). In conclusion, the potential benefits of diagnostic surgical lung biopsy must be considered against the risks of the procedure especially in patients with severe cardiopulmonary dysfunction.