Lung biopsy is often required for the definitive subtype classification of interstitial lung disease. The video-assisted thoracoscopic approach has been advocated as an alternative to standard open lung biopsy because it is less invasive; however, whether it makes a positive contribution to treatment strategy remains contentious. We investigated the safety and efficacy of the video-assisted approach in a retrospective review of 30 consecutive patients who underwent the procedure in an elective setting after being diagnosed with interstitial lung disease by chest radiography and computed tomography. The mean age of the patients was 56.7 years. The preoperative vital capacity and forced expiratory volume in 1 second were 80.0% and 83.6%, respectively. There was no operative mortality, but 2 cases of respiratory failure and 1 of prolonged air leak occurred. The diagnostic yield was 100%, and treatment was changed in 57% of the cases as a result of the histological diagnosis. The rate of treatment change was higher for patients with nonspecific interstitial pneumonia than for those with idiopathic pulmonary fibrosis. We conclude that video-assisted biopsy is effective in the subtyping of interstitial lung disease and is a safe procedure when performed electively at the early stage of the disease.