We report our experience with a policy of early chest tube removal after video-assisted thoracic surgical lung biopsy (VATS-LB) in 146 patients. The chest tube (24F) was removed if four conditions were met: immediate extubation, complete expansion of the lung, drainage <100 ml/h and absence of an air leak. VATS-LB was performed on 160 patients. In 146 (91.2%) early chest tube removal was feasible. Fourteen (8.8%) were too ill to be included in this program. The chest tube was removed in 135 patients (92.4%) less than one hour after. In nine patients (6.2%) it was removed 4-24 h after, due to initial air-leak. In only two cases (1.4%) was the tube removed later. Median hospital stay was 1.2 days (range: 0-7). There were 32 outpatient procedures since 2001 (50% of VATS-LB in this period). Postoperative hemothorax occurred in two patients (1.4%) and pneumothorax in three (2.0%). Three of the five required readmission (2%). Three patients died in the hospital due to the progression of their illness. In the absence of postoperative air-leak, early chest tube removal after VATS-LB appears to be safe, reduces hospital stay and allows an outpatient procedure in selected cases.