Sometimes a lung cancer tumor cannot be reached by bronchoscopy or needle procedures. In these cases, the only way to get a biopsy is with an operation. Lung surgery is performed by thoracotomy or video-assisted thoracoscopic surgery (VATS). During the procedure, as much of the tumor as possible is removed, and a biopsy is taken from the removed tumor. Unfortunately, this operation may not be successful in removing all tumor cells, especially if the tumor is large or has spread to the lymph nodes outside of the lungs. Thoracotomy and VATS are both major operations that are performed in a hospital.