Surgical management of tuberculosis (TB) has re-emerged as a critical adjunct to modern chemotherapy, particularly for localized drug-resistant disease. Evidence shows that adjunctive resection roughly doubles treatment success and reduces relapse without increasing mortality when integrated into multidisciplinary programs. Partial resections yield optimal outcomes, while pneumonectomy is reserved for unilateral destruction. With minimally invasive and robotic techniques and improved imaging to guide timing and extent of resection, surgery’s role is shifting from rescue to precision intervention addressing pharmacologic sanctuaries and consolidating cure in most difficult TB cases. Rehabilitation remains essential to facilitate patients’ return to normal life.