Emphysema continues to be a major cause of morbidity and mortality in developed countries. The disease affects approximately 2 million people alone in the United States and nearly 17,000 deaths each year are attributed to emphysema. In Hong Kong, it affects 9% of elderly (over 70 years) and together with other chronic lower respiratory diseases, it contributes to the 4th leading cause of death.

	COPD: Hyperinflated lungs with emphysematous changes

Common symptoms

• Cough
• Sputum production
• Short of breath
• Abnormal lung function/radiographs

Lung volume reduction surgery (LVRS) has been shown to be beneficial to selected patients with end-stage emphysema when medical therapy has failed. It is done to improve the quality of life of patients with emphysema but it is not a cure. The principal of lung volume reduction surgery (LVRS) is to remove the most diseased parts of the lung, it restores chest wall and diaphragmatic mechanics in respiration. It helps to improve breathing, lung capacity and quality of life.

This surgery can be performed by either median sternotomy or video-assisted thoracic technique. The median sternotomy involves an incision through the breastbone to open the chest. The video-assisted thoracic approach (VATS) is a minimally invasive technique. It involves three small incisions in both sides of the chest to allow the surgeon to insert instruments between the ribs and into the chest.