It has been over 12 years since Wakabayashi and colleagues1–
reported preliminary beneficial results using laser-induced lung volume shrinkage via unilateral thoracoscopy while attempting to improve functional capacity in patients with severe emphysema, and over 8 years since Cooper and coworkers2–
reported dramatic improvement in the lung function of such patients by surgically reducing lung volume bilaterally in emphysema patients with predominantly upper lobe disease, using stapling devices via sternotomy. This approach represented a modification of the original surgical concept by Brantigan and Mueller,3–
who performed surgical lung volume reduction surgery (LVRS) via bilateral thoracotomies in emphysematous patients almost 50 years ago. Although most reported trials agree in the concept that well-selected patients with severe emphysema derive benefit from LVRS, producing improvement in pulmonary function,4–
and quality of life,7
there has been considerable debate throughout this time regarding the optimal surgical approach to achieve this end. In most reported surgical outcomes from patients undergoing LVRS, prolonged air leaks are the most common complication.