Lung volume reduction surgery is designed to alleviate symptoms of breathlessness and improve the quality of life for selected patients with severe emphysema. By resecting hyperinflated, nonfunctional areas of the lung, thoracic volume is reduced, chest wall and diaphragmatic mechanics are improved, and ventilation to the remaining portions of lung is improved. The operative procedure is designed to obtain maximum improvement with the least possible risk. Early mortality (less than 90 days) has been 3%, all from respiratory complications. Late mortality (more than 90 days) has been an additional 2%. Refinements in operative technique, including use of continuous staple line excision buttressed by bovine pericardium, creation of apical pleural tents, and avoidance of suction the chest tubes, have led to a steady decline in hospital stay, with the current average of 11 days and a median of 7 days. Ninety-nine of the 100 patients have been extubated at the end of the procedure, thus avoiding the need for postoperative ventilatory assistance.