Surgical strategy for lung volume reduction surgery.

Lung volume reduction surgery (LVRS) has been a popular procedure since the early 1990s. It appears that there has developed a consensus in the literature that the ideal patient is one with evidence of marked hyperinflation and heterogenous disease. In this patient profile, LVRS has produced excellent results with respect to lung function and improved exercise tolerance. General areas of controversy are discussed which include the role of lasers; unilateral versus bilateral procedures; the role of a staged unilateral procedure; and which surgical route is best for patients. The existing literature is reviewed on these issues.