Emphysema affects 3.1 million people in the United States alone and causes severe disability and early death in up to 45% of patients.1 Emphysematous destruction of the lung is associated with decreased elastic recoil pressure. As a result, the diseased lung requires less pressure than a normal lung to inflate and, once inflated, exerts less pressure to empty; lungs in emphysema therefore tend to remain inflated, with overexpansion of the rib cage and flattening of the diaphragm. Patients are trapped in a state of permanent hyperinflation and dyspnoea. No amount of effort can empty their lungs: the harder they strain to breathe, the more the airways collapse and obstruct the outflow of gas.

Current medical treatment with inhaled bronchodilators, glucocorticoids, mucolytics, and antioxidants may improve symptoms temporarily but does not prevent the decline in lung function. Various surgical procedures have been implemented in the past to relieve dyspnoea and improve quality of life for such patients.^w1 Early results of surgery were often encouraging, but surgery rarely achieved sustained objective functional improvement and most of those procedures were gradually abandoned.

Bullectomy is the only operation that has stood the test of time. It allows re-expansion of restricted but potentially …