Lung volume reduction surgery, where 20-30% of lung is resected in patients with end-stage emphysema, has been shown in a number of published series to improve expiratory lung volumes, exercise capacity, and subjective well being. This procedure, originally described in the early 1950s, has caught the imagination of the public and medical fraternity. This operation may find utility as an alternative to lung transplantation. Only when the results of a number of randomized clinical trials are available, however, will an assessment of the true value of this procedure be known.