ABSTRACT
Since the reintroduction of lung volume reduction surgery (LVRS) by Cooper et al. in 1995 (1), there has been resurgent interest in this approach for the palliation of severe emphysema. In both the early clinical application of LVRS and in ongoing trials, two surgical approaches for the procedure have been employed. Cooper (1), and many others who followed, have preferentially employed a median sternotomy (MS) for surgical access, whereas other surgeons favor a bilateral, sequential video-assisted thoracoscopic (VATS) approach. It is currently unclear if either of these approaches is superior. We have favored the MS approach in most patients, for reasons that will be discussed below. This chapter will compare MS and VATS and describe our technique of LVRS by MS.
