In the 1990s, the concept of surgical therapy was introduced once again for the treatment of end-stage emphysema. The earliest reports touted laser ablation of emphysematous lung as definitive therapy. Although some discernable benefit was reported, this was associated with significant operative morbidity. In 1993, the concept of parenchymal resection or "lung volume reduction" was reintroduced as treatment for end-stage lung disease. Over the ensuing 3 years, different techniques and approaches have evolved at different institutions. Lung volume reduction has been performed bilaterally and unilaterally through multiple approaches including sternotomy, thoracotomy, and thoracoscopy. The results of these various approaches are reviewed and compared. Lung volume reduction appears to be a beneficial procedure when performed in carefully selected patients by personnel and at institutions that are experienced in the care of patients with end-stage emphysema.