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Patients with end-stage emphysema can be offered lung volume reduction surgery (LVRS), lung transplantation, or unilateral lung transplantation combined with contralateral LVRS if necessary, depending on multiple factors including age, lung function parameters, lobar predominance, and whether the disease is uni- or bilateral. Lung transplant is a complex and well-established therapeutic modality for patients with end-stage lung disease. The ideal candidate for LVRS is a patient with severe upper-lobe predominant emphysema and markedly impaired exercise capacity. Other groups may benefit from the procedure, but results are likely to be less good. The objective of this chapter is to describe the surgical techniques of bilateral lung transplantation and lung volume reduction surgery as performed at the University of Toronto.

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