1. Indications for surgery Ideal patient criteria: a series of pathophysiologic changes caused only by severe emphysema; heterogeneous distribution of lesions and the presence of severe lesion areas available for resection; hyperinflation of the lung. The following indications are relative and need to be further enriched and refined. 1.1 General (1) Age <75 years; (2) nutritional status >70% of standard body weight; (3) smoking cessation >3 months; (4) 6 min walking distance >200 m after rehabilitation. 1.2 Moderate to severe emphysema (1) Clear diagnosis of non-alveolar emphysema with severe dyspnea despite strict medical therapy. (2) FEV1<35% predicted, FEV1/FVC≤60%; DLCO<50% predicted. (3) Clinically stable for >1 month. 113 Hyperinflation of the lungs (1) Chest radiograph showing thoracic distension and diaphragmatic hypoplasia. (2) RV >250% of expected value, TCL >120% of expected value, RV/TLC >60%. 114 Lesion heterogeneity CT and lung ventilation and perfusion imaging show a highly heterogeneous distribution of lesions and the presence of severe lesion areas. 2 , Contraindications to surgery The following contraindications are also relative. 2.1 Hyperinflation of the lung or uniform lesion distribution (1) FEV1 > 50% of the expected value, RV < 150% of the expected value, TLC < 100% of the expected value. (2) Uniform distribution of lesions. 2.2 Surgery is inappropriate or not tolerated (1) Pulmonary hypertension (systolic pressure > 45 mmHg; mean pressure > 35 mmHg). (2) With adrenocorticosteroid prednisone >10mg/d. (3) Severe asthma, bronchiectasis or chronic bronchitis with large amount of pus sputum. (4) Cannot tolerate surgery, such as severe coronary artery disease, extreme wasting, etc. 3. Preoperative preparation 3.1 Improvement of general condition, including nutritional status, water and electrolyte balance, etc. 3.2 If taking hormones, the dosage should be reduced; dissolve sputum to stop cough, sputum culture + drug sensitivity if necessary. 3.3 Rehabilitation training, including necessary catharsis, motor exercise of limbs, respiratory training (e.g. lip retraction breathing, deep cough, etc.), clearing the airway (e.g. postural drainage), etc., usually for 6~8 weeks. Pulmonary function and 6min walk test are reviewed after training. 4. Surgical method 4.1 Incision Routinely choose thoracoscopic surgical incision, few add small incision; part of the sternum median incision. 4.2 Surgical materials Commonly used endoscopic suture incisors, partly with open-chest suture incisors, routinely with additional bovine pericardial piece. 4.3 Surgical operation 4.3.1 Anesthesia General anesthesia, double-lumen tube intubation, and routine indwelling epidural tube. 4.3.2 Position Thoracoscopic pulmonary decompression with lateral recumbency and change of position after surgery on the heavily diseased side; supine position for median sternal incision. 4.3.3 Incision Thoracoscopy is performed with 4 trocar incisions, the median sternal incision is the same as the conventional procedure, and the small incision is usually in the mid-axillary line. 4.3.4 Excisional tissue localization Anatomic localization: HRCT + thin section; functional localization: pulmonary ventilation and perfusion imaging. Intraoperative localization: direct visualization and exploration of persistently inflated emphysematous lung tissue. 4.3.5 Upper lobe lung decompression The decompression operation starts near the level of the anterior lung margin on the right side and on the left side at the junction of the superior and inferior lingual segments. 4.3.6 Lower lobe lung reduction surgery The lower lung ligament is first severed, and the resection begins at the anterior basal segment of the lower lobe and continues posteriorly around the base of the lower lobe up to the top of the dorsal segment. However, the lower lobe reduction is mostly irregular. 4.3.7 Intraoperative considerations The resected lung tissue accounts for about 20%-30% of the lung volume on one side, and care should be taken to avoid interlobular fissures when cutting, and the cut edge should be as close as possible to the shape of the thorax, which can be atrophied by puncturing the lung tissue in areas of severe lesions with persistent expansion.