Volume reduction surgery (VRS) is a new procedure based on the concept that relieving hyperinflation in emphysema improves diaphragmatic and chest wall mechanics and ventilation perfusion mismatch. We present our early experience with 16 patients who underwent VRS from August 1995 to June 1996. Patient selection was based on: PFT, CT scan, V/Q scan, ABG's and 6-min walk. After pulmonary rehabilitation, operation was by median sternotomy and bilateral lung shaving. Pulmonary function improved significantly. FEV1 increased from 0.68 +/- 0.2 to 1.0 +/- 0.2 L (p < 0.01) and FVC increased from 1.7 +/- 0.5 to 2.7 +/- 0.5 L (p < 0.017). Total lung capacity decreased from 129% +/- 24% to 108% +/- 20% (p < 0.03). 6-min walk increased from 221 +/- 90 to 404 +/- 123 meters (p < 0.001). Complications included 1 death, prolonged air leak in 7 cases and infection in 2. Quality of life improved substantially in 12 of the 16 cases; in 3 cases there was only slight improvement and in 1 the condition became worse. Volume reduction surgery is a promising surgical solution in selected patients with advanced emphysema.