Volume reduction surgery (VRS) has been adopted for patients with severe pulmonary emphysema who complain of continuous exertional dyspnea in daily life. VRS comprises two types of surgical procedure: resection of the peripheral lung by median sternotomy; and the thoracoscopic approach. The latter is considered to be less invasive and better tolerated by patients in poor physical condition, while the former has the disadvantage of heavier bleeding during surgery. However, postoperative air leakage tends to be much less with median sternotomy compared to thoracoscopic VRS.