Surgical procedures for treating emphysema were first developed nearly 100 years ago. Despite a wide range of surgical procedures performed over the years, only three appear to have true clinical benefit: bullectomy, lung volume reduction surgery (LVRS), and lung transplantation. Lung volume reduction surgery has been reintroduced in the past decade and is currently under active research. A recent large, multicenter trial showed LVRS to improve quality of life, exercise capacity, and even survival in certain highly selected patients. Some individuals with emphysema may be candidates for either LVRS or lung transplantation. Patient-selection criteria for these procedures are being developed.