Chronic obstructive pulmonary disease is the fourth leading cause of death in the world and is a significant cause of mortality and morbidity. Although medical management is the standard of care, as the symptoms progress and lung function declines, nonmedical options become available to patients. Lung volume reduction surgery has been a well-established surgery for the treatment of severe emphysema since the National Emphysema Treatment Trial in 2003 showed a survival advantage for patients with upper lobe emphysema and low baseline exercise capacity. 1 Mannino D.M. Kiriz V.A. Changing the burden of COPD mortality. Int J Chron Obstruct Pulmon Dis. 2006; 1: 219-233 PubMed Google Scholar For patients without upper lobe emphysema, alternative modalities have been investigated to improve functional status. Endoscopic lung volume reduction is an emerging nonsurgical strategy to help bridge the gap between optimal medical management and surgery. In patients with severe emphysema, results from the Improving Patient Outcomes by Selective Implantation of the Zephyr EBV (IMPACT) trial and the Pulmonx Endobronchial Valves Used in Treatment of Emphysema (LIBERATE) study have shown excellent improvements in patient’s lung function, exercise capacity, and quality of life over medical therapy. 2 Fishman A. Martinez F. Naunheim K. et al. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med. 2003; 348: 2059-2073 Crossref PubMed Scopus (1656) Google Scholar ,3 Criner G.J. Sue R. Wright S. et al. A multicenter randomized controlled trial of Zephyr endobronchial valve treatment in heterogeneous emphysema (LIBERATE). Am J Respir Crit Care Med. 2018; 198: 1151-1164 Crossref PubMed Scopus (160) Google Scholar Robotic Lung Volume Reduction Surgery With Extracorporeal Membrane OxygenationThe Annals of Thoracic SurgeryVol. 114Issue 5PreviewLobectomy for consolidation of failed endoscopic lung volume reduction for emphysema has been reported in selected patients with favorable results but with considerable morbidity. The challenging issues in such patients are frailty caused by severe emphysema itself, poor tolerance to single-lung ventilation, target lobe hyperinflation, and inability to use gas inflation for the minimally invasive resection. Careful planning, including use of a robotic platform and extracorporeal membrane oxygenation support, can circumvent such difficulties and ensure a safe, minimally invasive resection in the high-risk emphysematous patient. Full-Text PDF