The primary cause of emphysema is cigarette smoking. Candidates for surgery for emphysema require a complete history and examination. Three surgical treatment strategies exist for selected subgroups of emphysema patients: bullectomy, lung volume reduction surgery (LVRS), and lung transplantation (LTx). Surgical stapling devices or lasers are used to resect and seal the least functional lung segments. Stapling methods and buttressing techniques have evolved to reduce the risk of air leaks. Formal LVRS comprises a range of pulmonary resection procedures designed to achieve improved gas exchange via volumetric reduction of emphysematous lung. Lung transplantation is now an established therapeutic option for end-stage emphysema. Patients are assessed according to consensus criteria provided by the International Society for Heart and Lung Transplantation (ISHLT). The primary limitation for LTx is the shortage of suitable allograft donors, and the mortality of advanced emphysema patients on the waiting list is high.