Surgical Compared to Bronchoscopic Lung Volume Reduction in Patients With Severe Emphysema

Inclusion Criteria: * Patients suffering from emphysema (all morphologies, uni- or bilateral distribution) potentially qualifying for both study procedures, LVRS or BLVR (if possible, perfusion scintigraphy within \< 6 month of screening, CT scan within \< 4 months of screening) * Age ≥ 30 and ≤ 80 years * Body Mass Index (BMI) ≥ 16, but ≤ 35 kg/m2 * Non-smoking for 3 months prior to screening interview * Patient is able to understand and willing to sign a written informed consent document. Exclusion Criteria: * FEV1 more than 50% predicted * TLC less than 100 % predicted, RV less than 175% predicted, RV/TLC less than 58% predicted, and DLCO ≤ 20% predicted in homogeneous emphysema and DLCO ≤ 15% in heterogeneous emphysema, respectively * PaO2 ≤ 6.0 kPa (45mm Hg) at ambient air (only applicable for homogeneous morphology!) * PaCO2 ≥ 6.6 kPa (50 mmHg) at ambient air (only applicable for homogeneous morphology!) * Patients with incomplete interlobar fissures as revealed by quantitative computed tomography analysis with StratX® (fissure completeness ≤ 80%) * Patients with collateral ventilation as evidenced by bronchoscopic Chartis® measurement (only performed if fissure completeness according to StratX® is \< 95%) * 6-minute walking distance ≥ 470m * More than two COPD exacerbation episodes requiring hospitalization in the last year * More than two instances of pneumonia episodes in the last year * Unplanned weight loss ≥ 10% within 90 days prior to enrollment * Pulmonary hypertension as evidenced by Delta Psyst RV-RA \> 35 mmHg on recent echocardiography (within 3 months prior to screening) and confirmed by RHC (mPAP ≥ 35 mmHg) and signs of moderate to severe RV dysfunction. * Evidence of left ventricular ejection fraction (LVEF) less than 45% on recent echocardiography (within 3 months prior to screening) * History of exercise-related syncope * Myocardial infarction or congestive heart failure within 6 months of screening * Clinically significant arrhythmias that might put the patient at risk in regard to the interventions * Prior LVR (any method), bullectomy, or lobectomy * Clinically significant bronchiectasis with expectoration of ≥ 2 tablespoons/day. * Pulmonary nodule requiring surgery * Unable to safely discontinue anticoagulants or dual antiplatelet therapy for 7 days * Patients with a life expectancy of less than one year