Open supraglottic laryngectomy is a highly effective operation for patients with squamous cell carcinoma of the supraglottic larynx who meet the traditional oncological criteria. This operation confers attendant perioperative morbidity to include tracheotomy and feeding tube placement and hospitalization for 10 to 14 days. With the evolution of carbon dioxide laser operative techniques and the introduction of adjustable laryngoscopes, supraglottic laryngectomy can be done endoscopically in selected cases of early supraglottic cancer with the same margins obtained by the open techniques. The attendant morbidity, however, is greatly reduced. This chapter describes the historical development and principles of endoscopic resection, the surgical technique employed, and reported treatment outcomes using this endoscopic procedure.