Endoscopic treatment is becoming the standard for superficial cancer of the esophagus, and procedures for endoscopic mucosal resection (EMR) and endoscopic submucosal resection (ESD) have been established. However, endoscopic treatment cannot be the standard therapy for laryngo-pharyngeal superficial cancer, for which radiotherapy is usually the treatment of choice, since the stress of treating the lesion is large. Therefore, since June 2007 we have introduced endoscopic laryngo-pharyngeal surgery (ELPS) in cooperation with a gastrointestinal endoscopist as a minimal invasive surgery for patients with laryngopharyngeal superficial cancer. (Methods) The point of the surgery is to develop the operating field, and identify the lesion and counter-tension during resection. We could make a pharynx one lumen by using a curved laryngoscope, and obtained a sufficient operating field. Furthermore, we were able to identify the range of the lesion part precisely by using Lugol painting, a high-resolution endoscope and NBI endoscope. In cases where resection by the EMR and ESD procedures was difficult, we inserted the laryngeal fiber nasally and were able to make counter-tension during the resection by using retention forceps which we put out from there. Under this counter-tension, we performed resection using a gastrointestinal endoscope (the double scope method). We performed ELPS for 39 lesions up to January 2010, of which 20 lesions underwent resection by the double scope method. (Results) Extensive resection of more than 50 mm was possible. Also, complicated excision to achieve to endolarynx was possible. The pathological results of the resected specimen showed complete resection. (Discussion) Progress in ELPS is expected in future by developing the resection device. The double scope method is thought to be a useful procedure at present.
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