The patient, a 42-year-old male, developed hoarseness 4 years ago, which gradually worsened, and began to hold his breath 4 months ago. He was hesitant to seek medical attention for fear of laryngeal dissection surgery. Before coming to the hospital, he could not lie down, had obvious inspiratory dyspnea, and wheezing and suffocation were obvious with slight activity, which made the patient suffer a lot and seriously affected his life and lost his ability to work. After learning that our otorhinolaryngology-head and neck surgery department could use laser laryngeal microsurgery to treat benign and malignant tumors in the larynx, he came to our hospital. Under the outpatient fiberoptic laryngoscope, he saw a huge mass in the laryngeal vestibule, which completely covered the vocal cords and could not be seen by the vocal cords and ventricular cords bilaterally. After examining the patient, the physician thought that the mass was smooth on the surface but huge in size and undetermined in nature, so the source could not be accurately determined before surgery, and pathological examination could not be performed before surgery to avoid severe bleeding and asphyxia. The traditional surgical method requires tracheotomy, incision of the skin and soft tissues of the neck and laryngeal cartilage before the laryngeal mass can be exposed and removed, which is very traumatic, with a lot of blood loss, long hospital stay, expensive treatment and may leave permanent hoarseness after surgery. If laser laryngeal microsurgery is used to remove the laryngeal mass, it will not only avoid the incision of skin and laryngeal cartilage in the patient’s neck, but also achieve the minimally invasive treatment effect of less surgical trauma, less intraoperative bleeding and faster postoperative recovery, and effectively shorten the hospitalization time and reduce the hospitalization cost. However, the patient’s laryngeal entrance was almost completely occupied by the swelling, so successful surgical anesthesia intubation and precise surgical operation became the key to successful surgery. After a preoperative discussion with the anesthesiology department, a treatment modality of removing the intralaryngeal mass by laser laryngeal microsurgery under general anesthesia with tracheal intubation was determined, and various emergency measures such as emergency tracheotomy were formulated. After completing all preoperative tests, the patient was operated on March 23. Because the mass was too large to expose the voice box, and because of the severe laryngeal obstruction, the patient could not lie on his back and was difficult to be intubated routinely. After induction of anesthesia, the physician, with years of experience in intubation, successfully inserted the anesthesia tube through the posterior laryngeal connection in an unconventional wire-guided tracheal intubation in the lateral position, which ensured the patient’s breathing passage and avoided tracheotomy, laying the foundation for a smooth operation. When the patient was placed in the support laryngoscope, it was seen that the swelling occupied the entire field of view of the laryngoscope and the base of the swelling could not be exposed, so it was difficult to remove the swelling using conventional laser techniques. The mass was gradually removed from the vocal cord by laser, and the normal vocal ligament and other structures in the larynx were preserved as much as possible while removing the mass, which ensured the complete recovery of the patient’s articulatory function after surgery. When the patient woke up from anesthesia, the symptoms of laryngeal obstruction were completely relieved and he was breathing smoothly. The patient was able to get out of bed and move freely 8 hours after the surgery and was discharged one day later. At the time of discharge, the patient was moving as usual and his hoarseness was recovering. The success of this surgery fully demonstrates the superiority of laser laryngeal microsurgery treatment: less trauma – no neck skin soft tissue incision, no laryngeal cartilage damage. Less blood loss – the blood loss of the whole operation was only a few milliliters. Complete removal of tumor tissue – more precise operation under microscope ensures complete removal of tumor tissue. Good functional recovery – avoiding damage to laryngeal cartilage and preserving the integrity of vocal folds and various structures in the larynx to the greatest extent. Short hospitalization time and economy – patients can be discharged one day after surgery, which saves valuable medical resources and reduces the burden of patients. Cosmetic – There are no surgical scars on the neck. Therefore, laser laryngeal microsurgery is a minimally invasive, reliable, efficient, economical and cosmetic procedure recommended for most benign and malignant laryngeal tumors and other occupying lesions.