In 1964 we started to treat hypopharyngeal (Zenker's) diverticular endoscopically, using the procedure described by Dohlman. With the increase in the number of patients (274 patients up until 1982), the technique and the instruments used have improved. This paper describes the technique we have used since 1981, which involves exposure of the tissue bridge between esophagus and diverticulum with the aid of a specially designed scope and subsequent severance of this bridge under microscopic control. In 12 cases the bridge was severed by electrocoagulation, while the CO2 laser was used for this purpose in another 12 cases. Both techniques have given good results. Essential advantages or disadvantages of either of these methods could not be elicited. We regard the use of an operating microscope as a great improvement.

The CO2 laser is being used in several otolaryngology departments around the world. Clinical experience has shown that it is a unique surgical tool in the management of benign and in some malignant lesions of the larynx. Until now, little has been written about its indications in patients with carcinomas of the larynx. The purpose of this paper is to present our experience with 58 patients with various premalignant and malignant lesions of the larynx in which the CO2 laser was employed as a curative or palliative debulking procedure.

It is somewhat surprising that endoscopic treatment of hypopharyngeal diverticula has failed to become as widely known as the method merits in our opinion. In principle we use the Dohlman procedure. The septum between diverticulum and esophageal lumen is divided with a diathermic knife after electrocoagulation. In larger diverticula we prefer to divide the tissue bridge in several sessions. Endoscopic treatment (under local anesthesia, if necessary) can be carried out in patients whose general condition is poor. From 1964 until 1980 we have endoscopically treated 211 patients, including 6 patients with a recurrent diverticulum after transcutaneous surgery. The complication rate is low and the complications were successfully controlled except in 1 patient, who died from cardiac failure 2 days after operation. Ultimately 193 patients (91.5%) are very satisfied and 17 patients (8%) are fairly satisfied with the therapeutic result. We feel justified in maintaining that endoscopic treatment of hypopharyngeal diverticula can be regarded as a good method of treatment.

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Modern techniques have reduced the long existing reluctance to perform lingual tonsillectomy. The results of treatment of hyperplasia of the lingual tonsil with the carbon dioxide laser in 32 patients are presented. After exposure with a special endoscope the lingual tonsil can be vaporized or excised under microscopic control with promising results, far superior to the results obtained with other surgical techniques. Since the success rate of the surgery depends on the diagnostic criteria for applying this therapy, a careful selection of patients is essential.