Laryngeal lesions with difficult visualization and access require an alternative approach. Patients with difficult anatomy, anterior glottis, subglottic and upper tracheal lesions can present challenges for the anesthesiologist and surgeon. We describe a technique of ventilating patients through a laryngeal mask airway and passing a flexible bronchoscope with a potassium-titanyl phosphate fiber laser through the laryngeal mask airway for laryngeal and tracheal surgery. There are several advantages to this method, including ease of visualization of airway lesions, wide access for therapeutic interventions, and minimal vocal cord trauma. This technique is an important tool in the management of difficult laryngotracheal lesions. © 2011.