Open-neck organ preservation surgery in the treatment of ENT malignancies is based on the knowledge of the biological aspects of tumor growth and spread. The indications, contraindications, and modalities of treatments are precisely described. Regarding the use of endoscopic lasers, some experts claim that better results are achieved, and make it obsolete to respect the classical margins of tumor resection. Others see the use of lasers instead of conventional blades as a mere matter of fashion. In this issue, experts are discussing the relevance of endoscopic lasers in organ preservation surgery in the treatment of ENT malignancies, its implications in terms of safety, advantages for the patient and convenience for the surgeon. Further, the consequences of laser burns on the histological examination of the resected tissue are compared to those of standard procedures.