In recent years, surgical treatment of laryngeal cancer has evolved towards transoral resections. Transoral laser microsurgery (TLM) combines microscopic control with the precise cutting and coagulation capability that laser equipment has, making it possible to remove laryngeal tumours by the transoral approach, with very good oncological and functional outcomes. In early tumours, local control with TLM has been proved to be as good as in open surgery and totally comparable to that achieved under radiation protocols, at a much lower cost. Consequently, TLM is presently considered a first line treatment in early laryngeal cancer. These good oncological and functional results have led to an increase in TLM indications for intermediate or advanced carcinomas. In this article we review the role of TLM in the treatment of locally advanced tumours of the larynx, with special emphasis on appropriate patient selection and different technical considerations. Although TLM is not presently considered a standard treatment for locally advanced laryngeal tumours, the outcomes published in the literature are very encouraging, with results comparable to other treatment alternatives in appropriately selected patients. Compared to external surgical procedures, TLM reduces patient morbidity, provides faster recovery and makes it possible to avoid tracheotomy in a high number of patients.