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As a minimally invasive treatment, transoral endoscopic surgery offers advantages over (chemo)radiotherapy and open surgery, including preservation of voice and swallowing function and the option of future radiotherapy. However, some lesions remain undetected during preoperative examinations of conscious patients and are identified only intraoperatively under general anesthesia. In this study, we sought to clarify the clinical characteristics of lesions newly detected during surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed 193 patients with 284 superficial squamous cell carcinoma lesions of the oro-hypopharynx or larynx who underwent transoral endoscopic surgery between January 2016 and December 2024. To identify factors associated with intraoperative detection, newly identified lesions were compared with preoperatively detected lesions in terms of location, tumor size, histopathology, and preoperative endoscopic examination conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the 284 lesions, 24 (8.5%) were newly detected intraoperatively, which were significantly smaller than those detected preoperatively (median: 7.5 vs. 17 mm) and were mainly located on the posterior walls of the oropharynx and hypopharynx. Sixteen lesions were identified using narrow-band imaging (NBI) alone, whereas eight required additional Lugol staining. Lesions requiring Lugol staining were significantly more likely to be carcinoma in situ than invasive carcinoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Intraoperatively detected lesions were generally smaller and more frequently located on the posterior pharyngeal wall. Given the limitations of conscious endoscopic examinations, meticulous intraoperative inspection using NBI and Lugol staining is essential to avoid overlooking indistinct lesions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10147-026-03013-2","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T18:50:34Z","timestamp":1773859834000},"page":"906-914","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical characteristics of newly detected pharyngo-laryngeal lesions during transoral endoscopic surgery"],"prefix":"10.1007","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1008-6904","authenticated-orcid":false,"given":"Satoru","family":"Miyamaru","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daizo","family":"Murakami","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hidenori","family":"Katsura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hideaki","family":"Miyamoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenshi","family":"Matsuno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sadahiro","family":"Yamamura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Narumi","family":"Hayashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshinori","family":"Hirai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuhito","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yorihisa","family":"Orita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"3013_CR1","doi-asserted-by":"publisher","first-page":"1375","DOI":"10.1002\/cncr.20482","volume":"101","author":"M Muto","year":"2004","unstructured":"Muto M, Nakane M, Katada C et al (2004) Squamous cell carcinoma in situ at oropharyngeal and hypopharyngeal mucosal sites. 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