We analyzed 119 files of patients with Zenker's diverticulum who were treated with CO2 laser systems concerning treatment management, complications, and long-term results. Although the tissue bridge was dissected down to the fundus of the diverticulum, opening the mediastinum, mediastinitis was observed in none of the cases. Of the patients followed up for long-term results, 90.3% were completely symptom-free, and 5.8% of the patients reported an improvement in general condition. In view of the low rate of complications and the low level of morbidity and because of the good functional results, microendoscopic laser surgical diverticulotomy can be recommended as suitable therapy, especially as compared to external approaches or even other endoscopic treatment strategies. The main advantage as compared to staple-assisted esophagodiverticulostomy is that no special equipment is needed and that even small pouches can be treated successfully.