This video presents a detailed surgical excision of a vocal fold granuloma in a patient with prior laryngeal surgeries. After unsuccessful conservative management with Proton Pump Inhibitors and inhaled steroids, the lesion was removed endoscopically. Emphasis is placed on exposure, instrument handling, and tissue preservation to avoid cartilage damage. Hemostasis is achieved with epinephrine pledgets, and postoperative voice therapy is outlined. The procedure highlights key technical considerations and collaborative strategies essential for effective management of laryngeal granulomas.