Key Points: 1. External auditory exostosis (surfer’s ear) is a progressive condition of benign hyperostotic overgrowths of the external auditory canal, secondary to repetitive cold-water exposure, in which symptoms correlate to degree of exostosis. 2. Surgical intervention is the only available treatment, most commonly using the osteotome or microdrill, but these carry a risk of sensorineural hearing loss, post-operative stenosis, temporomandibular dysfunction and tympanic membrane perforation. 3. We describe the Sanu technique, an innovative method of canaloplasty with endoscopic underwater excision of exostoses using Piezoelectric saw and continuous irrigation with 1:1,000,000 adrenaline. 4. The inherent properties of the Piezoelectric saw reduce the overall risk of complications compared to otologic drill and osteotome, most notably of sensorineural hearing loss and temporomandibular joint dysfunction. 5. This novel technique is cost-equivocal and easily implemented in departments with endoscopic capabilities.