First head positioning. Pharyngoscopy after insertion of the mouthguard. An exophytic mass is seen starting at the entrance to the hypopharynx, growing into the endolarynx and affecting both sides of the glottic plane. Caudally, the tumor extends to the upper esophageal orifice. An infiltration cannot be ruled out with complete certainty after multiple diagnostic assessments and consultation with <CLINICIAN_NAME>, but resection appears to be possible here. In summary of all findings, decision to proceed with curative surgical treatment. Skin disinfection without infiltration anesthesia in known CHD. Formation of an apron flap. Double ligation of the external jugular vein. Dissection with exposure of both submandibular glandulae. Rearrangement and neck dissection on the left side: Dissection of the sternocleidomastoid. Finding the accessorius nerve, which is spared in the further course. From caudal to cranial then development of the lateral neck preparation with removal of regions V, IV, III, II and Ib. The jugular vein, the accessorius nerve, the hypoglossal nerve, the superior thyroid artery and the carotid artery are freed from connective tissue structures and their course is visualized, identified and spared. The superior thyroid artery is dissected after its caudal exit, doped and stitched. The superior laryngeal nerve is also identified as it enters the larynx together with the accompanying vessels and removed. Now mobilize the lateral laryngeal skeleton. Separate the infralaryngeal muscles and strike downwards. Mobilization of the left thyroid pole from the laryngeal skeleton, beating laterally after separation and ligation of the isthmus. Exposure of the left-sided hyoid bone. Exposure of the posterior border of the thyroid cartilage and the upper edge of the thyroid cartilage as well as the superior cornu. This is exposed and the constrictor, already pushed off on the inside, in preparation for the laryngectomy step. Transfer to the opposite side after hemostasis. Identical procedure on the right side. Identification of the sternocleidomastoid muscle and the accessorius nerve. Protection of both structures during the procedure. The vascular sheath and the internal jugular vein and the common carotid artery are also shown here. Cranial placement of the borders with identification of the digastric muscle through the apron flap. Dissection from caudal to cranial in levels V, IV and III. It can now be seen that a metastatic conglomerate of 3 nodes is located in the jugulofacial angle on the internal jugular vein and appears to infiltrate it. It is not possible to dissect the conglomerate from the vein sharply or bluntly without risking a lesion. Therefore, cranially locate the end of the vein and caudally remove the conglomerate after double ligation and repositioning. Identification of the hypoglossal nerve. This is also spared in the further course. Completion of the neck in levels II and III and ventral removal of connective tissue. The infralaryngeal musculature is not removed here, as infiltration by underlying tumor parts cannot be ruled out. Dissection of the carotid and residual venous parts as well as the vagus nerve, which are folded further laterally and spared, and mobilization of the constrictor muscles caudally. Now repositioning for tracheotomy. Exposure of the surgical site caudally. Insertion into the trachea between the 1st and 2nd tracheal clasp. Placement of 2 holding sutures. Further mobilization of the left thyroid lobe caudally and mobilization of the laryngeal preparation from the left and right. For this purpose, also identify the right-sided hyoid bone parts and separate them sharply with the electric knife. Also on the right side, attempt to expose the cornu superius of the upper edge of the thyroid cartilage, but this is not done due to the large tumor so as not to open the tumor. In the median plane, entry into the pre-epiglottic fatty tissue. Identification of the epiglottis and disluxation with the tumor grasping forceps. Now, starting from the healthy side, release the laryngectomy specimen from cranial to caudal with the right-sided hypopharyngeal carcinoma inside. Under visualization and leaving a macroscopically healthy mucosa and muscle layer, consecutive removal under bipolar coagulation. The specimen is submitted as a whole for frozen section and R0 diagnosis. The specimen grows to the left side before entering the upper esophageal sphincter, so that only a small pharyngeal tube remains here. According to <CLINICIAN_NAME> from the pathology department, parts of a carcinoma in situ are still found at the lateral central resection margin, so that 2 resections are taken here as a margin sample. As further resection is not possible under any circumstances, we do not wait for a frozen section diagnosis, but continue with the operation and send the samples for urgent histological processing. The decision is now made to cover the defect using a pectoralis major flap: Marking of the blood vessel supply and the medially overlying skin island, which is measured beforehand. First incision at the lateral edge of the pectoralis major and identification of the supplying arterial areas. Then cut around the skin area caudally. Adaptation with Vicryl sutures of the flap epithelium with the muscle. Mobilization of a tunnel and connection to the neck access under constant view of the supplying artery. Fluxing through the flap and now double-layer inverted suturing of the flap and the resection area at all points. A T-shaped suture is first created at the base of the tongue to enable tension-free suturing. The remaining adaptation is now very successful. In the cranial area towards the base of the tongue, a third row of sutures for complete wound closure. Now complete the tracheostoma suture using Ethibond. Two-layer wound closure after placement of Redon drains in the flap removal area. Two-layer wound closure on both cervical sides after placement of 2 Redon drains. On the right cervical side in the area of the flap pedicle, the skin is not closed in order to avoid compression of the feeding vessels. Lomatuell is applied here. The patient received Unacid 3 g every 8 hours intraoperatively; this should be continued for 5 days. As far as swallowing function is concerned, with subsequent radiotherapy, complaints are certainly to be expected in the context of this maximum reconstruction. The gastric tube should be removed between the 7th and 10th postoperative day after an X-ray pre-swallow. In any case, postoperative radiotherapy if borderline in sano resection is possible at all. Voice rehabilitation can be attempted by means of ructus, but here too the chances of success are rather critical. Termination of the operation.