Induction of anesthesia and intubation by the anesthetist. Then entry with the Kleinsasser tube and inspection of the hypopharynx and larynx. No abnormalities in the hypopharynx including the piriform sinus on both sides. Inspection of the laryngeal plane. Here, an exophytic tumor is seen in the area of the vocal folds with a transition to the pocket folds on both sides. The vocal folds themselves are no longer visible. The arytenoids are glassy swollen on both sides and on the right side the tumor extends to the ary. A definite infiltration on the right side of the arytenoid cartilage cannot be confirmed. A nasogastric tube is then inserted. Insertion with the flexible esophagoscope and pre-scanning into the stomach. If the diaphanoscopy is good, a PEG tube is inserted using the thread pull-through method. The skin incision is then made in the form of an apron flap. As the patient has already undergone a tracheostomy due to shortness of breath, the stoma is also incised so that part of the trachea can also be removed. A subglottic extension of the tumor was described. Then dissection of the apron flap in the usual manner below the platysma. Then fixation and suturing of the wound edges. Then skeletonization of the hyoid bone with detachment of the musculature and the base of the tongue. Then skeletonization of the larynx and detachment of the oblique laryngeal musculature. However, this prelaryngeal musculature is left on the larynx. A CT scan cannot rule out the possibility of a thyroid cartilage rupture 100%. At the very least, the thyroid cartilage is eroded and, for oncological safety reasons, a relatively large amount of tissue must be left on the outside of the larynx. Then skeletonize the thyroid cartilage upper horns on both sides, incise the periosteum and push off the piriform sinus on both sides, then perform the pharyngotomy above the hyoid bone. Pull out the epiglottis and incise the pharyngeal mucosa on both sides along the edges of the epiglottis up to the postcricoid region; a relatively large amount of the pharyngeal mucosa must be removed on the right side as the tumor borders are close to the palpation. A lot of mucosa can be saved on the left side. Dissection of the thyroid gland and visualization of the trachea. Deposition of the larynx in the upper tracheal area so that the former upper edge of the stoma is integrated into the specimen. Then take marginal samples in the pharyngeal mucosa area and send for frozen section. No tumor remnants and no carcinoma in situ in the frozen section. The laryngeal specimen itself is macroscopically far removed from the healthy tissue and is sent for final histology. Neck dissection is then performed by <CLINICIAN_NAME>. First on the right side. Exposure of the sternocleidomastoid muscle. Then expose the cervical vascular sheath, dissect the internal jugular vein, locate and expose the accessorius nerve, expose the submandibular gland and the hypopglossus, clear out levels IIa, III, IV and V while sparing the plexus branches. Then neck dissection on the opposite side (left through <CLINICIAN_NAME>): Exposure of the sternocleidomastoid muscle here too. Exposure of the cervical vascular sheath, dissection of the internal jugular vein, exposure of the submandibular gland, hypoglossal nerve and accessorius nerve, then clearing of levels IIa to IV while sparing the plexus branches. Then perform the pharyngeal suture in the usual manner with single button sutures for the 1st and 2nd suture, then partial readaptation of the constrictor pharyngis muscle as far as possible. Perform a myotomy on the sternocleidomastoid muscle to achieve a flat stoma. Incision of the stoma, placement of 2 Redon drains. A provox was of course placed before the pharyngeal suture. This involves palpation of the esophageal entrance, which is very wide, so there is no need for a myotomy in the esophagus; you can almost pass through it with 2 QF. The Provox is performed in the usual way using the pull-through method. A size 8 Provox is inserted. The operation is completed without complications. Please continue antibiotics for 3 days. The patient should be fed via the PEG tube for 10 days and then receive another swallow of gruel. If there is no fistula, gradually build up the diet. After receiving the histology, presentation at the tumor conference.