After active patient identification, the patient is brought into the operating theater. Carrying out the team time-out. Introductory consultation with the anesthesia department. Induction of anesthesia and intubation of the patient. Positioning of the patient by the surgeon. Insertion of the mouth guard. Insertion of the size D small bore tube. The tumor is now inspected with the aid of the support autoscope and the surgical microscope. Even after several attempts, the anterior commissure can only be visualized insufficiently. The decision is therefore made to access the tumor from the outside. Removal of the small bore tube. Positioning of the patient in head reclination. Skin spray disinfection and infiltration anesthesia. Skin wipe disinfection and sterile draping. First mark the thyroid incision. Marking of the planned incision using the broken-line technique. Sharp cutting of the cutis as well as the subcutis. Insert the retractors. Exposure of the prelaryngeal musculature. Locating the midline and lateralizing the musculature. Exposure of the thyroid cartilage and the ligamentum conicum. Incision of the perichondrium in the median line using the 15 mm scalpel. Creation of a horizontal incision in the area of the ligamentum conicum. Prepare two perichondrium flaps and also knock them aside. Opening of the larynx in the sense of a thyrofissure using the wheel. Insertion of the two-pronged retractor. A tumor is found in the area of the anterior and middle third of the left vocal fold. This reaches the anterior commissure. Incision of the tumor area with the 15 mm scalpel and removal of various marginal samples. During the intraoperative frozen section, tumor, i.e. carcinoma infiltrates, are still visible supraglottically on the left. In the cranial, caudal and supraglottic right margin samples, extensions of a carcinoma in situ are still visible. Therefore indication for resection and submission of new margin samples. These are now found to be tumor-free in the frozen section diagnostics. The extent of the resection therefore extended from the anterior commissure via the vocal ligament, vocal muscle and thyroarytaenoid muscle to just before the vocal process. Due to the extent of the tumor, the inner cortex of the thyroid cartilage is now cut with the diamond drill. Hemostasis by insertion of a suprarenin-soaked strip. This is followed by punctual hemostasis using bipolar coagulation. Persistent dry wound bed at the end of the operation. Insertion of a 14-gauge wedge. Drilling of a total of four holes. Fixation of the wedge with Vicryl 3-0, followed by knocking back the neatly prepared perichondrium flaps and complete covering of the previously inserted wedge. In addition, readaptation of the previously mobilized prelaryngeal muscles. Prior to this, the wound is irrigated with H2O2 and Ringer's solution. Insertion of a sterile flap. Subcutaneous suture with Vicryl 4-0 and skin suture with Ethilon 5-0. Application of a wound dressing and a pressure bandage. Completion of the operation without complications. Final consultation with the anesthesiologist. Note: The patient should be scheduled for a control MLE, if necessary with removal of the cone, in approx. 6 weeks postoperatively.