Introductory consultation with the anesthetist. Positioning of the patient and injection of local anesthetic with adrenaline in the area of the scar of the apron flap. Then skin incision along the old neck scar and preparation of an apron flap. Then exposure of the front edges of the sternocleidomastoid muscle on both sides. Start with the neck dissection on the right side. Exposure of the cervical vascular sheath. Long dissection of the cervical vascular sheath with the internal jugular vein and the carotid artery and its branches as well as the vagus nerve. Exposure of the accessorius nerve. Displacement, neurolysis and re-embedding of the vagus nerve and accessorius nerve. Exposure of the cervical plexus. A small lymph node conglomerate lateral to the vein can be seen caudal to the cervical plexus. This is excised. Careful hemostasis is performed. Dissection on the deep cervical fascia cranially up to the accessorius triangle. The hypoglossal triangle and the anterior neck preparation are also excised. Overall, there is massive scarring here, which is why the preparation conditions are significantly more difficult. Transition to the left side. Slightly less scarring here and therefore easier preparation. However, after exposing the cervical vascular sheath, the lateral neck preparation is still relatively complete. Therefore, exposure of the accessorius nerve, displacement, neurolysis and re-embedding of the accessorius nerve and removal of the lateral neck preparation. Subsequently, the hypoglossal triangle and the anterior neck preparation were exposed and evacuated while sparing all branches of the external carotid artery and the internal jugular vein. On the right side, the facial vein was ligated. This results in neck revisions of levels Ib, II, III, IV and V on both sides. This is released cranially. This is followed by caudal release of the infrahyoid muscles. Separation of the prelaryngeal musculature in the median line so that the infrahyoid musculature and infralaryngeal musculature can be dissected away to the side. This exposes the laryngeal framework. The tumor does not appear to have penetrated the larynx on the right side, the cartilaginous border is intact here. Dissection up to the exposure of the cricoid cartilage. Dissection of the anterior wall of the trachea. Separation of the scarred parts of the thyroid gland. Hardened or suspicious nodules are not palpable in the thyroid gland if multinodular goiter is known. Visualization of the old scar of the former tracheotomy. Enter the trachea and prepare a visor tracheotomy. Subsequent intubation via an endotracheal tube via the tracheostoma and removal of the nasal tube placed by the anesthesia colleagues. Insertion of a McIvor blade into the vallecula and opening of the pharynx. Widen the pharyngeal opening so that the restepiglottis is visible. The supraglottic tumor described on the right side can now be seen in the view. Partial resection of the restepiglottis and caudal dissection. The dissection is performed above the level of the ligament. Lateral incision on the right side. Here it can be seen that the tumor has grown subepithelially paraglottically to far caudally, well below the vocal cord level. There is extensive tumor infestation here, which no longer allows partial laryngeal resection, so a switch is made to total laryngectomy. This completely exposes the lateral edges of the thyroid cartilage and dissects the pharyngeal wall. Complete the incision via the aryepiglottic fold of the right side into the postcricoid region so that the pharynx can be separated from the larynx here by cutting around the aryepiglottic fold of the right side, which is completely consumed by the tumor. Further dissection caudally at the posterior edge of the larynx up to the cricoid cartilage plate. The larynx is then deposited below the cricoid cartilage. Examination of the specimen. The tumor is resected in sano. Despite this, marginal samples are taken from the base of the tongue. It appears that the tumor may have invaded this area. The tissue appears conspicuously hardened and somewhat restless, so that a small portion of the base of the tongue is resected first. A marginal sample is then taken for a frozen section assessment. Also take marginal samples from both pharyngeal side walls and the postcricoid region. All marginal samples are assessed as tumor-free. Insertion of the Provox prosthesis in the form of a Provox 2 size 6 at the typical location. Subsequent closure of the pharynx after myotomy on both sides. The pharynx is closed with single button sutures and then in a second layer using continuous sutures. TachoSil is glued to the ends on both sides and to the intersection of the horizontal and vertical pharyngeal suture. Suture the infrahyoid muscles in front of the pharynx again. Then release the medial parts of the insertion of the sternocleidomastoid muscle to prevent the tracheostoma from sinking in deeply for later treatment. Repeated careful hemostasis. Insertion of large Redon drains into the neck on both sides. Two-layer wound closure of the apron flap and circular suturing of the tracheostoma. Application of a pressure bandage on both sides. A nasogastric tube was placed in the patient at the beginning of the operation. This is now reattached and remains in place. The patient received intravenous antibiotics preoperatively and at the end of the operation, which were to be continued for 3 days postoperatively. Final consultation with the anesthesia department. The patient is kept awake in the in-house intensive care unit for monitoring.