Start of the operation by tracheotomy. For this purpose, approx. 3 cm horizontal skin incision below the cricoid cartilage. Cut through the skin of the subcutis. Identification of the infralaryngeal muscles and separation in the midline. Separation of the muscle bellies and identification of the thyroid isthmus. Undermining of the thyroid isthmus with the clamp and bipolar coagulation of the isthmus as well as isthmus splitting. Now identification of the anterior tracheal wall and entry into the 3rd intertracheal ring space by means of a visor tracheotomy. Insertion of an 8 mm tube. Now draw in the apron flap. This runs on both sides along the anterior edge of the sternocleidomastoid muscle to the mastoid (2 QF) below the mandible. Now cut the cutaneous and subcutaneous tissue on both sides. Separation of the platysma. Subplatysmal dissection of the apron flap in the usual manner and slinging using 3 sutures. Now pharyngoscopy and laryngoscopy again: positioning of the patient. Insertion of the Kleinsasser tube. The tumor can be seen on the left, which passes from the arytenoid cartilage via the aryepiglottic fold to the piriform sinus and onto the hypopharyngeal side wall up to the cranial vallecula. Base of tongue not infiltrated macroscopically. Overall indication for laryngectomy with partial pharyngectomy, if necessary with flap coverage. Sterile draping and injection of a total of 10 ml Ultracaine 1% with adrenaline into both sides of the neck follows. Then lift an apron flap in the typical manner up to the submandibular gland on both sides and subplatysmal at the level of the hyoid bone. Then neck dissection on the left: Exposure of the sternocleidomastoid muscle, omohyoid muscle and digastric muscle. Exposure of the internal jugular vein, facial vein and external and internal carotid arteries. Exposure of the accessory nerve, glossopharyngeal nerve and vagus nerve. Clearing level II to V. Here also visualization and preservation of the branches of the cervical plexus. Macroscopically no clear evidence of lymph node involvement. Subsequent right neck dissection Level II to V: Identification and visualization of the anterior border of the sternocleidomastoid muscle and dissection down to depth. Identification of the omohyoid muscle. Dissection along the omohyoid muscle up to the hyoid bone. Now cranial identification of the digastric muscle and detachment of the submandibular gland from the glandular capsule. Now identify the accessorius nerve. The nerve is safely spared and dissected free from the neck preparation. Also identification of the hypoglossal nerve. Sharp dissection along the V. jugularis interna and lateral tapping of the neck preparation. Now free the cervical vascular nerve sheath from the neck preparation. The carotid artery, vagus nerve and jugular vein must be safely identified and protected. Now remove the neck preparation in the usual manner from cranial to caudal while sparing the deep plexus branches. Completion of the neck dissection on the right side without complications. Subsequent laryngectomy with partial pharyngectomy: first exposing the hyoid bone and separating it from the suprahyoid musculature. Pre-epiglottic fatty tissue is included in the resection. Exposure of the left superior cornu and exposure of the laryngeal skeleton. Hypopharynx remains on the laryngeal skeleton. Caudal dissection of the thyroid gland. Subsequent isolation of the right superior cornu, dissection of the hypopharynx from the laryngeal skeleton. Caudal dissection of the thyroid gland. Subsequent entry into the larynx, initially from the right paramedian side. Exposure of the tumor. Cut around the tumor macroscopically with a safety margin of at least 1 to 1.5 cm. The larynx is integrated into the resection. Caudal dissection of the larynx from the distal hypopharynx or esophageal entrance. Deposition of the larynx above the tracheostoma. Prior to this, preparation of a mucosal flap from the cricoid cartilage, which is dissected off here and sutured to the tracheal cartilage remaining cranial to the tracheostoma. This creates a Hermann ridge. Sutures with 3 or 4-0 Vicryl. The larynx is marked with sutures. In the area from the middle of the base of the tongue to the left pharyngeal wall, a further marginal sample is obtained and also marked with sutures; this is sent to the frozen section. The frozen section still shows carcinoma in situ infiltrates in the area of the middle of the tongue base and moderate dysplasia in the area of the left pharyngeal wall. Therefore, another 1 cm resection was taken from the base of the tongue, which extended to the left pharyngeal wall. No more infiltrates in the tumor-free part in the frozen section. However, there is still moderate dysplasia at several edges, no further surgical measures in the case of suspected field carcinomatization. Myotomy on the left in the typical manner and insertion of a size 8 provox prosthesis in the typical manner. Subsequent suturing of the hypopharynx, partly continuous, partly inverting single button sutures. Subsequently 2nd suture inverted over the 1st suture. Further inverting sutures are made, particularly in the area of the base of the tongue. Then 3rd suture of the musculature over the 2nd suture, also with Vicryl 4-0 single button sutures. A gastric tube was inserted as a splint before pharyngeal closure. Subsequently, careful irrigation of the wound area with hemostasis and layered wound closure with insertion of a Redon drainage in both sides of the neck. The tracheostoma was also epithelialized. Subsequent completion of the procedure without complications. Patient received preoperative antibiotics with Unacid. Please continue this antibiotic treatment for one week. Feeding via PEG tube for approx. 12 days, then carefully build up diet after swallowing porridge. Presentation at the interdisciplinary tumor conference after receipt of the final histology. Due to the moderate dysplasia and suspected field carcinomatization, discuss radiotherapy postoperatively.