Induction of anesthesia by the anesthesia colleagues. Intubation via the existing tracheostoma. First of all, entry with the small bore tube and inspection of the tumor. The tumor fills the entire right piriform sinus, grows onto the medial piriform sinus wall and reaches the arytenoid cartilage, growing around the arytenoid cartilage towards the postcricoid region. The endolarynx itself is free, including the left arytenoid cartilage. Insertion of a PEG tube in the usual manner, with very good diaphanoscopy. Injection of Ultracaine/suprarenin mixture and sterile washing and draping. Placement of an apron flap in the usual manner. Neck dissection on the right. Exposure of the sternocleidomastoid muscle, the omohyoid muscle, the submandibular gland and the cervical vascular sheath. Level II shows a very large metastasis, which is successively dissected out, sparing the external and internal jugular veins, the accessorius nerve and the hypoglossal nerve. These structures can be preserved, including the facial vein. During dissection, the jugular vein is torn twice and carefully sutured over with Ethilon. Remove the remaining neck tissue from level II to Va while sparing the plexus branches. Turn to the opposite side. Here also expose the sternocleidomastoid muscle, the omohyoid muscle, the cervical vascular sheath, the submandibular gland and evacuate levels IIa to Va while sparing the plexus branches. Sparing of the external and internal jugular, hypoglossal and accessorius nerves and the facial vein. Release of the larynx on the left side. Dissection of the thyroid gland and the cervical vascular sheath. Ligation of the upper laryngeal bundle. Detachment of the infrahyal musculature. Release and removal of the hyoid bone. Turning to the opposite side. Here, only the upper part of the larynx is detached while detaching the infrahyal muscles. The rest is left in place due to the tumor infiltration. Release of the piriform sinus on the left side. No release of the piriform sinus on the right side due to tumor infiltration. Entering the pharynx while simultaneously pulling out the epiglottis. Incision of the mucosa, initially on the left side with opening of the pharynx. Inspection of the tumor under direct vision. Here you can clearly see that the tumor infiltrates the entire wall of the piriform sinus and also reaches the posterior arytenoid cartilage. The larynx is removed with appropriate removal of pharyngeal mucosa and placed caudally. Two marginal samples are taken from the postcricoid region and the lateral pharyngeal wall. No evidence of tumor or carcinoma in situ in the frozen section. Therefore R0 situation in the frozen section. Due to the very narrow remaining mucosa (well under 6 cm), the decision was made to lift a graft. Lifting of the supraclavicular island flap by <CLINICIAN_NAME>. For this purpose, a 9x5 cm skin island is cut around the upper arm and lifted, taking the muscle fascia with it. An auxiliary incision is made in the front below the clavicle and dissected in front of and behind the clavicle. The flap is lifted with a very wide handle and is well supplied with blood during the entire dissection. Form a skin bridge towards the pharynx. Pull through the graft and insert the graft into the pharynx. Insertion of the graft into the pharynx, starting at the esophageal entrance and moving cranially. This was successful without any problems. Of course, a Provox prosthesis was inserted in the usual manner prior to insertion. A myotomy was performed in the area of the sternocleidomastoid muscle on both sides to create a flat tracheostoma. Insertion of two Redon drainage tubes in the shoulder area and also on each side of the neck. The tracheostoma must be partially revised. There is an extremely deep tracheostomy tube in the anterior section. Here it is not possible to suture the skin to the anterior wall of the trachea again. This is possible without any problems in the posterior section. Two-layer wound closure. Insertion of a tracheal cannula. IV antibiotics for 24 hours, X-ray pre-swallow on the 10th postoperative day.