First positioning of the head, insertion of the mouthguard and insertion of the MLE tube size C and D alternately. The tumor, which is located in the area of the left vocal fold, is revealed. Compared to the previous assessment, the tumor is significantly larger and the growth is not only limited to the vocal fold, but also extends in the direction of the morgue sinus and is significantly more broad-based in the anterior commissure. The tumor is now resected with the laser at the back of the healthy area. Resection extends cranially to above the left pocket crease, resection is performed at the same height in the anterior commissure. Resection extends to the cartilage due to the significantly enlarged tumor growth. Adjustability of the anterior commissure, with relatively voluminous tumor, significantly more difficult. The tumor is therefore reduced in size and removed using the piecemeal technique. This significantly improves the overview. Resection extends slightly over the commissure to the right side at the very front. Detachment of the tumor. Dissection of the cartilage in the area of the anterior commissure. Destruction of the cartilage is evident here and tumor growth into the cartilage, therefore indication for an external procedure. The patient is repositioned and a total of 10 ml Ultracaine 1% with adrenaline is injected. A Z-shaped skin incision is then made prelaryngeally, ending in a Kocher collar incision. Dissection to the prelaryngeal muscle. This is split in the middle. A pZZZZcondral flap is dissected from the left over the anterior commissure. The cartilage is not infiltrated or even perforated on the outside. A median thyrotomy is created by cutting out a triangle or box-shaped piece of cartilage to the left. Cartilage is resected from the right paramedian to the left via the possible infiltration zone on the inside. Overview now improved. Mucosal remnants with tumor residues lying in front of the cartilage are also resected. Also soft tissue on the left caudal side in front of the cartilage. Co-resection of the ligamentum conicum. Marginal samples are taken in the area of the anterior commissure caudally from the area of the thyroid membrane, caudally on the left in the subglottic area, thread-marked in the arytenoid area, the soft tissue basally, supraglottically in the middle in the area of the anterior commissure, supraglottically on the left thread-marked as well as in the area of the right pouch ligament and vocal cord on the opposite side. All marginal samples go to the frozen section. Relatively little epithelium in the supraglottic center frozen section, but only slight dysplasia visible here. With a currently comprehensible R0 status, mucosa is again removed from the cranial area to be on the safe side, here already at the lower edge of the petiolus. However, this marginal sample is sent for final assessment. The removed cartilage and the fragmented tumor are also sent for final assessment. This is followed by careful hemostasis. The tracheostoma is created after the thyroid gland has been severed in the isthmus area. This is treated with stitches. Visualization of the trachea. Creation of a broadly pedicled Björk flap in the 2nd/3rd intermediate cartilage. Epithelialization of this. Subsequently, closure of the thyroid cartilage via drilled holes. The perichondrium flap is then placed over the thyrofissure and covers it completely. Fixation with 4-0 Vicryl single button sutures on the soft tissues caudally and on the perichondrium on the opposite side. Cranial suture of the soft tissues also with 4-0 Vicryl single button sutures with 4-0 Vicryl single button sutures. Then suture the infrahyoid musculature above with 3-0 Vicryl single button sutures. Then insertion of a flap. Layered skin closure in the typical manner. After lateral tracheotomy, an 8 mm tracheostomy tube was inserted. The procedure was completed without complications. Overall cT2 laryngeal carcinoma of the left vocal fold, growing into the anterior commissure. Therefore switch from transoral laser resection to frontolateral partial laryngectomy. Overall signs of a relatively fast-growing tumor. Microscopically R0 resection intraoperatively. Postoperative swallowing test, if problems persist insertion of a gastric tube and temporary feeding via this. Then presentation to the voice and speech department to initiate swallowing training as soon as possible. However, the swallowing function should not be impaired by the defect in the larynx area. Wait for the final marginal samples and discuss the further procedure at the interdisciplinary tumor conference.