After induction of anaesthesia, a tracheoscopy is first attempted, which is not possible due to the complete alteration of the glottis by the tumor. The patient is then anesthetized via the existing tracheostomy. The surgeon then intubates the patient naso-tracheally to facilitate the first steps of the operation. The esophagogastroscopy is then performed and the PEG tube is inserted in the typical manner. After a positive diaphanoscopy, 4 ml of xylocaine with adrenaline is injected, the Troikart is inserted and the tube is placed using the fall-through method. Now inject 10 ml xylocaine with adrenaline on both cervical sides and then abjode the neck. An apron flap is then passed through the upper edge of the existing tracheostoma. The subplatysmal formation of the apron flap is then performed up to the level of the hyoid bone. The neck is then dissected on the right side. Dissection along the anterior edge of the sternocleidomastoid. Expose the omohyoid muscle and the digastric muscle. Identification of the accessorius nerve. Then dissect the internal jugular vein from caudal to cranial. At the same time, the facial nerve is also exposed, dissected and protected. Then identify the hypoglossal nerve and form the complete middle preparation. After completion of the neck, the lateral preparation is then also dissected far caudally, starting from level IIb and sparing the accessory nerve and the plexus branches. Now proceed identically on the left side. The sternocleidomastoid muscle is also exposed here. The omohyoid muscle and the digastricus venter posterior muscle are then exposed and the accessorius nerve is identified and spared. Finally, the internal jugular vein is dissected from caudal to cranial and a very deep facial vein is also dissected and spared, as on the opposite side. After identifying the hypoglossal nerve and skeletonizing the submandibular gland, the medial neck preparation is also performed on the left side. After completion of the LE, the lateral preparation is also made here, sparing the plexus branches and the accessorius nerve, whereby it should be noted here that clearly enlarged lymph nodes were palpated far caudally on both sides. Now prepare for the laryngectomy: For this purpose, the cervical vascular sheath is first dissected medially on the right side up to the scalene muscles. Cranially, the bundle of the superior laryngeal nerve can be identified and ligated. The superior thyroid artery is then followed caudally, as removal of the thyroid gland is unavoidable on the left side, the thyroid gland is very carefully spared on the right side, but the paratracheal area and along the cricoid cartilage are now dissected in depth and the vessels and nerves are successively severed. This ensures that the thyroid gland is separated from the trachea without further injury. The constrictor muscle of the pharynx is then separated from the thyroid cartilage on the right side using the electric needle and the upper thyroid horn is exposed. The piriform sinus is then freed from the inner side of the thyroid cartilage using the Freer. A similar procedure is now performed on the left side. Here, the cervical vascular sheath is also dissected medially until the scalene muscles are reached. The bundle of the superior laryngeal nerve is then ligated and severed; as the thyroid gland is also to be removed here, the thyroid gland is dissected caudally laterally. Prior to this, the superior thyroid artery is ligated and transected. The omohyoid muscle is then also cut and dissected lateral to the thyroid gland. Caudal to the thyroid gland, the resection is now completed up to the tracheal side wall. Now use the electric needle to cut through the pharyngeal constrictor muscle and the upper thyroid horn on the left side as well. Then free the piriform sinus from the inner side of the thyroid cartilage with the Freer. The hyoid bone is now exposed and completely freed laterally. Then dissect into the depth of the pre-epiglottic space until the petiolus of the epiglottis is reached, from there dissect subperichondrally on the lingual side of the epiglottis until the free edge is reached. The pharynx is now opened here. As the tumor mainly extends subglottically, the preparation is made very close along the pharyngo-epiglottic fold and along the arytenoid region and the arytenoid cusps, sparing as much mucosa as possible. This works very well. The tumor, which has infiltrated the thyroid gland and also extends into the postcricoid region, can now be easily palpated. For this reason, the dissection is now carried out very carefully, not directly along the cricoid cartilage, but along the hypopharyngeal mucosa, so that the upper esophageal sphincter is also removed in the dissection. Overall, the esophagus must be dissected very far caudally so that it is no longer in direct contact with the trachea, which was also separated caudally of the cricoid cartilage with approx. 3 tracheal clamps. First cut on the right side and then completely resected at a distance of approx. 1 cm from the tumor, which not only infiltrated the subglottic space but also the trachea on the left side. The complete preparation of the laryngectomy and thyroid cartilage removal is then sent for frozen section diagnostics. A site in the postcricoid region that was clinically suspicious for tumor infiltration is clarified again with an additional frozen section diagnosis; this was also tumor-free. All frozen sections were found to be tumor-free by the pathology department. In between, the lateral neck preparations were carried out. Finally, the pharynx was reconstructed. For this, the pharyngeal tube is first readapted using inverted 3-0 Vicryl sutures. The 2nd suture is then placed submucosally approximately 5 mm lateral to the primary suture, followed by a 3rd layer as far as possible, which includes the preserved M. constrictor pharyngis. After careful hemostasis with hydrogen and Ringer's irrigation, 2 redon drainage tubes are placed on the right and left and the wound is closed in two layers using subcutaneous 3-0 and 4-0 Vicryl sutures. The tracheostoma is naturally formed around the stump of the trachea with 2-0 Mercelene sutures. Re-intubation to a 10 mm cannula. The patient was given 2 x Unacid 3 g intraoperatively, which is to be continued for 3 days, and 1 x 250 SDH additionally due to his lung problems.