Induction of anesthesia and transnasal intubation by the anesthesia colleagues. Entry with the small bore tube and inspection of the hypopharynx and larynx. There is an exophytic mass in the laryngeal region, which starts from the right glottic plane, infiltrates the pocket folds and the anterior commissure, extends to the opposite side and involves the entire postcricoid region on the right side. Further extended subglottic extension to approx. 2.5 cm below the glottic plane. Sinus piriformes and esophageal entrance as well as epiglottis free on both sides. Injection of xylocaine-adrenaline mixture and sterile washing and draping. Creation of an apron flap and start with the release of the larynx on the left side. Exposure of the sternocleidomastoid muscle, the cervical vascular sheath and the omohyoid muscle as well as the hyoid bone. The 4-cervical vascular sheath is detached from the larynx. The superior laryngeal nerve, artery and superior laryngeal vein are cut off. Then release the hyoid bone and release the piriform sinus, exposing the thyroid cartilage and removing the infrahyoid muscles on the left side. Then transition to the right side. Exposure of the sternocleidomastoid muscle, the omohyoid muscle, the submandibular gland and the cervical vascular sheath. Detachment of the cervical vascular sheath from the larynx. Detachment of the thyroid gland. Here it can be seen that the thyroid gland on the right side is nodularly altered and very coarse; the thyroid isthmus is also very coarse in the middle, in the sense of a nodule, altered in a manner suspicious of metastases. The thyroid gland is dissected close to the capsule so that the epithelial bodies fall dorsally. Intraoperative demonstration on <CLINICIAN_NAME>. He confirms that the epithelial bodies on the right side were not removed. Then release of the piriform sinus with visualization of the thyroid cartilage and the posterior surface of the thyroid cartilage. This is only partially successful. Then release of the hyoid bone and removal of the hyoid bone. Then enter the pharynx at the level of the epiglottis. Pull out the epiglottis. Cut along the posterior edge of the epiglottis up to the postcricoid region. Then release the postcricoid region while saving the mucosa. Release of the esophagus from the trachea. Prior to this, a deep tracheotomy was performed between the 3rd and 4th tracheal cartilage. The laryngeal preparation is then also removed at this level. A marginal sample is taken from the laryngeal preparation in the area of the trachea and sent for frozen section. There is no evidence of invasive carcinoma, carcinoma in situ or dysplasia. The laryngeal specimen itself is sent for final histology. Then insertion of a size 8 Provox prosthesis in the usual manner. Perform the pharyngeal suture in the usual manner, initially in two layers and after completion of the neck dissection by adapting the prelaryngeal muscles and the pharyngeal muscles. Then neck dissection on the right side. Exposure of the submandibular gland, the accessorius nerve, the hypoglossal nerve, the cervical sinus and free preparation of the internal jugular vein. Release of the neck preparation II a to V a, sparing the plexus branches. Then neck dissection on the left side. Exposure of the submandibular gland, the accessorius nerve and the ................................ nerve. Then release the neck preparation II a to V a, while protecting the plexus branches. Then perform the myotomy at the insertion of the sternocleidomastoid muscle on both sides. Insertion of 2 Redon drainage tubes and insertion of the tracheostoma. This is relatively difficult as the tracheostoma is very deep. Two-layer wound closure and completion of the operation without complications. Post-operative calcium control according to standard thyroid regimen. X-ray gruel swallow on the 10th postoperative day. Antibiotics for 24 hours.