First induction of anesthesia and ventilation of the patient via the existing tracheostoma. Re-intubation of the patient onto a laryngectomy tube and subsequent performance of a laryngoscopy using a Kleinsasser C-tube. This revealed an exophytic, contact-vulnerable mass covering the entire supraglottis on the right side with clear infiltration of the interaryngeal region and the arytenoid region on the right side and infiltration of the vocal fold on the right side. The rest of the endolarynx and the hypopharynx were unremarkable. Subsequently, a nasogastric feeding tube was inserted under visualization in a typical manner. A PEG insertion was deliberately avoided in this session due to the condition after the previous operation and the expected scarred conditions in the abdomen. This should then be inserted by the surgical colleagues. Local anesthesia is then applied cervically ........... submedially. Skin ablation and sterile draping. Skin incision. Dissection of the subcutaneous tissue and the platysma and formation of a subplatysmal apron flap in the typical manner. Exposure and transection of the prelaryngeal muscles in the midline. Exposure of the thyroidithm, which is still present. Dissecting it in the midline. Exposure of the anterior wall of the trachea. Subsequent exposure of the external jugular vein on both sides. Dissection along the anterior border of the sternocleidomastoid muscle on the right side. Exposure and sparing of the auricular nerve. Exposure of the digaster muscle (venter posterior). Exposure of the accessorius nerve and the omohyoid muscle. Exposure of the internal jugular vein, the accessorius nerve and the common carotid artery. Dissection along the cervical vascular sheath from caudal to cranial up to the digaster muscle. Successive removal of the posterior and anterior neck preparation while sparing the above-mentioned structures and the plexus branches. Several suspicious lymph nodes in regions III and IV, which were also removed in the neck preparation. Repositioning of the patient on the left side to perform the neck dissection. Dissection along the anterior edge of the sternocleidomastoid muscle. Exposure and protection of the auricularis magnus nerve. Exposure and ligation of the external jugular vein. Exposure of the accessorius nerve, the posterior venter of the digaster muscle and the omohyoid muscle. Exposure of the internal jugular vein. Exposure of the vagus nerve and the common carotid artery. Dissection along the cervical vascular sheath from caudal to cranial. Successive removal of the posterior and anterior neck preparation while protecting the above-mentioned structures and the plexus branches. Dry conditions on both sides. Subsequent skeletonization of the hyoid bone. Dissection of the infrahyoid musculature. A large part of the sternohyoid muscle and the sternothyroid muscle at the level of the thyroid cartilage is removed with the tumor preparation. Subsequent exposure of the thyroid cartilage. Skeletonization of the same. Scalpel incision along the posterior edge of the thyroid cartilage on both sides and removal of the muscle fibers of the constrictor pharyngis medius muscle on both sides. Sparing of the wall of the piriform sinus on both sides. Subsequent dissection of the hyoid bone from the suprahyoid soft tissue. Dissection in this region and exposure of the free edge of the epiglottis and pharyngotomy. Opening of the pharyngeal lumen. Incision along the lateral edges of the epiglottis and along the aryepiglottic folds on both sides. Strict care is taken to preserve the mucosa of the piriform sinus on both sides as much as possible. Joining of both vertical incisions in the postcricoid area. Separation of the mucosa of the hypopharynx from the laryngeal skeleton and further dissection between the hypopharynx as well as the esophagus and the posterior wall of the trachea. Repeated hemostasis using bipolar coagulation. Deposition of the preparation at the level of the third tracheal cartilage clasp. Hemostasis using bipolar coagulation. Three marginal samples were taken (right piriform sinus, anterior and posterior tracheal margin). All three samples were found to be tumor-free by the pathology colleagues. Subsequently insertion of a size 8 Provox prosthesis in the typical manner. Perform a careful cricopharyngeal myotomy over a distance of 3 cm laterally on the left. Resection of the caudal end of the sternocleidomastoid muscle on both sides. Three-layer pharyngeal suture. Reinforcement of the pharyngeal suture using Tachosil. Suture adaptation of the prelaryngeal musculature. Knockback of the subplatysmal apron flap. Tracheostomy sutures. Two-layer wound closure. Application of a pressure dressing. Re-intubation of the patient to a size 8 tracheostomy tube. Completion of the procedure without complications. Conclusion: Laryngectomy, modified radical neck dissection on both sides, insertion of a size 8 Provox prosthesis, insertion of a nasogastric feeding tube. Please present the patient to our interdisciplinary tumor conference as soon as possible. If adjuvant radiochemotherapy is indicated, a PEG should be inserted by our surgical colleagues due to the patient's condition following previous surgery.  