Induction of anesthesia and nasal intubation by the anesthetist. First, pharyngoscopy again. An exophytic mass was found on the posterior pharyngeal wall on the left side. Then, anterior reflection and inspection of the piriform sinuses on both sides. These are unremarkable. Then adjustment of the glottic plane. The left pocket fold and the left vocal fold are completely covered by the tumor. The tumor moves ventrally to the opposite side. The laryngeal epiglottis is also infiltrated by the tumor. Sterile covering. Creation of an apron flap by subplatysmal dissection in the typical manner. Veins are bipolized or ligated. The apron flap is dissected up to the level of the hyoid bone or the submandibular gland. The apron flap is then folded upwards and fixed in place with retaining sutures. Neck dissection on the right side. Exposure and free preparation of the sternocleidomastoid muscle. Then exposure of the omohyoid muscle and the digastric muscle. Exposure of the submandibular gland and exploration of the cervical vascular sheath. Exposure of the accessorius nerve. Then free preparation of the internal jugular vein. Exposure of the internal/external carotid artery and vagus nerve and exposure of the accessorius nerve and hypoglossal nerve. Release of level II to V while preserving the branches of the cervical plexus. Exposure of the facial vein and release of the medial neck block. The superior thyroid artery was cut and ligated. Then switch to the left side and modified radical neck dissection, in principle in the same way. Exposure of the sternocleidomastoid muscle, omohyoid muscle and digastric muscle. Exposure of the cervical vascular sheath and the accessorius nerve. Exposure of the internal jugular vein, external/internal carotid artery, vagus nerve, accessorius nerve and hypoglossal nerve. All structures can be preserved. Clearing of levels II to V while preserving the branches of the cervical plexus. Exposure of the thyroid gland and free preparation of the trachea on the anterior wall. Opening of the trachea between the 1st and 2nd tracheal cartilage. Creation of a mucocutaneous anastomosis on the anterior wall of the trachea. Re-intubation and transition to laryngectomy. Separation of the infrahyoid muscles at the hyoid bone. Exposure of the upper horn of the thyroid cartilage and dissection of the prelaryngeal muscles. Release and dissection of the pharyngeal tube. Blunt dissection of the piriform sinus. Performing a small tansversal pharyngotomy and entering the larynx while pulling out the epiglottis. Detachment of the pharyngeal tube from the laryngeal preparation up to the level of the cricoid cartilage. Separation of the larynx from the trachea and preservation of the cricoid cartilage. Sending the laryngeal preparation with suture marking for frozen section. The pathologist assesses all margins as tumor-free. Then inspection of the pharyngeal tube and placement of a left-lateral myotomy on the esophagus. Insertion of a Provox prosthesis size 80 in the typical manner. <CLINICIAN_NAME> was called in intraoperatively to demonstrate this. The placement of this voice prosthesis was successful. Then transition to the pharyngeal suture. First the first layer between the mucosal remnants. Then placement of a further single button suture on top. Finally, the constrictor pharyngeal muscle is sutured over it as a third single button suture. The prelaryngeal residual musculature and the infrahyoid musculature as the fourth suture are also placed over it in the form of single button sutures. Once again careful hemostasis with bipolar coagulation. Insertion of two Redon drains. Two-layer wound closure. Insertion of a 10 mm tracheostomy tube. Completion of the procedure without complications. Patient transferred to the intensive care unit for monitoring. Continue antibiotics for 24 hours. Please keep the patient fasting for 10 days, followed by an X-ray gruel swallow and, if necessary, a diet. In the meantime, nutrition via PEG tube. Postoperative presentation in the phoniatrics department to initiate voice rehabilitation and presentation of the patient at the tumor conference.