Transfer of the patient to the operating theater. Introductory consultation with the anesthesia department. Team time-out. Positioning of the head and start of biopsy endonasal nasal inspection: positioning of the patient's head by the surgeon. Insertion of high inserts, which are removed again before the operation begins. There is a deviated septum to the right. The nasal cavity is adjusted with the speculum, initially inconspicuous conditions. Now enter the nasal cavity on the right side with 45° optics and lateralize the inferior turbinate. Careful medialization of the middle turbinate without fracturing it. A polypous mucosa is seen in the area of the middle nasal passage, which is resected with the blunt Blakesley. In addition, the middle turbinate is polypous and distended. The lateral part of the middle turbinate is carefully resected with the sharp Blakesley. The middle turbinate is not fractured. Overall, macroscopically non-suspicious conditions. The removed sample is sent to the pathology department for frozen section examination. After consultation with <CLINICIAN_NAME>, it is an inflammatory polyp with no evidence of malignancy. Now completion of nasal inspection without complications or bleeding. Repositioning of the patient for pharyngoscopy and laryngoscopy: Insertion of the small bore tube size C and D again after insertion of a mouth guard. The described exophytic tumor can be seen, which runs laterally from the anterior area of the left lateral wall over the anterior wall to the area of the arytenoid fold and extends here to the arytenoid cartilage. Thickening at the back in the area between the arytenoid cartilage, cricoid cartilage and thyroid cartilage. Tumor infiltration can also be seen here on CT, which ultimately leads to the indication for laryngectomy. Initial PEG placement: adjustment of the esophageal inlet. Careful advancement with the flexible gastroesophagoscope into the stomach. Inspection of all sections of the stomach, which are unremarkable. Now perform the positive diaphanoscopy and insert the PEG tube in the usual manner using the thread pull-through method. Subsequent repositioning for laryngectomy and neck dissection on both sides: also cover the left forearm if radial flap is necessary. First of all, positioning and neck dissection on both sides. Neck dissection on the right: skin incision and dissection through the subcutaneous fatty tissue. Subplatysmal dissection of the apron flap. Exposure of the anterior border of the sternocleidomastoid muscle and discovery of the accessorius nerve. Now expose the omohyoid muscle and expose the medial edge. Dissect the submandibular gland and expose the posterior venter of the digastric muscle, sparing the marginal ramus until posterior to level IIb. Now open the cervical vascular sheath and expose the internal jugular vein and the facial vein. Protection of the cervical sinus and the hypoglossal nerve in the jugulofacial angle. Displacement and, at the end of the operation, re-embedding of the hypoglossal nerve in the sense of a neurolysis. Clearing of level IIb, the accessorius nerve is unusually high here, but can be spared without any problems. Displacement and, at the end of the operation, re-embedding of the accessory nerve in the sense of a neurolysis. Removal of the lateral neck preparation while sparing the brachial plexus, the common carotid artery and the vagus nerve. Displacement and, at the end of the operation, re-embedding of the vagus nerve in the sense of a neurolysis. Careful dissection of the caudal margin and careful hemostasis using bipolar coagulation. Now also removal of the medial neck preparation. Neck dissection on the left: Positioning of the patient by the surgeon in a slightly reclined position. Injection of Suprarenin in the area of the skin incision. Now mark the skin incision and cut through the cutaneous-subcutaneous tissue. An apron flap is selected for the incision. Now cut through the platysma and subplatysmal dissection of the apron flap until the submandibular gland is exposed on both sides just above the hyoid bone. Approximation of the apron flap and identification of the anterior border of the sternocleidomastoid muscle. Identification of the omohyoid muscle. Now dissection along the sternocleidomastoid muscle into the depths, exposing and sparing the branches of the cervical plexus. Now also identification of the accessorius nerve. Identification at the cranial end of the posterior venter of the digastric muscle and careful release of the neck dissection onto the muscle. Exposure of the accessorius nerve and protection of the nerve. Displacement and at the end of the operation re-embedding of the accessorius nerve in the sense of a neurolysis. Now dissection medially along the cervical vascular nerve sheath and detachment of the neck preparation from the cervical vascular nerve sheath. Then detachment of the neck preparation in regions II to IV while preserving the neuronal and vascular structures. Then laryngectomy and partial pharyngeal resection on the left: First dissection of the infrahyoid muscles from the hyoid bone. Fat and lymph node tissue, which lies in front of the infrahyoid musculature, is sent in separately as neck dissection level VI. Infrahyoid musculature is dissected and cut caudally. The superior cornu is released on the right, the constrictor is dissected. This is not possible on the left due to the tumor location. The thyroid gland is dissected caudolaterally on both sides, with a remnant still present on the right. In the isthmus area, a small, harder nodule is seen, which is also removed on the way to removal of the larynx. The left thyroid gland remnant with the cranial cystic mass is not touched and is dissected caudolaterally. The suprahyoid muscles are then dissected from the hyoid bone and beaten caudally with pre-epiglottic fatty tissue. Entering the pharynx, grasping the epiglottis. Successive detachment of the mucosa, which was previously dissected from the inside of the thyroid cartilage on the right side to preserve the piriform sinus. From the left side, the tumor is now cut around under direct vision with a safety margin of at least 1.5 cm on all sides. This ultimately results in a partial pharyngeal resection that extends to the tip of the piriform sinus, but not quite to the end of the tip of the piriform sinus. The larynx is removed caudally, whereby the maximum mucosal width is also preserved postcricoidally. The larynx is finally removed caudally together with the tumor. Prior to this, a tracheotomy is created between the 1st and 2nd intercartilaginous spaces and re-intubation. Finally, the larynx is removed. Tumor with surrounding mucosa is marked with a suture. A marginal sample is taken from the left-lateral pharyngeal region, which is thread-marked and sent to the frozen section. There is still a small tumor nest in the frozen section towards the cranial side. Therefore, a resection is performed in the base of the tongue and cranial-lateral pharyngeal wall area, followed by removal of a marginal sample from this area. No more tumor in the marginal sample. Thus now R0 status. Assessment of the remaining pharynx. This can still be sutured well without becoming too tight. To improve the passage, after further dissection of the thyroid gland on the left side, a myotomy is performed in the area of the cricopharyngeal muscle and constrictor pharyngis laterally up to the mucosa. Length approx. 3 - 3.5 cm caudally. Subsequent insertion of an 8 mm Provox prosthesis at the typical site without complications. Then closure of the pharynx with the first layer of mucosa-inverting sutures using 4-0 or 3-0 Vicryl single-button sutures. A further layer is placed over this, also inverting with 4-0 or 3-0 Vicryl single button sutures. A third layer can be sutured in the caudal and cranial region, which is not possible in the medial part due to the resection of the hypopharyngeal muscle. The nasogastric tube inserted at the beginning of the operation serves as a splint. The remainder of the infrahyoid musculature is sutured caudally via the pharyngo-oesophageal junction. The site is then irrigated and the bleeding carefully stopped. No bleeding at the end of the operation. Layered closure of the neck wound with insertion of a Redon drain on both sides and epithelialization of the tracheostoma. Insertion of a 9 mm tracheostomy tube. Application of a pressure bandage. Completion of the procedure without complications. Final consultation with the anesthesiologist. Patient is extubated and transferred to the intensive care unit for monitoring for 1 - 2 days. Overall cT4a hypopharyngeal carcinoma, whereby not the tumor size but the infiltration into the region between the arytenoid cartilage, cricoid cartilage and thyroid cartilage was decisive for the indication for laryngectomy. Please continue postoperative antibiotics with Unacid as already started intraoperatively. Feeding via the inserted PEG tube for 10 days, then X-ray pre-swallow and, if necessary, diet build-up. Wait for the final histology and discuss the further procedure in the interdisciplinary tumor conference.