Induction of anesthesia by the anesthesia colleagues. Nasal intubation. Placement of a nasogastric tube. Abjodation and draping. Apron flap placement with inferior border at tracheostoma level. Exposure of the sternocleidomastoid muscle on both sides. Beginning with the neck dissection on the left side. Exposure of the inner edge of the sternocleidomastoid muscle. Visualization of the accessorius nerve. Finding the digastric muscle. Dissecting the omohyoid muscle. Dissection of the vascular nerve sheath and development of the lateral neck preparation. Exposure and protection of the hypoglossal nerve. Opening of the cervical vascular sheath. Exposure of the common, internal and external carotid artery. Visualization of the vagus. Development of the medial neck preparation, which remains connected to the later laryngectomy preparation including the infrahyoid musculature. Separation of the superior laryngeal artery. Development of the intrahyoid musculature and deposition on its inferior part suprasternal. Raising the infrahyoid musculature. Exposure of the thyroid capsule. Undermining of the isthmus. Severing of the isthmus. Re-perforation of the thyroid lobe margins. Exposure of the anterior surface of the trachea. Transition to neck dissection on the right side. Exposure of the inside of the sternocleidomastoid muscle. Exposure and visualization of the accessorius nerve. Exposure of the digastric muscle, following it to its anterior end at the hyoid bone. Exposure of the omohyoid muscle. Exposure of the cervical vascular sheath and development of the lateral neck preparation. Exposure of the internal and external common carotid artery. Exposure and visualization of the vagus nerve. Separation of the superior laryngeal artery. Now cut through the omohyoid muscle on both sides. Separation of the suprahyoid muscles at the level of the hyoid bone. Expose the hyoid bone and separate the ligaments from the lesser horn of the hyoid bone. Entering the pre-epiglottic fatty tissue and resection of the pre-epiglottic space together with the epiglottis. Release of the prelaryngeal musculature. Careful release of the sinus piriformis mucosa primarily on the left side. Careful resection on the right side, maintaining a safety margin of one cm, and development of the tumor, which has spread to the medial wall and into the anterior region of the piriform sinus on the right side. Now proceed to tracheotomy. Horizontal incision superior and inferior to the third tracheal clasp. Longitudinal division of the same. Fixation of the tracheal part with inferior stoma sutures. Separation of the cricoid cartilage, forming a mucosal flap lining the posterior edge of the cricoid cartilage. Finally, the complete larynx is removed. The mucosal flap just mentioned closes the still standing tracheal cylinder cranially. Removal of marginal samples and sending for frozen section. All frozen sections are tumor-free. Continuous inverting primary pharyngeal suture running vertically and cranially horizontally. Adapting sutures of the overlying pharyngeal musculature. Myotomy of the constrictor muscles before pharyngeal suture. Furthermore, placement of a Provox voice prosthesis in the typical manner without complications. Suturing of the tracheostoma. The split tracheal clips are sewn into the upper edge of the skin from the inside. Creation of Redon drains on both sides of the neck. Subcutaneous suture. Cutaneous suture. Re-intubation onto a 10 mm tracheal cannula. Completion of the procedure with no indication of complications. Conclusion: Complete laryngectomy and neck dissection on both sides with lymph nodes definitely clinically conspicuous on the right side. Please leave the nasogastric tube in place for 10 days and then take an X-ray before starting food. Antibiotic cover for 5 days with Unacid. Adjuvant treatment after pathological result.