First, induction of anesthesia and intubation by the anesthesia colleagues. Entry with the Kleinsasser tube and inspection of the tumor. The tumor completely infiltrates the right vocal fold, passes into the anterior commissure and infiltrates two thirds of the left vocal fold, it grows supraglottically and infiltrates the entire pocket fold on the right side and two thirds of the pocket fold on the left side. The mucosa at the vocal process is also infiltrated. Mechanically, the ary on the right side is still mobile with the small double spoon, but less mobile than on the left side. Demonstration of the findings on <CLINICIAN_NAME> and <CLINICIAN_NAME>. It is decided to first resect the mucosa in the area of the posterior artery and send it for a frozen section. This is also done. The patient also has a rather benign cyst postcricoid on the right side. This cyst is also removed with the scissors and sent for frozen section. The frozen section showed no evidence of carcinoma in either specimen, so the decision was made to continue with the laser resection and to forgo a complete laryngectomy for the time being. Now loosening and removal of the tumor on the posterior surface, then repositioning and removal of the tumor in the area of the anterior commissure. This is relatively difficult as the patient cannot be adjusted well at the anterior commissure. Finally, the tumor is successfully released there. It must be completely lasered off the thyroid cartilage. Infiltration of the thyroid cartilage is not present on CT morphology or clinically. Then first resection of the tumor portion on the left side. Here, half of the pocket fold on the vocal fold falls. It is clear that the tumor is also growing approximately 0.5 cm into the subglottic appendix on both the right and left sides. Here, too, resection is necessary. Finally, the tumor is also resected on the right side, including the pocket fold and the subglottic slope for 0.5 cm. The arytenoid cartilage can be preserved, but the mucosa in the area of the vocal process must be completely resected. The specimen is placed on cork for final histology. Subsequently, marginal samples are taken subglottically on both sides as well as centrally, then in the area of both pocket folds and the posterior margins. All marginal samples are R0 in the frozen section. The entire surface of the tumor is covered by the margin samples and an R0 resection can be assumed. Then repositioning for neck dissection on the right side. For this, the skin incision is made relatively caudally in a skin fold that extends up to the mastoid. It is theoretically possible to extend this skin incision to the apron flap in a second operation if a functional laryngectomy should become necessary. Now the platysma is shown. Exposure of the sternocleidomastoid muscle, the omohyoid muscle, the submandibular gland and the digastric muscle. Then release of the neck preparation level II a to IV while sparing the plexus branches. Tearing of the internal jugular vein occurs in level II, which is sutured over with Vascufil 6.0. Then consultation with <CLINICIAN_NAME>. The latter was cautious about the overall indication for neck dissection in this procedure, so the neck dissection on the left side was not performed. Repositioning for tracheotomy. Perform the tracheotomy in the usual manner with formation of a mucocutaneous anastomosis in the sense of a visor tracheotomy. Then transfer intubation to a tracheostomy tube 8.0. Then insertion of a nasogastric tube. Please present the patient at the tumor conference after receiving the final histology, to plan any adjuvant therapy. No oral food for 5 days, then attempt to swallow and build up diet, if necessary speech therapy swallowing training. As he was able to remain standing on the right side and on the left side, swallowing should not cause any problems in the long term, if no adjuvant therapy is necessary, please have a control MLE in 10 to 12 weeks. If there is clear granulation tissue, then remove the granulation tissue and possibly insert a Dacron foil or PDS foil secondarily.  