First pharyngoscopy and laryngoscopy: The exophytic tumor can be seen, which is centrally located, extends to the subglottic area, grows into the arytenoid region and into the arytenoid fold at the back of the cricoid cartilage. Thus confirmation of the tumor location. Overall cT3 tumor, which cannot be sensibly operated on with laryngeal preservation. Therefore, transfer for laryngectomy and neck dissection. First, skin disinfection and injection of a total of 20 ml Ultracaine 1% with adrenaline into both sides of the neck and sterile draping of all relevant surgical areas. The patient is already tracheotomized and the tube is removed caudally. First, an apron flap is created in the typical manner up to the level of the hyoid bone and submandibular gland. Then neck dissection on the right: exposure of the sternocleidomastoid muscle. Exposure of the omohyoid and digastric muscles. Exposure of the internal carotid artery, external carotid artery and superior thyroid artery. Visualization of the internal jugular vein. Depiction of the hypoglossal nerve. Hypoglossal nerve, vagus nerve, accessorius nerve. Successive evacuation Level II to IV. Evacuation includes small parts of Level V. Neck dissection is performed while preserving and exposing the branches of the cervical plexus. Subsequent neck dissection on the left: This is performed in the same way as on the right side. Evacuation of level II to IV as well as small parts of V. Visualization and preservation of the same structures. Overall, no significant lymph nodes. Then mobilization of the larynx and laryngectomy: visualization of the hyoid bone. Dissection of suprahyoid muscles. Subsequent dissection of the sternohyoid muscle. Exposure of the superior cornu and dissection of the pharyngeal tube. Caudal dissection of the thyroid gland, which is dissected caudolaterally. Remains of the isthmus are coagulated bipolarly. Mobilization of the larynx on both sides in the same way. Subsequent exposure of the epiglottis. The pre-epiglottic soft tissues are included in the preparation together with the hyoid bone. Entering the larynx. Exposure of the epiglottis. Cut along the epiglottis and the aryepiglottic fold on both sides. Successive development of the larynx. Bipolar coagulation of the vessels between the larynx and pharyngeal tube. Dissect down to the esophageal opening. Subsequent removal of the larynx. Suture marking of the larynx. No cranial, caudal or basal tumor margins in the frozen section. Therefore R0 resection. Myotomy now performed on the left by cutting the muscles down to the level of the mucosa. This resulted in a noticeable widening of the pharyngeal inlet. Subsequent insertion of a 10 mm Provox prosthesis in the typical manner without complications. Then suturing of the pharynx in an inverted 1st suture with Vicryl 4-0 single button sutures. Then the 2nd suture inverted over it, also with 4-0 Vicryl single button sutures. Then suture the constrictor muscle and the suprahyoid muscles using 3-0 Vicryl single button sutures. Subsequent suturing of the sternohyoid muscle in the middle. As already done several times, especially after tumor resection, extensive irrigation with hemostasis. Then epithelialization of the trachea on the loosened apron flaps. This is done without tension. Then wound closure in layers with insertion of a Redon drain on both sides. Completion of the procedure without complications. Patient received Unacid intraoperatively, please continue antibiotics for 1 week. Feeding via the inserted PEG tube for 10 days, then X-ray gruel and, if necessary, diet build-up. Overall cT3 cN0 laryngeal carcinoma. Awaiting final histology. Discussion of further procedure in the interdisciplinary tumor conference.