After active patient identification, the patient is brought into the operating theater. Carrying out the team time-out. Introductory consultation with anesthesia. Induction of anesthesia and transition to tracheoscopy. This turns out to be extremely difficult. With great effort, the anesthesia colleagues manage to intubate the patient using the Glidescope optics. After fixing the tube, the surgeon positions the patient. Insertion of the mouth guard. Enter with the size D small bore tube. The endolarynx cannot be adequately monitored with this. Even after several attempts, the tumor in the area of the right vocal fold cannot be adequately adjusted, so the decision is made to resect the tumor via an external approach through a thyrofissure. Removal of the small drainage tube. Repositioning of the patient. Skin spray disinfection and infiltration anesthesia. Skin wipe disinfection and sterile draping. Palpatory identification of the thyroid cartilage and the thyroid incisura. Mark the planned incision horizontally in a skin fold. Cut sharply through the cutis and subcutis. Expose the prelaryngeal musculature. Locate the midline. Lateralization of the prelarygneal musculature. Exposure of the thyroid cartilage. This dives relatively far into the depths. Therefore significantly more difficult preparation conditions. Subsequently, first incise the periosteum over the entire length of the thyroid cartilage. Subsequently, horizontal incision of the ligamentum conicum. Dissect two perichondrium flaps and lateralize them to the left and right. Subsequently, opening of the larynx in the median line in the sense of a thyrofissure using the oscillating wheel. Insertion of the three-pronged retractor. After the larynx has been opened in the median line, it can be seen that the right vocal fold is subtotally affected by the tumor. This extends from the vocal process beyond the anterior commissure to the left middle third of the vocal fold. First resection of the tumor in the area of the right vocal fold, including the ligament and the vocalis muscle. The same procedure is also carried out on the left side. Here, the ligament and the vocalis muscle are resected up to the middle third of the vocal fold. The resection margins are now inspected with the aid of the rigid endoscope. Slightly suspicious mucosal changes appear in the area of the medial surface of the arytenoid. First dissect the mucosa with the FREER. Then take circular margin samples on the right and left side ( right vocal fold margin sample cranial and caudal, left vocal fold margin sample cranial and caudal ). Since the tumor went over the anterior commissure, the periosteum in the area of the anterior commissure is now also resected. In addition, grinding of the anterior commissure of the thyroid cartilage with the diamond burr. Hemostasis is achieved by inserting a suprarenin-impregnated laryngeal swab and bipolar coagulation. During the telephone frozen section, tumor-free margin samples are found on all sides. Therefore, proceed to laryngeal closure. Creation of four drill holes in the area of the thyroid cartilage. Insertion of a 14 mm laryngeal wedge. Closure of the thyrofissure and suturing of the Keel with PDS 4-0, followed by retraction of the perichondrium flaps and complete covering of the Keel. Suture the incision in the area of the ligamentum conicum. Readaptation of the prelaryngeal muscle bellies in the median line. Additional mobilization of the lateral laryngeal bellies and medialization of the same and also fixation of the same using continuous sutures with Vicryl 4-0. Finally, insertion of a flap. Subcutaneous suture with Vicryl 4-0 and skin suture with Ethilon 5-0. Suturing of the flap. Application of a wound dressing and a compression bandage. Proceed to resection of the suspicious efflorescence in the area of the left helix. Marking of the planned incision. Spindle-shaped incision of the suspicious mass. Suture marking of the mass. Hemostasis using bipolar coagulation. Successive mobilization of the cutis and primary wound closure following a rapid incision announcement of R0 status by telephone. Application of a wound dressing. Final consultation with the anesthetist. Completion of the operation without complications.