First of all, induction of anesthesia and intubation by the anesthesia colleagues. Intubation is extremely difficult as the patient is very difficult to adjust. Then intubation with the small bore tube, this is only possible with the D-tube and inspection of the hypopharynx and larynx. No abnormalities in the hypopharynx. Then adjustment of the glottic plane, this is only possible in the posterior two thirds, the anterior commissure cannot be adjusted even after the greatest possible effort. An exophytic mass can be seen in the area of the left vocal fold, which does not infiltrate the arytenoid cartilage, but extends right up to it. Now images with the NBI device and the Cellvizio device by <CLINICIAN_NAME>. Rearrangement and injection of Ultracaine. Sterile washing and draping. Zigzag skin incision in the usual manner. Exposure of the prelaryngeal musculature. Push aside the prelaryngeal musculature. Formation of a perichondrium flap. Then sawing open the larynx in the median line. Opening of the larynx and inspection of the tumor region. As previously described, the tumor appears on the left vocal fold, extends to the arytenoid cartilage up to the anterior commissure, but does not infiltrate the opposite side. The tumor extends into the subglottic slope, but does not infiltrate the subglottic region very far down, at most 0.5 cm below the glottic level. Now detach the tumor from the inside of the thyroid cartilage, this can be done without any problems. Temporarily remove the tube and detach the tumor with scissors. The tumor specimen is thread-marked for final histology. A resection is then taken in the area of the pocket fold. Now marginal samples. The marginal samples show invasive carcinoma in the subglottic and arytenoid cartilage and carcinoma in situ in the area of the perichondrium on the inner side of the thyroid cartilage. In this case, the inside of the thyroid cartilage is removed with a diamond burr and resections are made of both the subglottic and the arytenoid cartilage. The tip of the arya falls off. Now close the larynx in the usual way after drilling holes and suturing the ligamentum conicum. Then overlap the perichondrium flap of the thyroid gland and the prelaryngeal musculature. A flap was sutured in beforehand. Then two-layer skin closure and before suturing, a tracheotomy was created between the 2nd and 3rd tracheal cartilage and a mucocutaneous anastomosis was formed. Re-intubation to a tracheal cannula and insertion of a nasogastric tube. Completion of the procedure without complications. Please wait for the histology and plan a follow-up MLE in 6 to 8 weeks.