After bronchoscopic intubation and preparation by the anesthesia colleagues, the patient is positioned. Initially, the Kleinsasser tube is inserted under dental protection. The oral cavity and oropharynx are unremarkable, and the hypopharynx up to the tips of the piriform sinus and the entrance to the oesophagus is also unremarkable and clear. Subsequent endoscopically controlled insertion of a nasogastric feeding tube. Adjustment of the endolarynx. The exophytic tumor process can be seen on the right side, but in the area of the anterior commissure there is also a transition to the opposite side and palpation reveals a clear fixation on the laryngeal skeleton. Posteriorly, the mass extends to the arytenoid, so that a laryngectomy is indicated for oncological and functional reasons. The patient was then repositioned. Injection of xylocaine with added adrenaline. Skin incision and lifting of an apron flap. Palpation of the laryngeal skeleton reveals the tumor section that has broken through, but this does not go into the skin. To ensure that a soft tissue mantle is preserved, the platysma is left on the specimen in the relevant area, otherwise the platysma is dissected cranially. High suture of the apron flap on both sides Exposure of the sternocleidomastoid muscle, omohyoid muscle, submandibular gland and digastric muscle. Carry out the neck dissection starting with the left side. First dissect the anterior part of the neck, preserving the cervical anterior aspect of the facial vein, the superior thyroid artery and the hypoglossal nerve. Expose the accessory nerve and complete level V while carefully preserving the cervical plexus roots. Macroscopically no suspicious nodes on the left side. Careful hemostasis and turning to the opposite side. Same procedure in principle here, also not resected separately. Left-sided release of the thyroid cartilage horn, release of the piriform sinus. Subsequent right-sided release of the piriform sinus. Caudal free dissection of the trachea and the cricoid cartilage. Dissection of the thyroid isthmus and exposure of the anterior surface of the trachea. Release of the hyoid and preservation of the surrounding musculature. Entering the vallecula. Extension of the pharyngotomy. Resection of the specimen along the aryepiglottic folds. Now a good overview of the tumor, which adheres to the right or anteriorly to the thyroid cartilage and infiltrates it. The laryngeal musculature on the right side is not perforated, but all soft tissue is left on the specimen as described above, so that a safe in sano resection is achieved in the anterior region. Postcricoid resection sparing the mucosa. Release of the piriform sinus. In the case of inital subglottic expansion, resection of the first tracheal clasp and removal of the preparation. As suspected, this shows a clear subglottic expansion with growth approx. 1.5 cm below the glottic level, but here too a safe in sano resection. Also on the specimen in sano resection with here also supraglottic expansion in the area of the petiolus and the beginning laryngeal epiglottis area. To confirm the R0 situation in the area of the mucosa covering the margins as well as in the area of the tracheal margin. No higher-grade dysplasia or tumor is found here, meaning that a safe R0 resection has been achieved. The anterior wall of the trachea is then resected. A Provox prosthesis of size 8 mm is placed at the cranial tracheal margin. The two-layer inverted closure of the pharyngeal defect is then performed under wide and strong mucosal conditions. Overall intact conditions. This is followed by transection of the sternocleidomastoid muscle insertions close to the stone on both sides. Subsequent wound inspection and wound irrigation and, if the wound was completely dry, insertion of two size 10 Redon drains and subsequent insertion of the tracheostoma as well as careful two-layer wound closure and finally reintubation with a size 10 low cuff cannula and completion of the procedure without any indication of complications. Note: The patient received 3 g Unacid intraoperatively; please continue this for 24 hours postoperatively. Conclusion: Intraoperative R0 resected cT4a cN0 G3 glottic laryngeal carcinoma with thyroid cartilage perforation and both supra- and subglottic extension. In the absence of clinical signs of a pharyngeal fistula, please perform a postoperative X-ray pre-swallow on the 8th to 9th postoperative day.