After an introductory consultation with the anesthesiology colleagues, the glottic plane is first adjusted by laryngoscopy. Then, using 0 degree optics, visualization up to the glottic plane. This reveals an uneven mucosal change on the left side and a smooth mucosal protrusion on the right anterior side. The subglottic slope and the trachea are completely free of irritation and unremarkable. The patient is then intubated somewhat laboriously by the surgeon. The patient is then repositioned for esophagoscopy. The mucosa is found to be free of irritation when the flexible instrument is inserted into the esophagus. The patient is then viewed through to the stomach, where a regular mucosal relief can also be seen. After aspiration of the insufflated air, careful inspection of the esophagus during reflection. Here too, the mucosal conditions are normal. The patient is then repositioned for inspection of the oral cavity and oropharynx. Here too, the conditions are normal and unremarkable. Remove the Kleinsasser tube. Then, the hypopharynx is examined, where the mucosal conditions are also normal and without irritation. Then add the support autoscopy and the surgical microscope. Difficult adjustment of the glottic plane. The findings described above can be seen here. A deep sample is now taken from the area of the anterior third of the vocal fold on the right side under intact mucosa, which is carefully split with scissors. This is sent for frozen section diagnostics. After the diagnosis of an invasive carcinoma is made, the intraoperative endoscopic site is inspected again. This shows that the tumor is moving far forward into the anterior commissure. With difficult positioning of the patient, reliable tumor control from the endolaryngeal side is not possible. The decision is therefore made to operate on the larynx from the outside. After removing all instruments, the patient is repositioned for partial laryngeal resection from the outside. Injection of local anesthetic with adrenaline. Then Z-shaped incision prelaryngeal. Layered preparation in depth. Separation of the prelaryngeal muscles. The muscles are then pushed away from the anterior surface of the larynx. Slitting of the perichondrium. Then opening of the thyroid cartilage with the wheel. Horizontal opening of the ligamentum conicum and opening of the larynx. This shows that the tumor is significantly larger than initially expected from the endolaryngeal side. The tumor is then detached from the inner surface of the thyroid cartilage together with the perichondrium. Further dissection in the dorsal direction. The tumor almost reaches the vocal process. The tumor is deposited here near the vocal process. ................................ Parts of the subglottic slope are also resected. The resection extends cranially into the entrance of the pyriform sinus. The pouch ligament is unaffected by the tumor and remains completely intact. In the area of the anterior commissure, however, the tumor slightly crosses the midline, so that the resection must also extend to the opposite side here. Then take frozen section samples from all marginal areas of the resection. These are sent for frozen section diagnostics. However, it should be noted that the cranial and dorsal margins of the right side as well as the lower center are not in sano. Therefore, another clear resection in the area of the upper dorsal margin. The pocket ligament remains intact. Resection of the entire ligamentum conicum, the entire horizontal on the cricoid cartilage and at the attachment to the thyroid cartilage. These resected areas are sent for final histological diagnosis. Then marginal samples are taken again for rapid diagnosis from the area of the caudal margin of the thyroid cartilage on the outside and endolaryngeally at the transition to the trachea. These are still found to be tumor-free intraoperatively. The edge specimen of the dorsal cranial margin was also found to be tumor-free in the frozen section, so that an R0 resection can now be assumed. Careful hemostasis is therefore performed. Subsequently, a burr hole is made in the area of the thyroid cartilage and the ligament is tightened anteriorly in order to possibly ensure better voice regulation. In addition, two further drill holes are made in the area of the thyroid cartilage at the top and bottom on both sides. A laryngeal wedge is then sutured into place using these drill holes. The prelaryngeal muscles are then mobilized and sutured in front of the larynx. A slightly gaping space remains due to the missing ligamentum conicum between the cricoid cartilage and thyroid cartilage. This is also closed prelaryngeally with mobilized muscles. A large wound flap is inserted here, which is then drained to the outside. A second layer of prelaryngeal muscle is sutured again. Subcutaneous suture and skin suture and application of a pressure bandage. Before closing the larynx, a marginal sample was taken from the pocket ligament on the left side. If a carcinoma in situ is also found here, these findings should be discussed in detail in the tumor conference with regard to adjuvant therapy. A follow-up MLE should be planned for the patient in 6 weeks. If necessary, Keel removal can then also be performed. Final consultation with the anesthesia colleagues.