Introductory consultation with the anesthetist. Then advance the 0° telescope through the glottic plane into the trachea. Inconspicuous mucosal conditions in the area of the trachea. Further advancement of the endoscope to the exit of the segmental bronchi on both sides. Inconspicuous mucosal conditions on all sides. Now intubate the patient. Then advance the flexible esophagoscope into the stomach. Careful reflection back. Inconspicuous findings in the area of the esophagus. Now inspect the hypopharynx on both sides and the postcricoid region: Inconspicuous mucosal conditions. Inspection of the oropharynx and the oral cavity: normal mucosal conditions on all sides. Adjustment of the larynx with the small small bore tube (size C). Exposure of the glottic plane is very difficult with this tube. A large tumor is seen, which starts from the right vocal fold and extends to the transition from the middle to the posterior third of the vocal fold. The tumor extends to the anterior commissure. It is not possible to differentiate the tumor from the left side by microlaryngoendoscopy. Try to adjust the glottic plane with the smallest tube. Here too, a safe resection is not possible with a known malignant tumor. Therefore, indication for an external procedure. Application of local anesthesia in the prelaryngeal soft tissue area. Abjode and cover the surgical area. Zigzag incision in the median line. Dissection through the fatty tissue. Exposure of the infrahyoid musculature. Exposure of the linea alba. Exposure of the thyroid cartilage. Exposure of the cricoid cartilage, exposure of the ligamentum conicum. Opening of the larynx in the median line after the ligamentum conicum has been split. Careful opening of the larynx by dissecting the supraglottis and subglottis. A voluminous tumor is seen, which fills the vocal fold on the right and starts from the transition from the posterior to the middle third of the vocal fold, freely invades the morgue sinus..........................., the subglottic slope and extends to just before the anterior commissure. Clinically, no tumor is detectable on the left side. However, there is a circumscribed leukoplakia on the left side in the area of the anterior third of the vocal fold, which is left in place during further dissection. This should be removed during a control microlaryngoendoscopy 6-8 weeks postoperatively. Now return to the tumor. This tumor extends forward to the ligamentum conicum. Careful resection of the tumor and clinical removal of the tumor in healthy tissue. The vocal process of the arytenoid cartilage is freed of mucosa. The resection covers the areas of tumor extension described above, whereby the tumor has not infiltrated deep into the vocalis muscle so that parts of the vocalis muscle can be preserved. Careful hemostasis. Removal of six marginal samples. Careful hemostasis. As part of the frozen section diagnosis, a carcinoma in situ is diagnosed in the area of the posterior margin sample below the arytenoid cartilage. As a result, resection is performed. The new frozen section histology shows a tumor-free resection. After careful hemostasis, two drill holes were made in the area of the thyroid cartilage. Closure of the thyroid cartilage with two Vicryl sutures. Reconstruction of the ligamentum conicum. Irrigation of the wound with water and hydrogen. Readaptation of the infrahyoid musculature after insertion of a flap. Wound closure in layers. Wound dressing. Final consultation with the anesthetist. The patient is transferred to the intensive care unit extubated and should be observed there for two days postoperatively. The patient therefore has a T1a laryngeal carcinoma, which was resected in healthy tissue using frozen section histology. Due to the extent of the tumor, a control microlaryngoendoscopy is absolutely necessary in 6-8 weeks. Attention should also be paid to the anterior third of the vocal fold on the left. As the resection did not include the anterior commissure of the left side, the insertion of a Keel is dispensed with.