After intubation of the patient, MLE is now performed: the thickened vocal fold is visible, especially on the right, up to the anterior commissure. Overall, the tumor also appears to be growing into the ventriculus laryngeus. Overview difficult due to the poor adjustability, therefore, due to the overall situation, the decision was made to perform the operation by means of partial laryngeal resection from the outside. Therefore now repositioning. Injection of a total of 8 ml Ultracaine 1% with adrenaline. Sterile draping. Zigzag skin incision. Exposure of the larynx. Creation of a perichondrium flap from the left side. Then opening of the larynx, whereby a triangle is cut out more on the right than on the left with the wheel. The larynx is then opened. Entering the larynx from the supraglottic side. Now inspect the tumor. Cut around the tumor or the visible thickenings and palpable thickenings with a safety margin of at least 4 mm on all sides. The entire vocal fold up to the arytenoid area on the right, the mucosa up to the upper edge of the cricoid cartilage, the entire area of the pouch ligament. The tumor, including the perichondrium, is removed from the right side after it has been dissected away from the cartilage, as well as from the front left side, whereby the anterior vocal fold is also resected macroscopically in the anterior part of the healthy area. Resection caudally up to the ligamentum conicum. Tumor is marked with sutures. Samples are taken from the supraglottic margin and the basal anterior margin. In the frozen section at the border of the supraglottic to the arytenoid region or the arytenoid region to the subglottic region, the tumor forms a margin. Also in the area of the vocal fold on the front left. A resection is performed on the left side, which includes the supraglottic, glottic and subglottic areas and is sent in marked with sutures. The sutures are all remote from the tumor. Also post-resection dorsal right and subglottic right. A marginal sample is then taken from subglottic and dorsal in the arytenoid region. Here in the first post-resection supraglottic left still clear carcinoma infiltrates, glottic and subglottic none. In the direction of the arytenoid region, there is a tumor, although metaplasia is also possible. Post-resection is therefore also recommended here. Overall, the resection in the arytenoid region on the right has already progressed to the interary area. Further massive removal of the mucosa is not possible without functional damage. Therefore, mucosa is removed from the arytenoid region in the dorsal area and subglottically only as a resection. In addition, an extensive resection is performed in the glottic and supraglottic area on the left, whereby the sutures are placed remote from the tumor. Ultimately, a vocal fold remnant remains on the left, supraglottic mucosal remnant on the left. Overall, the situation is now borderline. In principle, there is also a suspicion of field carcinomatization with an overall macroscopically invisible tumour extension. Now laryngeal closure. Creation of drill holes and 2 Vicryl sutures, which adapt the cartilage. Perichondrium is sutured over the laryngeal cartilage defect or over the laryngeal cartilage. The muscle layer is sutured over this. A further layer of soft tissue is then applied. The skin is then closed in layers with the insertion of a flap. A tracheostoma was also created via a slightly deeper, small Kocher collar incision. The trachea was first exposed by dissecting through the subcutaneous tissue. The thyroid isthmus was cut and ligated beforehand. A modified Björk flap is then created, which has a wide stalk. The tracheostoma is then epithelialized in the typical manner. An 8 mm tracheostomy tube is then inserted. Overall, the procedure is completed without complications. Patient goes to the intensive care unit for monitoring. Overall borderline situation as far as partial laryngeal resection is concerned. No further resection can be performed, particularly in the direction of the interary space, without the interary region shrinking and leading to respiratory distress. If tumor residues are still present, a laryngectomy should be discussed in any case. Even in an R0 situation, the situation is borderline, so that a laryngectomy would ultimately be the safest option for long-term survival. Postoperative nutrition via a nasogastric tube if necessary.