After bronchoscopic intubation by the anesthesia colleagues, positioning of the patient. Entry with the small bore tube under dental protection and inspection of the primary tumor region. The oral cavity and oropharynx are unremarkable. Likewise the hypopharynx with inconspicuous postcricoid region and free piriform sinus as well as free esophageal entrance. There is now a tumorous protrusion in the endolaryngeal region, especially on the right anterior side, with a barely adjustable glottic plane. In conjunction with CT imaging, confirmation of the initially described extent and indication for laryngectomy. Placement of a nasogastric feeding tube. Incision and elevation of a broad-based apron flap. This reveals extensive subcutaneous scarring on the right side, with a history of parotidectomy, which extends to the entire neck area. The neck dissection is now initially performed as a revision of the right side. Release of the markedly scarred sternocleidomastoid muscle. Exposure of the omohyoid muscle. Release of the submandibular gland and exposure of the digastric muscle, which is also scarred. A long scarred cervical vascular sheath can also be seen. Removal of the anterior neck preparation and preservation of the external carotid arteries and the hypoglossal nerve. Initial exposure of the facial vein. This is later removed for tumor resection. Exposure of the upper pole of the thyroid gland on the right side. Free preparation of the internal jugular vein with careful removal of scars. Towards the lateral neck preparation, regular tissue is visible again. Careful exposure of the cervical plexus and clearing to level Va. Significant cranial scarring again. Despite careful visualization and preparation, the accessorius nerve cannot be visualized and was presumably resected during the previous operation. Later, the upper horn of the thyroid cartilage and the hyoid are visualized. Significant scarring here as well, questionable after radiotherapy or more extensive previous surgery than can be determined from the history. Careful lateral release of the thyroid cartilage and release of the piriform sinus. Anterior exposure of the cricoid cartilage. Exposure of the anterior surface of the trachea and lateral dissection of half of the thyroid gland. Turn to the opposite side. No preliminary treatment here. Exposure and preservation of the external vein and auricularis magnus. Exposure of the sternocleidomastoid muscle and the omohyoid muscle. Release of the submandibular gland and visualization of the digastric muscle. Release of the anterior neck preparation with careful protection of the V. facialis, A. thyroidea superior, N. hypoglossus and Ansa cervicalis. Tracing of the thyroid vessels and also dissection of the left thyroid lobe. Dissection of the left lobe of the thyroid gland. Dissection of the internal jugular vein after exposure of the accessorius nerve. After free dissection of the cervical vascular sheath, exposing the common carotid artery and the vagus nerve, completion in the direction of level V, with careful protection and preservation of the cervical plexus branches. Finally, in the case of sonographically conspicuous findings, exploration and evacuation of level Ib. To do this, release the submandibular gland. Cranial dissection of the nerve-conducting connective tissue. Careful exploration. Removal of the facial lymph nodes. Careful exploration. There are no suspicious changes here. Lymph nodes are also found dorsally and anteriorly to the gland. No further measures after final palpation. Finally, if the wound is dry, expose the thyroid cartilage horn on the left side. Finally, removal of the upper laryngeal bundle. Release of the piriform sinus and now detachment of the infrahyoid musculature. Here, the larynx appears to be coarsely widened, especially on the right side, and when the infrahyoid muscles are lifted, they are compressed and there is a questionable tumor breakthrough. It was therefore decided to leave the infrahyoid muscles completely on the laryngeal skeleton. Even if the relationship between the thyroid and hyoid is unclear, the hyoid should be removed and the soft tissue detached en bloc. Enter the pharynx in the area of the vallecula. Exposure of the epiglottis. Extension of the resection to protect the mucosa. As described above, there is no growth extending beyond the larynx in the area of the mucosal level. Careful release of the piriform sinus. Postcricoid release. Now a good overview of the tumor, which extends in the area of the larynx, especially on the right side, towards the thyroid cartilage, partly also towards the pre-epiglottic space and here, at least palpatorily, there is a suspicion of a thyroid cartilage rupture. Entry into the trachea and intubation. Removal of the first tracheal ring, creating a dorsally elevated trachea. The preparation now shows wide resection margins in relation to the mucosal level, with only a narrow area in the region of the raised infrahyoid musculature when the trachea breaks through. Therefore, an edge sample is taken at the situs, at the closest distance to the infrahyoid musculature left here. The frozen section shows this to be tumor-free, so that an R0 situation can be assumed here. A size 10 Provox prosthesis is now placed, with cranial puncture of the trachea and placement of the Provox voice prosthesis using the usual pull-through method. Finally, good positioning. Sparing right lateral myotomy in otherwise wide conditions and already visible reflux. No further measures in the area of the upper esophageal sphincter. Separation of the sternal insertions of the sternocleidomastoid muscle and subsequent careful two-layer pharyngeal closure. Careful wound inspection. If the wound is dry, insertion of a 10-gauge Redon drain. Careful two-layer wound closure with incision of the tracheostoma. Subsequent reintubation to a size 10 low-cuff cannula. Conclusion: Intraoperative R0-resected cT4a transglottic laryngeal carcinoma with right emphasis. Please continue antibiotics for 24 hours with Unacid 3 g. Perform an X-ray pre-swallow on the 8th to 10th postoperative day. Please present at our interdisciplinary tumor conference. Determination of any pre-irradiation carried out in the case of conspicuously extensive scarring on the right cervical side.