Induction of anesthesia and intubation via the tracheostoma by the anesthetist. Then injection of Ultracaine. Entry with the small bore tube and inspection of the hypopharynx. There are no abnormalities here, the postcricoid region and both piriform sinuses are unremarkable. Then attempt to adjust the larynx. This is only possible with the smallest tube. The tumor has completely taken over the glottic plane and the glottis so that no lumen is visible. Then sterile washing and covering. Form an apron flap in the usual manner, integrating the tracheostoma. Suturing of the skin flap. Start with the neck dissection on the right side. Exposure of the sternocleidomastoid muscle. Exposure of the omohyoid muscle. Exposure of the submandibular gland and the digastric muscle. Exposure of the cervical vascular sheath with free preparation of the internal jugular vein. Exposure of the accessorius nerve. Clearing of levels II to V while sparing the plexus branches and the hypoglossal nerve and facial vein. Then turn to the opposite side. Exposure of the sternocleidomastoid muscle, the omohyoid muscle, the submandibular gland and the digastric muscle. Exposure of the nervus accessorius, the cervical vascular sheath and free preparation of the internal jugular vein. Clearing of levels II to V while sparing the plexus branches. Exposure of the hypoglossus and facial vein. Clearing of the medial neck block. Level VI was divided in the middle and added to the neck preparations on each side. Then dissection of the cervical vascular sheath from the larynx on both sides. Dissection of the thyroid gland from the larynx on both sides. Ligation of the upper laryngeal bundle on both sides. Exposure of the hyoid bone. Removal of the hyoid bone. Skeletonization of the larynx so that in the anterior region .............. Release of the piriform sinus on both sides. Then enter the mouth with the large Langenbeck spatula and lift the base of the tongue. Perform the pharyngotomy at this point. Pull out the epiglottis and open the pharynx along the epiglottis. This is very easy on the right side, on the left side the tumor appears to have grown into the medial area of the piriform sinus, so the mucosa must be removed more generously here. The entire larynx is detached so that it is only attached to the trachea and the cricoid cartilage. The larynx is removed below the cricoid cartilage and sent for a frozen section. The pathologist can no longer detect any tumor in the edges of the incision and the specimen is therefore resected in sano in the frozen section. Then transition to insertion of a Provox prosthesis. Entry with the trocar and creation of a tracheoesophageal fistula and insertion of a size 10 Provox prosthesis using the pull-through method. Then perform a posteromedial esophagomyotomy on the left side. Perform a myotomy on the sternocleidomastoid muscle to flatten the tracheostoma. Performing the pharyngeal suture with single button sutures. Perform another pharyngeal suture over the first pharyngeal suture, also with single button sutures. The constrictor pharyngeal muscle is then adapted as well as possible. This cannot be done in all places so that the pharynx does not narrow, but so that the largest part of the 3rd pharyngeal suture is still covered. Insertion of 2 Redon drainage tubes. Cut out the skin on the tracheostoma, as it is massively macerated by the previously placed tracheostoma. Then suture the skin to the trachea. Fold back the apron flap and complete the mucocutaneous anastomosis in the tracheal area and close the wound in two layers. Please do not feed orally postoperatively and carry out an X-ray gruel swallow after 10 days, then build up the diet when the pharyngeal suture is tight.