After an introductory consultation with the anesthesia colleagues, initially no infiltration of local anesthetic with adrenaline. Zigzag incision prelaryngeal. Dissection in layers down to the prelaryngeal musculature. Cut off several large veins here. Then separate the prelaryngeal musculature in the midline and dissect the thyroid cartilage. Exposure of the ligamentum conicum and the cricoid cartilage. Subsequent exposure of the thyroid isthmus, which is undermined and dissected after coagulation. Then expose the anterior surface of the trachea. Then incision of the perichondrium on the thyroid cartilage. This is then pushed off to the right and left. Then open the thyroid cartilage with the wheel in the midline. Transverse incision of the ligamentum conicum. Then insertion of retractors into the outer edge of the wound and into the thyrofissure. An exophytic mass is now visible, which extends into the anterior commissure. The endolarynx was opened paramedially on the right side. Now take a marginal sample in the area of the anterior commissure on the right side, where there is no longer a tumor macroscopically. The tumor is then dissected out at the level of the ligament and in the area of the subglottis from front to back. The endolaryngeal musculature lateral to the vocal cord does not appear to be infiltrated by the tumor. This boundary is therefore respected as the resection boundary. The resection is performed up to the base of the vocal process, where the tumor ends in the area of the posterior commissure. This is followed by careful hemostasis using bipolar coagulation and application of Otriven swabs. Further marginal samples are then taken from the cranial, caudal and dorsal margins and the basal area of deposition. All marginal samples are diagnosed intraoperatively as tumor-free in the frozen section. Therefore, an R0 resection of the specimen can be assumed. Careful hemostasis is performed again. The anterior surface of the trachea is then exposed again. Now incision of the trachea between the 2nd and 3rd cartilage clasp. The 3rd cartilage clasp is then removed as the cartilage here is very fragile. Creation of a tracheostoma with the chondrotome. The tracheostoma is then sutured circularly to the skin. Due to the depth and the short neck, the entire preparation is considerably more difficult. The patient had to be intubated and extubated several times during the creation of the tracheostoma. Finally, the thyrofissure was sutured after 4 drill holes were made in the area of the thyroid cartilage. Insertion of a laryngeal keel, which was also fixed with 2 sutures. Then suture of the conic ligament. Now move several muscle layers over the thyroid cartilage, which are also sutured in the midline. Beforehand, insert a wound flap that extends to the keel. Then two-layer wound closure and application of a pressure bandage. At the end of the operation, the patient is then intubated with an 8 mm tracheoflex tracheostomy tube. The procedure is then completed after a final consultation with the anesthesia colleagues. After waking up without any problems, the patient is then transferred to the intensive care unit for monitoring.