Induction of anesthesia. Sterile washing and draping. Prior to this, the pharyngeal and laryngeal areas were inspected again with the small bore tube and the findings from the previous panendoscopy were confirmed. Creation of an apron flap and preparation of the platysma in the usual manner. Then start with the neck dissection on the left side. Exposure of the sternocleidomastoid muscle. Exposure of the omohyoid muscle and the submandibular gland. Exposure of the cervical vascular sheath and removal of the neck levels II a to V a while sparing the plexus branches. Furthermore, the accessorius nerve and the hypoglossal nerve as well as the cervical sinus are spared. Unfortunately, the facial vein must be removed. Then release the hyoid bone on this side. Dissect the cervical vascular sheath from the pharyngeal and laryngeal area. Detach the thyroid gland from the larynx and turn to the opposite side. Similar procedure here. Exposure of the sternocleidomastoid muscle and exposure of the submandibular gland and the omohyoid muscle. Detachment of the cervical vascular sheath from the larynx. Release of the hyoid bone and detachment of the thyroid gland from the larynx. Dissection of the anterior wall of the trachea and creation of a tracheotomy between the 2nd and 3rd tracheal cartilage. Creation of a mucocutaneous anastomosis in the caudal region. Release of the piriform sinus on the right side and also on the left side. This is only possible to a very limited extent on the left side, as tumor infiltration can already be felt here. Now palpate the pre-epiglottic fatty tissue and localize the epiglottis. Entry into the right paramedian pharynx. Incision of the mucosa along the edges of the epiglottis up to the postcricoid region. Detachment of the larynx from the pharynx and placement of the larynx below the cricoid cartilage. A marginal sample is taken in the area of the pharyngeal side wall towards the soft tissue, as the tumor was resected very close to the healthy tissue here. The edge sample is diagnosed as tumor-free by the pathologist. Now completion of the neck dissection on the right side. Free dissection of the internal jugular vein and removal of the level IIa to IV neck specimen while sparing the plexus branches. Accessory nerve, hypoglossal nerve and facial vein are also spared on this side. The superior thyroid artery is present on the right side. It must be severed on the left side. Now insert a size 6 Provox prosthesis (model no. 2). Perform a two-layer pharyngeal suture in the usual manner using single button sutures. Finally, reduction of the attachments of the sternocleidomastoid muscle in the caudal region and retraction of the apron flap and formation of an epithelialized tracheostoma. Insertion of 2 Redon drains and skin suture in two layers. Please feed via the inserted nasogastric tube for 10 postoperative days, then carry out an X-ray pap-swallow examination and dietary reconstruction and present the patient to the tumor conference after receiving the histology. Continue antibiotics for 24 hours.