After appropriate preparation, first mark the apron flap. Incise it and lift it above the hyoid bone. Then expose the front edge of the sternocleidomastoid muscle. A metastasis can be seen in region IV, which is partially attached to the muscle and also appears to be firmly connected to the vein. Opening of the vascular nerve sheath and protection of the artery and vagus nerve. Dissection of the internal jugular vein. This shows that the metastasis cannot be dissected from the vein wall in a healthy layer. Therefore, expose the vein caudally and cranially under the digaster muscle. Deposition of the vein there. Subsequent partial resection of the sternocleidomastoid muscle together with the metastasis left on the vein. The following neck dissection is completed by <CLINICIAN_NAME>. Neck dissection on the left (<CLINICIAN_NAME>/PJ): Showing the borders of the neck dissection planned from level II to V. The submandibular gland is shown here, the posterior venter of the digaster, the hypoglossal nerve, the accessorius nerve, the anterior border of the sternocleidomastoid muscle, cervical plexus, cervical vascular sheath with the internal jugular vein, the external and internal carotid arteries, the omohyoid muscle was dissected to the detachment of the larynx. The neck preparation is now dissected and removed, preserving the non-lymphatic structures from level II to V. Punctual hemostasis. Placement of a 10 Redon drain. Exposure and protection of the nervus accessorius and nervus hypoglossus until the end. Then dissection and removal of the superior thyroid artery and dissection of the carotid artery medially and detachment from the laryngeal skeleton. Cranial exposure of the lateral horn of the hyoid bone and removal of the suprahyoid musculature up to the middle. Then cut through the straight neck muscles on the thyroid gland. Then pass under the isthmus and ligate on both sides so that the anterior trachea is clearly exposed. Opening of the trachea between the 3rd and 4th tracheal clasp with insertion of an LE tube. Then dissection of the right thyroid lobe laterally. Now transition to the opposite side. In principle, the procedure is similar here. The only difference is that all non-lymphatic structures are preserved here. Dissection of the large caliber lingual artery and facial artery for subsequent anastomosis. After appropriate detachment of the laryngeal skeleton, the epiglottis is completely freed of mucosa ventrally up to the upper edge of the glottis. There the mucosa is incised and the entrance into the pharynx is made. The tumor on the right side of the hypopharynx is directly visible. First, release the larynx on the left side along the epiglottis, leaving out the previously released piriform sinus. The hypopharynx is then successively removed at a distance of about 1.5 cm from the tumor. After uniting the incisions from both sides postcricoidally and detaching the larynx caudally under the cricoid while preparing a caudally pedicled mucosal flap for the subsequent Herrmann chimney, the larynx together with the right hypopharynx is removed in toto. Subsequently, marginal sections are taken from the resulting mucosal margins, all of which are found to be free of tumor and dysplasia in the frozen section histological examination. Then completion of the Herrmann chimney by suturing the mucosal flap to the upper tracheal clasp. Subsequent myotomy of the constrictor pharyngis muscle. Insertion of a Provox-Vega voice prosthesis. Again, completion of the neck dissection on the left side by <CLINICIAN_NAME>. Neck dissection on the right (<CLINICIAN_NAME>/PJ): Showing the borders of the nervus accessorius, cervical vascular sheath, omohyoid muscle, which was cut to detach the larynx, glandula submandibularis, venter posterior of the digaster. The anterior border of the sternocleidomastoid muscle is exposed after creation of the apron flap. There is a metastasis in level IV, which cannot be dissected from the internal jugular vein. After demonstrating the findings to <CLINICIAN_NAME>, the decision is made to remove the internal jugular vein. The jugular vein is thus integrated into the preparation. Exposure of the vagus nerve, exposure of the common carotid artery, internal carotid artery, external carotid artery. All of the above structures can be spared. Release of the neck preparation of level II a, II b, III, IV and V. Punctual hemostasis and placement of a 10 Redon drainage. The ALT flap is then applied on the right side with a size of 4 x 9 cm. After Doppler sonographic visualization of the perforators, the flap is outlined and incised caudally medially down to the muscle fascia. Expose the muscle septum with medialization of the vastus medialis muscle. Then widen the incision cranially so that the vascular pedicle is clearly visible. Then cut around the flap medially cranially and caudally laterally. Finally, the stalk is also exposed distally at the end of the flap and removed. The flap is thus successively developed cranially with a muscle cuff. Finally, fine dissection of the pedicle is performed, whereby the vein and artery are exposed as far as their exit from the circumflex femoral artery. Once the neck dissection is complete, the flap is removed, rinsed with heparin solution and transferred to the neck. There the reconstruction of the hypopharynx is performed using single-button sutures. The flap is then anastomosed to the lingual artery on the left side and to the internal jugular vein. Conclusion: Hypopharyngeal/laryngeal carcinoma on the right with total laryngectomy with hemipharyngectomy, primary voice rehabilitation by implantation of a Provox voice prosthesis, pharyngeal reconstruction with a microvascularly anastomosed ALT flap from the right thigh, radical neck dissection on the right and selective neck dissection on the left, PEG placement.