After induction of anesthesia and intubation by the anesthetist, 3 g of Unacid is administered preemptively. Flexible esophagogastroscopy is then performed under constant air insufflation. After positive diaphanoscopy, insertion of the trocar and placement of the PEG tube using the thread pull-through method in the typical manner. The tumor is now positioned with the spread laryngoscope. The left aryepiglottic fold is found to be about 1 cm wider, thickened and uneven without clearly exophytic tumor growth. Under the microscope, however, the clearly uneven mucosa is visible. The mass does not infiltrate the arytenoid cartilage and extends both endolaryngeally and towards the median piriform sinus wall over a width of approx. 5 mm. Cranially and anteriorly, it reaches the aryepiglottic fold without actually infiltrating the lateral side. Demonstration of the findings to <CLINICIAN_NAME>, who approves the procedure. Now the resection is started with the CO2 laser at 4 watts and continues mode, initially on the median side and at the border to the arytenoid cartilage. Then laterally over the base of the epiglottis into the pharyngoepiglottic fold. Laterally, the anterior piriform sinus wall is also resected in the entrance area of the piriform sinus and then the resection is completed along the median piriform sinus wall with a safety margin of approx. 5 mm. During the resection, a small arterial hemorrhage occurs once, which can be easily stopped using monopolar coagulation. After careful consideration of the tumor specimen, a decision is made to perform another small resection in the anterior and cranial area of the pharyngoepiglottic fold/laryngeal epiglottis junction. This is also done with the laser. Now, after consultation with <CLINICIAN_NAME>, several marginal samples are taken: 1x medial to the aryepiglottic fold/transition pocket fold, 1x anterior cranial along the pharyngoepiglottic fold, the 3rd starting from the arytenoid cartilage over the median piriform sinus wall to the lateral and the 4th in the area of the wound bed. The frozen section diagnosis reveals mild to moderate dysplasia in the area of the median piriform sinus wall. A resection is therefore carried out in this area if the mucosa is normal and sent for frozen section diagnostics. A resection is also performed in the area of the median aryepiglottic fold/transition pocket fold if the mucosa is slightly suspicious under the microscope. The 2nd frozen section diagnosis now reveals non-irritant conditions in the area of the median piriform sinus wall, but a tiny carcinoma in situ in the area of the median aryepiglottic fold/pocket fold junction. Therefore, a second resection is performed here, which is sent for final histology and a second marginal sample of the aryepiglottic fold in the median direction. In between, neck dissection level I b to V b is performed on the left side, which involves partial resection of the sternocleidomastoid muscle and resection of the internal jugular vein and facial vein. Initial curved skin incision along the sternocleidomastoid muscle. Dissection through the platysma. Protect the external jugular vein. Now attempt to dissect the anterior border of the sternocleidomastoid muscle. However, it quickly becomes apparent that this is cemented to the tumor conglomerate, but only in the central area. The anterior margin is therefore exposed in the caudal and cranial area and a partial resection of the sternocleidomastoid muscle is performed in the central area. The resection is then continued subglottismal to anterior, then the omohyoid muscle is followed posteriorly to anterior without the digastric venter muscle. The submandibular gland is skeletonized. In addition, the facial vein is identified and ligated. Then identify the hypoglossal nerve and the superior laryngeal nerve and form the preparation from median to lateral. The thyroid gland and the deep laryngeal musculature are visualized in the caudal region. Now expose the internal jugular vein cranially and caudally of the tumor conglomerate. This is relatively small and without a lumen, so that a thrombosis of the vein must be suspected. It was therefore decided to resect and ligate the internal jugular vein in its cranial and caudal insertion. Now dissect along the common carotid artery from median to lateral. It can be seen that the tumor conglomerate can be easily pushed away from the carotid artery. In addition, identify the vagus nerve and spare the last one. Now laterally expose the scalene musculature. Identify the accessorius nerve, which can be spared, and complete the neck dissection in its lateral section from cranial to lateral while sparing the plexus branches and the accessorius nerve. In the deep caudal area, care is taken to resect level II b as well. Now careful hemostasis. Placement of a 10 Redon drain and two-layer wound closure using subcutaneous and skin sutures. After consultation with <CLINICIAN_NAME>, a temporary plastic tracheotomy is performed: horizontal incision approx. 1 cm caudal to the cricoid cartilage. Dissection through subcutaneous tissue and platysma. Exposure of pretracheal musculature. Spreading in the linea alba. Identification of the thyroid isthmus and undermining. Bipolization of the thyroid isthmus and spreading of the trachea. Opening of the trachea between the 2nd and 3rd tracheal ring and epithelialization of the slit-shaped opening in the sense of a visor tracheotomy. Re-intubation with an 8 mm Rügheimer cannula. Now proceed to neck dissection of the right side selectively level II to IV. Dissection through subcutaneous tissue and platysma. Expose the sternocleidomastoid muscle, the digastric muscle and the omohyoid muscle. Identification and protection of the accessorius nerve. Dissect the internal jugular vein from caudal to cranial and expose the facial vein and, after isolating the cervical vascular sheath, form the lateral neck preparation from cranial to caudal while sparing the plexus branches and the accessory nerve. This is followed by resection above the venous angle after identification of the hypoglossal nerve and finally removal of the median neck preparation caudal to the facial vein. Hemostasis by means of bipolar coagulation. Irrigation with hydrogen and Ringer. Placement of a 10 Redon drain and two-layer wound closure. The final frozen section diagnosis now results in an R0 resection, meaning completion of the procedure without bleeding and without complications. Conclusion: cT1 cN2b supraglottic laryngeal carcinoma of the left side, which was laser resected R0. Intraoperative administration of Unacid, which should be continued for 3 days. The patient should not be given any oral food for 1 week and then the cannula could be removed after a swallowing attempt.  