Induction of anesthesia by anesthesia colleagues. Intubation transnasally by the anesthesia colleagues. Entry with the Kleinsasser tube and inspection of the hypopharynx, piriform sinus and postcricoid region. No abnormalities here. Attempt to adjust the tumor, which can be seen on the left side in the area of the glottis and supraglottis. Adjustment of the tumor is extremely difficult as the adjustability is very low. CT morphologically, the tumor breaks through the thyroid cartilage. Placement of a nasogastric tube. Repositioning for PEG insertion. Entering with the flexible esophagoscope and advancing into the stomach. Insertion of a PEG using the thread pull-through method. With good diaphanoscopy, this can be done without any problems. Sterile washing and draping. Creation of an apron flap. Preparation of the platysma. Raising and fixation of the apron flap. Start with the neck dissection on the left side. Here you can see a large rough metastasis which macroscopically infiltrates far into the sternocleidomastoid. Therefore, expose the sternocleidomastoid and the submandibular gland, the omohyoid muscle and remove the sternocleidomastoid muscle in the caudal region. Raise the muscle and dissect along the cervical vascular sheath in a cranial direction. It can be clearly seen that the internal jugular vein has a very small caliber, so that it can be assumed that the tumor has also penetrated the vein. This also becomes clear on further dissection. The vein is therefore clamped and cut in the caudal area and the ends are ligated. Further dissection cranially along the external and internal carotid artery. The metastasis can be easily pushed away from these vessels. The metastasis also infiltrates the posterior digastric venter muscle. This is also partially removed. The hypoglossal nerve can be spared and the facial vein must unfortunately also be removed. Removal of the metastasis and removal of the legal neck block II a to V a, sparing the plexus branches, whereby it must be said that the accessorius nerve and the cranial plexus branches were also partially resected, as these have penetrated directly into the metastasis. Turning to the opposite side. Exposure of the sternocleidomastoid, omohyoid, digastric and submandibular gland and exposure of the cervical vascular sheath. Free preparation of the internal jugular vein, the facial vein and removal of the neck levels II a to V a, while sparing the plexus branches. Detachment of the neck vessels from the pharynx and larynx area. Exposure of the hyoid bone. Detachment of the base of the tongue from the hyoid bone. Skeletonization of the larynx with detachment of the oblique laryngeal musculature. Entering the pharynx, just above the hyoid bone. Pulling out the epiglottis and cutting along the epiglottis to the postcricoid region, initially on the right side. Inspection of the tumor region. This breaks through the thyroid cartilage ventrally and also laterally on the left. A great deal of tissue is left in the ventral and lateral region of the laryngeal preparation. The thyroid gland is difficult to dissect and is therefore sharply dissected to avoid getting into the tumor. Further dissection of the laryngeal preparation and removal of the larynx below the cricoid cartilage. Before this, a tracheostoma was created and the ventilation tube was intubated. Removal of a resected specimen with a marginal sample from the thyroid gland area, as the tumor is at least very close here macroscopically. The marginal sample from the thyroid gland is tumor-free. The laryngeal specimen is sent for final histology. Insertion of a Provox prosthesis in the usual manner with the auxiliary trocar, approx. 1 cm below the upper edge of the tracheostoma. A myotomy of the esophageal sphincter is omitted, as this could be passed loosely with a transverse finger. Perform a myotomy in the sternocleidomastoid muscle to achieve a flat stoma. Performing the pharyngeal suture in a three-layered manner with single button sutures, without creating a T. Placement of two Redon drains and two-layer wound closure with epithelialization of the tracheostoma.  