First, tracheoscopy and MLE again: The exophytic tumor is visible, which extends from the arytenoid region on the right to the front over the anterior commissure. Supraglottic anterior right and left tumor also glottis left. Tumor also extends slightly onto the subglottis on the right. Now superimposition of partial laryngectomy according to Leroux-Robert and tracheotomy: skin disinfection, injection of a total of 10 ml Ultracaine 1% with adrenaline. Then Z-shaped skin incision running caudally into tracheotomy incision. Dissection of the subcutaneous tissue. Exposure of infrahyoid musculature. Splitting of these and dissection to the side. Exposure of the larynx. Incision in the area of the perichondrium on the left and dissection of the perichondrium from the left via the anterior commissure to the opposite side. The epiglottis is opened cranially and medially with the laryngeal hook. A triangle is cut out caudally. Enter the larynx from the left. The tumor extending to the left is revealed. Successive resection of the tumor with a safety margin of 3-4 mm on all sides. The anterior third of the left vocal fold and also the left pocket fold are removed. Resection extends to the opposite side including the cartilage triangle. As on the left side, the perichondrium is also removed here. As on the opposite side, there is no infiltration. The anterior supraglottic region on the right and the entire glottis on the left with adjacent soft tissue up to the cartilage are removed with clear deep infiltration of the tumor. The resection extends posteriorly to the arytenoid cartilage, which is partially removed, leaving the posterior upper part intact. The tumor specimen is then marked basally on the right side and sent in as a basal margin section. Marginal sample of the interary region on the right. Additional marginal specimens from the right subglottic arytenoid region and the right caudal supraglottic and right cranial regions, whereby the anterior region is also included. Marginal sample from subglottic and marginal sample from the glottis and supraglottis region on the left. All marginal samples are healthy, as is the basal area on the right. Thus an overall R0 situation. This is followed by careful hemostasis with bipolar and supratubers. Due to the extent of the tumor and the lack of clarity with the tube in place, a tracheotomy was performed during the resection. This involved exposing the thyroid isthmus, passing under it and clamping it, cutting it and treating it with a puncture ligature. Then expose the trachea. Entering the 2nd/3rd interspace. Caudal reintubation and epithelialization of the tracheostoma. In the further course after R0 resection and closure of the larynx. Drill holes are made in the cranial area for this purpose. A drill hole is made on the left This fixes the left vocal fold at the front using a 4/0 Vicryl suture. The larynx is then adapted anteriorly using a 3/0 Vicryl suture. The preserved perichondrium is moved back from the right to the left and fixed here with 4/0 Vicryl single button sutures so that complete closure is also achieved in the area of the conic ligament. The infrahyoid musculature is closed over this using 3/0 Vicryl single button sutures. The wound is then closed in layers with epithelialization of the remaining tracheostoma. Subcutaneous suture with 3/0 Vicryl and skin suture with 4/0 Ethilon single-button sutures. Finally, reintubation and insertion of an 8 mm tracheostomy tube. The cannula can be removed if the swallowing function is adequate; early reclosure of the tracheostoma can then be attempted.