First, induction of anesthesia and transoral endotracheal intubation by the anesthesia colleagues and positioning of the patient by the surgeon. A laryngoscopy was performed using a Kleinsasser C-tube. This revealed a pronounced submucosal mass affecting the entire glottis and the subglottis on both sides over a distance of approx. 3 cm caudally. Thus, the indication for complete laryngectomy can be confirmed due to the pronounced subglottic tumor spread. Placement of a nasogastric feeding tube. Subsequent skin spray disinfection and application of local anesthesia cervically median, skin ablation and sterile draping. Due to the postoperative radiotherapy in the neck area and the lack of indication for neck dissection (postoperative neck dissection 2006, current cN0 status), the decision was made to make a circumscribed zigzag incision in the median cervical region. Dissection of the subcutaneous tissue and the platysma. Expose the prelaryngeal musculature and push it aside. Exposure from cranial to caudal of the hyoid bone, the thyroid cartilage, the cricoid cartilage and the anterior wall of the trachea. Exposure of the thyroid isthmus, transection of the same, treatment of the thyroid surface using bipolar coagulation. Subsequently, due to the clear subglottic extension of the tumor, decision to perform a deep tracheotomy between the 4th and 5th tracheal cartilage clasp. Re-intubation onto a size 8 laryngectomy tube, followed by skeletonization of the larynx, initially at the level of the thyroid cartilage. Perichondrium incision. Dissection of the piriform sinus from the thyroid cartilage leaves on both sides. Skeletonization of the hyoid bone with transection of the supra- and infrahyoid muscles at this level. Expose the epiglottis and perform the median pharyngotomy. Then incision along the aryepiglottic surfaces on both sides. Maximum protection of the piriform sinus on both sides. Transverse incision postcricoid and union of the lateral incisions. Entering the postcricoid area. Complete release of the larynx and the upper trachea from the postcricoid region and the esophagus. Dissection caudally. Resection and sending in of the laryngectomy specimen for intraoperative frozen section examination (suture marking: short-short tracheal separation margin anteriorly, long-long tracheal separation margin posteriorly). The following representative marginal samples are then taken: postcricoid region, right piriform sinus, left piriform sinus, right tongue base, left tongue base. All 5 marginal samples as well as the thread-marked areas on the laryngectomy specimen are found to be tumor-free by the pathology colleagues during the frozen section examination. Perform a cricopharyngeal myotomy. Subsequently, three-layer pharyngeal suture (submucosa, muscular layer, infrahyoid musculature). The pharyngeal suture is reinforced, particularly in the area of the base of the tongue, using cut pieces of Tachosil. Placement of a 10 Redon drain. Two-layer wound closure. Epithelialization of the tracheostoma at the caudal edge of the vertical skin incision. Re-intubation of the patient to a size 10 cannula. Application of a pressure dressing. Completion of the procedure without complications. The patient received Unacid 3 g intravenously intraoperatively as a single shot antibiotic. Please X-ray gruel swallow on the 10th postoperative day.