Reclination of the head. Then insertion of the size C small bore tube. The tumor is visible, which extends in the area of the glottis on the right to the front, up to the anterior commissure and does not exceed this to the left. The tumor clearly grows in depth and also in the direction of the laryngeal ventricle. Dorsal extension to the arytenoid region on the right. This is followed by PEG insertion: insertion of the esophagoscope into the stomach. Creation of diaphanoscopy. Insertion of a 15 mm stomach wall tube in the typical manner. No problems, no complications. Fixation to the abdominal wall. Completion of the procedure without complications. Repositioning for tumor resection and neck dissection on both sides: injection of a total of 20 ml Ultracaine 1% with adrenaline in the anterior and cervical neck area. Then first partial laryngeal resection with tracheostomy: zigzag skin incision anteriorly, extending caudally for a planned tracheostomy. Dissection through the subcutaneous tissue onto the larynx. Dissection of the perichondrium with overlying soft tissue from the left and dissection to the right, here the perichondrium is dissected from the cartilage to the dorsal side as a flap. Then enter the larynx after opening the larynx. For this purpose, the thyroid cartilage is cut cranially in the middle caudally slightly to the left with the wheel. Entering the larynx and creating an overview. The tumor remains confined to the right side, no macroscopic extension to the left can be detected. A marginal sample is taken from the left anterior region of the vocal fold and from the left anterior region of the commissure from the soft tissue. Then resection of the thyroid cartilage in the anterior region on the right, leaving a brace caudally and cranially. The perichondrium is dissected from the dorsal area, which was left in place. The tumor is removed on all sides in the healthy area with a safety margin of at least 4-5 mm. Most of the arytenoid cartilage on the right is also resected. Parts at the back and top remain. The aryepiglottic fold is completely spared. The tumor is removed. It is thread-marked dorsally and ventrally basally. Marginal samples are taken from the caudal, dorsal and cranial sides. The tumor is removed basally in healthy tissue. Also tumor-free margins, especially cranially. All margin samples are also in healthy tissue, thus R0 resection. Careful hemostasis. Before the tumor resection was completed, a tracheostomy was created for a better overview. For this purpose, the thyroid isthmus was exposed, passed underneath, clamped, cut and supplied with two puncture ligatures. The trachea was then exposed. Entry into the 2nd/3rd intercartilaginous space. Creation of a wide pedicled Björk flap and partial epihtelization of the flap. Laryngeal closure is performed cranially on each side using 3.0 Vicryl single button sutures after making two drill holes in the remaining thyroid cartilage. The perichondrium is sutured again using four Vicryl 3.0 single button sutures to create a complete and stable closure of the larynx, also in the subglottic direction. Overlying soft tissues are sutured in two layers, the last layer being the infrahyoid musculature. The skin is then closed in layers with the insertion of a flap. Epithelialization of the tracheostoma. Insertion of an 8-gauge tracheostomy tube at the end of the operation. Neck dissection on both sides: Start on the right. Curved skin incision slightly lateralized. Exposure of the anterior edge of the sternocleidomastoid muscle. Dissection of the lymph node fat package. Exposure of the omohyoid muscle, digastric muscle. Exposure of the cervical vascular sheath with internal jugular vein, common carotid artery, internal/external carotid artery. Exposure of the vagus nerve, accessorius nerve and hypoglossal nerve. All structures are preserved. Successive evacuation of levels II-IV while preserving the branches of the cervical plexus. Careful hemostasis. Wound closure in layers with insertion of a Redon drain. Neck dissection on the left: This is performed via a shortened incision. Level II and III evacuation with exposure of the structures as on the opposite side. Here too, after careful hemostasis, the wound is closed in layers and a Redon drain inserted. Final inspection of the endolarynx with the MLE tube: no bleeding. Completion of the procedure without complications. Overall cT2 laryngeal carcinoma with spread to the paraglottic and in the direction of the laryngeal ventricle and slightly in the direction of the supraglottis. R0 resection with resection of the anterior area of the thyroid cartilage. The patient is admitted to the intensive care unit for postoperative monitoring. Nutrition via PEG tube for the first few days.