So we start with a biopsy and a frozen section. But first, induction of anesthesia by the anesthesia colleagues. Transoral intubation, after tracheoscopy by the surgeon. Entry with the Kleinsasser tube and inspection of the tumor. The tumor is approx. 4-5 cm in size, clinically it encompasses the semicircular entrance of the piriform sinus and extends to the vallecula. There is a deep ulcer in the center. After incision, deep samples are taken from this ulcer and sent for frozen section. The samples are tumor-free. Therefore, the decision is made to continue with the tumor resection, as the prevertebral fascia is not included in the frozen section. Storage. Sterile washing and draping. Start creation of a tracheotomy through <CLINICIAN_NAME> and <CLINICIAN_NAME>. For this, enter below the cricoid cartilage. Dissection of the thyroid isthmus. Exposure of the anterior tracheal wall and creation of a visor tracheotomy. Creation of an apron flap in the usual manner. Start with neck dissection on the left side. Exposure of the sternocleidomastoid muscle, the omohyoid muscle, the submandibular gland, the cervical vascular sheath, the hypoglossal nerve and the accessory nerve and removal of the neck specimen II a to V a while sparing the plexus branches. Then turn to the opposite side. Same procedure here. Expose the sternocleidomastoid muscle, the omohyoid muscle, the digastric muscle and the submandibular gland. Exposure of the accessorius nerve and the hypoglossal nerve. Exposure of the cervical vascular sheath and removal of neck levels II a to V a, while sparing the plexus branches. Macroscopically, a metastasis is seen in level III. Then the Kleinsasser tube is inserted and the tumor is inspected again and the pharyngotomy height is determined. The tumor extends to the lower edge of the tonsil, so the pharyngotomy must also be performed relatively high up in the area of the base of the tongue. Then open the pharynx and cut around the tumor with a safety margin of 1.5 cm. The tumor grows in the arytenoid cartilage onto the mucosa of the arytenoid cartilage and the upper part of the thyroid cartilage on the right side must also be removed for the tumor resection. The tumor is placed on a cork for a frozen section. In the area of the base of the tongue, the tumor appears non in sano, so a generous resection is taken here and also sent for frozen section. In the frozen section, all edge samples are free of carcinoma, but in the area of the vallecula up to the pharyngeal side wall there is still carcinoma in situ. Therefore, a resection and a narrow marginal specimen are taken here again. Intraoperatively, it became apparent that covering the defect with a flap would lead to permanent aspiration due to the involvement of the larynx. It was therefore decided to remove the rest of the larynx for functional reasons. This decision was made together with <CLINICIAN_NAME>. Then release of the larynx on both sides. On the left side, the rest of the hyoid bone is removed and the infrahyoid muscles are removed and spared. On the right side, the infrahyoid muscles are removed. Then laryngectomy by <CLINICIAN_NAME>. To do this, expose the anterior wall of the trachea and detach the larynx from caudal to cranial with maximum protection of the mucosa. Enough mucosa remains to perform a primary closure in the pharynx. First, creation of a tracheal stump chamber through <CLINICIAN_NAME> and insertion of the tracheostoma. Then perform an esophageal myotomy on the dorsal left side so that the esophagus can be entered without difficulty. Insertion of a nasogastric tube and two-layer pharyngeal closure in the usual manner. Prior to this, a relatively large amount of mobilization is required in the base of the tongue, as there is a large defect in the mucosal area. There is already slight tension in the base of the tongue. However, the pharynx can ultimately be completely closed in this area. At the end, two Redon drains were inserted and the wound was closed in two layers. Overall, the radialis graft could not be lifted completely, regardless of the fact that the patient did not need it in this case, as the lumen of the proximal radial artery was severely reduced and could only be lifted with a very short pedicle. Therefore, the radial artery flap was not dissected further and the existing suture was closed again. Before starting the neck dissection, an esophagogastroscopy was performed and a PEG was placed using the suture pull-through method. There was a good diaphanoscopy. Please leave wrap bandage for 7 days. X-ray pap smear on the 12th postoperative day and continue antibiotics for 3 days.  