Once again, after intubation by the anesthesia colleagues, pharyngoscopy and laryngoscopy as well as MLE. The distended tumor can be seen, which is located on both vocal folds, reaches just in front of the arytenoid region and extends to the anterior commissure in each case. Overall, with clearly deep tumor growth, laser resection does not make sense, but rather an external approach. Therefore now repositioning. Skin disinfection. Injection of a total of 10 ml with Ultracaine 1% with adrenaline. Sterile draping. Z-incision with the possibility of creating a tracheostomy underneath. Subsequent dissection of the subcutaneous tissue. Separation of the infrahyoid muscles. Exposure of the larynx. Creation of a perichondrium flap, which extends from right to left and is pedicled there. Subsequent insertion into the larynx after sawing out a triangle, which protrudes anteriorly and to the right. Then push off the mucosa and the perichondrium on both sides directly from the cartilage to behind the arytenoid region. After enoral inspection, now subglottic entry, from there development of the tumor also subglottically at the upper edge of the cricoid cartilage. Then develop the tumor supraglottically on both sides, whereby the pocket fold must also be resected on both sides. Posterior resection of the anterior lower parts of the arytenoid cartilage on both sides, but the main part at the back remains intact. The tumor is removed in its entirety and also marked with sutures. Due to the extent of the tumor, marginal samples are taken. Left supraglottic margin specimens with anterior suture marking, left subglottic anterior/subglottic left suture marking anterior basal left with paraglottic musculature, subglottic right anterior suture, right arytenoid region, supraglottic right, paraglottic basal right with musculature and supraglottic right with anterior suture marking. All frozen section margin samples without evidence of tumor, thus R0 resection. Careful hemostasis is now performed. Now, due to the extent of the tumor and the expected temporary dysphagia, a tracheostoma is created: This is done through a small Kocher incision, which is made caudally. Visualization of the trachea. Insertion between the second and third tracheal cartilage. Creation of a modified Björk flap. This is epithelized in the typical manner, without tension. Subsequently reintubation and insertion of an 8 mm tracheal cannula. Then closure of the larynx. Drill holes are made and the thyroid cartilage is sutured together using 3.0 Vicryl single-button sutures. Subsequent suturing of the perichondrial flap with the perichondrium lying inwards on the right side, ensuring tension-free, complete and secure closure. Then suture the infrahyoid muscles. Flap insertion and layered wound closure. Application of Steristrip dressing. Completion of the procedure without complications. Overall extensive cT2 laryngeal carcinoma with infiltration of the glottis up to just before the arytenoid region as well as parts of the supraglottic region, mainly on the left, less so on the right. The arytenoid region is essentially preserved, dysphagia to be expected temporarily. Therefore temporary placement of a nasogastric tube. The final postoperative histology is awaited and then discussed in the interdisciplinary tumor conference. Plan closure of tracheostoma at intervals.