After induction of anesthesia and preparation of the patient by the anesthesia colleagues, the patient is first positioned. Entry with the small bore tube under dental protection to inspect the primary tumor region. The base of the tongue, vallecula and epiglottis are clear. The tumorous mass begins in the area of the aryepiglottic fold on the left, extends to the ary, infiltrates it and moves over the pocket fold to the left vocal fold, extends there to the anterior commissure, growth over the medial wall of the piriform sinus to the anterior wall here and tumorous fixation of the piriform sinus to the hemilarynx. The lateral wall of the piriform sinus, the posterior wall of the hypopharynx and the entire right side are tumor-free, as are the postcricoid region and the esophageal entrance. Insertion of a nasogastric tube under visualization. Repositioning of the patient and injection of xylocaine with added adrenaline. Skin incision to perform an apron flap. Cutting through skin and subcutaneous tissue. Exposure and dissection of the platysma. High dissection of the platysma and high suture of the apron flap. Exposure of the sternocleidomastoid muscle on both sides and preservation of the external jugular vein. Exposure of the omohyoid muscle, exposure of the submandibular gland and the digastric muscle on both sides. Exposure and free preparation of the hyoid. Subsequent dissection of the infrahyoid musculature from the hyoid. Skeletonization of the larynx. Exposure of the thyroid cartilage horns. On the left side, the tumor can already be palpated endolaryngeally in this area and therefore a tissue sleeve is left here. Complete skeletonization on the right side. Release of the piriform sinus. Exposure of the cricoid cartilage. Separation of the thyroid isthmus. Exposure of the anterior surface of the trachea. Laryngoscopy showed no evidence of subglottic expansion, therefore tracheotomy was performed between the 1st and 2nd tracheal ring and later intubation was changed to an LE tube. With the vallecula and epiglottis free, the tube is now inserted below the hyoid and centrally into the vallecula, followed by the epiglottis. Resection along the right aryepiglottic folds and thus extension of the pharyngotomy. Now a good overview of the tumor. This is as described above. Triggering of the right piriform sinus. Resection postcricoid. Here on the left side of the postcricoid ary widening of the safety margin with superficial whitish changes. Partial resection of the left piriform sinus while maintaining a safety distance of approx. 1.5 cm from the tumor here. Safe in sano conditions on all sides towards the depth with overlying soft tissue mantle. After resection of the tumor, preparation strictly close to the cartilage. Release the esophagus and place the larynx at the level of the tracheotomy. Careful inspection. ............... A somewhat narrow area can be seen in the area of the pharyngeal side wall, otherwise wide on the right side. No extension towards the subglottic area. A post-resection is now performed in the area of the scarce deposit in the area of the pharyngeal side wall, which generously covers the described part. Subsequently, left-sided and postcricoid specimens are taken from the margins, completely mapping the tumor. These were found to be free of tumor and dysplasia in the frozen section diagnosis. Therefore, the overall situation here is R0. The neck dissections are now performed. Start with the right side. This shows a markedly strong jugular vein.... ........ or a divided internal jugular vein. A strong portion lies in front of the omohyoid muscle. Dissection of the vein. It can be seen that the very, very strong vein rejoins the internal jugular vein below the omohyoid muscle and also flows back into it cranially. Leave the vascular variation. Free preparation of the veins. Clearing of level V a with careful protection of the cervical plexus branches. Here several nodes are not necessarily macroscopically suspicious. Exposure of the accessorius nerve. Release of the accessorius triangle with careful protection of the nerve. Clearing of the anterior neck preparation with exposure of the common carotid artery, preservation of the superior thyroid artery and the hypoglossal nerve. Overall, there were no compelling suspicious nodules. Careful wound inspection and turning to the opposite side if the wound is dry. A clinically clear metastasis measuring approx. 5 cm is seen at the transition from level III to IV. Caudal dissection of the internal jugular vein. Clearing of the anterior neck preparation while preserving the superior thyroid artery and the hypoglossal nerve. The metastasis extends medially to the common carotid artery and prevertebral fascia, but can be easily detached without any signs of infiltration and regular release of the hypoglossal nerve. Careful dissection of the internal jugular vein. Here it is noticeable that an area of approx. 2 cm is clearly infiltrated at the free edge and therefore caudal separation of the internal jugular vein. Laterally, there is no clear infiltration of the sternocleidomastoid muscle, but there is clear adherence here. Therefore, a muscle cuff is taken and left on the node. Take level V a with careful protection of the caudal lymph vessels. Caudal ligation when moving towards level V b. Before removing the vein, secure and follow the vagus nerve. This is safely free. Cranially, the accessorius nerve can be exposed and preserved. Clear the accessorius triangle with careful protection. Leave the inflow of the facial vein caudally and remove the anterior jugular vein cranial to the metastasis and remove the neck preparation. The cervical plexus was also preserved. Careful wound inspection and, if the wound was dry, insertion of an 8 mm Provox prosthesis. Placement in the usual manner using the pull-through method at the cranial edge of the tracheal insertion margin. The paramedian myotomy in the area of the upper esophageal sphincter had already been performed previously. This results in wide ratios. Later, the sternal insertions of the sternocleidomastoid muscle are also removed. Subsequently, if the mucosal conditions are strong and sufficient, the initially submucosal, inverting mucosal suture is used to close the pharynx. Overall two-layer closure. Subsequent readaptation of the released infrahyoid muscles to the hyoid. Subsequent final wound inspection and, if conditions are dry and the wound is irrigated, insertion of 2 10-gauge Redon drains and careful, two-layer wound closure with circular suturing of the tracheostoma without increased tension. The patient was given intraoperative intravenous antibiotics with Unacid 3 g. This should be continued for 24 hours postoperatively. Please continue this for 24 hours postoperatively. Conclusion: Intraoperative R0 resected cT3 cN2a supraglottic laryngeal carcinoma on the left. With clinically normal wound healing, postoperative X-ray gruel swallow on the 10th postoperative day please. Presentation at our interdisciplinary tumor conference for adjuvant therapy, which will certainly be necessary.  