Initial consultation with the anesthesiologist. After a detailed discussion with the patient, indication for an external procedure if the glottic plane cannot be adjusted. Local anesthesia is administered prelaryngeally. Abjode, cover the surgical area. Zigzag incision in the median line of the forehead..................... is well ......................... Exposure of the infrahyoid musculature. Exposure of the linea alba. Dissection through LInea alba. Exposure of the thyroid condyle, exposure of the cricoid cartilage, exposure of the ligamentum conicum. Dissection of the ligamentum conicum. Opening of the thyroid cartilage in the median line and exposure of the inside of the larynx. With inconspicuous conditions in the area of the right larynx, a mass is seen which occupies the entire left vocal fold on the left side, whereby the anterior commissure is macroscopically tumor-free. Dorsally, the tumor extends to the tip of the arytenoid cartilage, but does not reach the posterior commissure. On palpation, the tumor is very voluminous. After injecting local anesthesia, the tumor is now inserted in the area of the anterior border of the thyroid cartilage on the left side. Exposure of the perichondrium. Pushing off the tumor with the perichondrium and careful dissection in the area of the inside of the larynx. The tumor is resected in the area of the morgue sinus and the entire subglottic slope. Careful dissection, particularly in the area of the posterior laryngeal sections, and removal of the tumor, including the vocal process of the arytenoid cartilage. As far as can be assessed intraoperatively, this very voluminous tumor can be completely removed in the healthy tissue, even if the dissection is certainly very narrow in the direction of the perichondrium. Careful hemostasis. Removal of numerous marginal samples, which are found to be tumor-free in the frozen section histology. Very difficult dissection overall due to the size of the tumor. However, as far as can be assessed intraoperatively, the tumor can be completely removed from the healthy tissue, so that no further measures are required at this time. However, this patient must undergo regular check-ups and must be informed accordingly. Now careful hemostasis. Closure of the thyroid cartilage by suturing after a total of 4 perforations of the thyroid cartilage. Reconstruction of the ligamentum conicum. Insertion of a flap. Wound closure in layers. Finally, a coarse needle biopsy of the left thyroid nodule is performed under sonographic control. Exposure of the thyroid nodule and corresponding coarse needle biopsy. Finally, a gastric tube is inserted into the patient. Completion of the procedure. Final consultation with the anesthetist. Very difficult dissection conditions due to the anatomy and size of the tumor. Close monitoring is absolutely essential.