First orotracheal intubation by the anesthesia colleagues. The site is then covered as for a possible laryngectomy with neck dissection on both sides. This is followed by a Z-shaped incision and a small Kocher collar incision. The larynx is exposed via the Z-shaped incision. To do this, dissect through the subcutaneous tissue down to the infrahyoid musculature, which is split. Then dissect the perichondrium from right to left on the left side. Then split the larynx median. Entering the larynx anteriorly. The larynx is then inspected. The fibrin-covered area at the level of the arytenoid cartilage, where the sample had been taken and the G3 carcinoma had been confirmed, can be seen at the back. A macroscopic growth is extremely difficult to delineate with almost inconspicuous mucosa. Therefore, the resection was started slightly dorsal to the anterior part of the left vocal cord and immediately extended to the cartilage. This was because a cartilage infiltration could not be ruled out on CT, but this could not be clearly confirmed on ultrasound. Removal of the entire soft tissue from the cartilage below the perichondrium to the dorsal region of the arytenoid cartilage. Most of this is also resected. The posterior upper parts remain. Resection caudally up to the subglottic slope and cranially including parts of the pouch ligament. Dorsal removal of the largest parts of the arytenoid cartilage. The aryepiglottic fold is only slightly affected. The specimen is removed in toto and marked with sutures, especially dorsally and basally. A marginal sample is taken from the mucosa in the arytenoid region and soft tissue from the dorsal arytenoid region. The entire specimen and the 2 marginal samples are sent for frozen section. In the frozen section, the tumor is removed from the healthy area and the marginal samples are also healthy. Due to dysplastic extensions to the subglottic and anterior regions, it is recommended to take corresponding resections in these regions. Therefore, the remaining parts of the anterior left vocal cord up to the anterior commissure and the attached soft tissue are removed. A further mucosal sample is then taken from the entire subglottic area from anterior to posterior. No more dysplasia in the frozen section. Overall, including the marginal samples, R0 resection. This is followed by very careful hemostasis. A tracheotomy had already been performed before the tumor resection. For this purpose, a Kocher's collar incision was made slightly dorsally and after dissection through subcutaneous tissue, the infrahyoid musculature was pushed apart, the isthmus was cut and treated with puncture ligatures. After exposing the trachea, the 2nd/3rd intercartilaginous space is entered and a visor flap is created. This was then epithelialized. The tumor resection was then performed as described above. After creation of the R0 resection, very careful hemostasis and closure of the larynx. For this purpose, the remaining parts of the arytenoid cartilage were first sutured dorsally to the soft tissue of the arytenoid fold to improve stability. Then fixation of the remains of the anteriormost parts of the right vocal cord to the cartilage using 4-0 Vicryl single-button sutures. After making 3 drill holes, closure of the thyroid cartilage with 3-0 Vicryl single button sutures. Stable closure. Then close the ligamentum conicum with 4-0 Vicryl single button sutures. The left perichondrium soft tissue flap is then swung over around the laryngeal skeleton. This is sutured to the remaining soft tissue on the right side of the larynx with 4-0 Vicryl single button sutures so that the laryngeal skeleton is completely closed with soft tissue. Then suture the infrahyoid musculature. Suture of subcutaneous tissue. Insertion of a flap and skin suture. Subsequent completion of the epithelialization of the tracheostoma. Neck dissection left level II to IV: skin incision and dissection through the subcutaneous fatty tissue and dissection through the platysma. Dissection in a subplatysmal manner and discovery of the anterior border of the sternocleidomastoid muscle. The external jugular vein is ligated. Expose the accessorius nerve and spare it. Now locate the omohyoid muscle and follow it cranially. Expose the submandibular gland. Expose the gland and elevate the gland using Langenbeck to spare the marginal ramus of the facial nerve. Exposure of the posterior venter of the digastric muscle up to level II. Now also exposure of the cervical vascular nerve sheath and vagus nerve with preservation of all the structures mentioned. Now dissection of level IIb, here a relatively large mass in the sense of a lymph node is seen, which is successively dissected. Dissection in a caudal direction so that a total of levels IIa and b, level III and level IV are removed. Successive development and removal of the lateral neck preparation. The cervical plexus can be spared without any problems, also removal of level V. Further free preparation of the cervical sheath and development of the medial neck preparation while sparing the hypoglossal nerve. There is increased bleeding, not even after a Valsalva attempt, for this reason insertion of a Redon drainage and two-layer wound closure. Then reintubation, insertion of a 7 mm tracheal cannula. Insertion of a nasogastric tube to feed the patient. The procedure is then completed without complications. Patient admitted to intensive care unit for one night for postoperative monitoring. Nutrition initially for a few days via the nasogastric tube. Then carefully build up the diet. A swallowing disorder may well be present and may also be somewhat protracted. Therefore, if there are problems with swallowing, start swallowing training at an early stage. Overall, glottic carcinoma is difficult to diagnose cT1 to cT2 in terms of its extent with rather microscopic findings. Due to the tumor location and G3 stage, neck dissection level II to IV was performed on the left. Further procedure after receipt of the final histology. Then presentation at the interdisciplinary tumor conference. A follow-up MLE in 8-12 weeks seems sensible in any case.