After active patient identification, the patient is brought into the operating theater. Carry out the team time-out. Introductory consultation with anesthesia colleagues. Induction of anesthesia and intubation of the patient. Positioning of the patient by the surgeon. Initial re-inspection of the endolarynx. Insertion of the mouth guard. Insertion of the size D small bore tube. With difficulty, the posterior commissure can be adjusted with the small bore tube. The anterior commissure can only be seen with the aid of the fixed telescope. There is a flat change in the right vocal fold, as already described in the previous panendoscopy. Removal of the small water tube and repositioning of the patient in head reclination. Skin spray disinfection and infiltration anesthesia in the area of the planned incision. Skin wipe disinfection and sterile draping. First mark the planned incision from the incisura thyroidea to the cricothyroid ligament. Make the incision using the broken-line technique. Sharp cutting of the cutis and subcutis. Dissection of the platysma and exposure of the prelaryngeal musculature. Locating the linea alba. Blunt lateralization of the prelaryngeal musculature. Insertion of the retractors. Clear identification of the incisura thyroidea and the ligamentum conicum as well as the level of the cricoid cartilage. Incision of the perichondrium and formation of 2 perichondrium flaps. These are beaten laterally. The laryngeal skeleton is then opened using the wheel. A horizontal incision is also made in the area of the ligamentum conicum. Open the larynx in the median line. You now have a very good overview of the vocal fold on the right side, which has changed over a large area. The extent of the resection is determined with the aid of 0° optics. Endoscopically, the suspicious mucosal change extends into the subglottic slope of the right side. Cranially, the abnormal mucosa extends into the morgue sinus. Maintaining an appropriate safety distance, the entire right vocal fold is now excised, including the vocal ligament and the vocalis muscle. Dorsally, the tumor is deposited on the vocal process of the arytenoid cartilage. Suture marking of the main preparation. Removal of marginal samples (right cranial vocal fold, right caudal vocal fold, anterior commissure, margin of the vocal process). Hemostasis using bipolar coagulation. During the intraoperative frozen section diagnosis, both the specimen and the margin samples show that clear extensions of a carcinoma in situ are still present on all sides. For this reason, circular resection was initially carried out and new marginal samples were taken. It is now also apparent that there are also clear CIS extensions in the area of the vocal fold on the left front. Therefore, the extent of the resection is extended over the anterior third of the vocal fold on the left to the middle third of the vocal fold up to just before the posterior third of the vocal fold. In the area of the right vocal fold, the entire subglottic slope is resected. The medial mucosa-covered surface is also resected in the area of the right arytenoid. Finally, there are still CIS extensions in the area of the left vocal fold and the right medial arytenoid surface. After further resection, new marginal samples are taken and sent for definitive histological examination. The extent of resection on the right ary extends here to just before the interarytenoid region. A further resection in the same session does not appear to make sense, also in view of the patient's numerous previous illnesses. Therefore, hemostasis using bipolar coagulation. Insertion of a 12 mm laryngeal wedge. Prior to this, 4 drill holes were made in the area of the thyroid cartilage. Fixation of the Keel with PDS 4.0, followed by folding back the perichondrium leaves and suturing them over the Keel. Suture the incision in the area of the ligamentum conicum. Mobilization of the lateralized muscle bellies with the prelaryngeal musculature and readaptation in the midline area. Insertion of a sterile flap. Subcutaneous suture with Vicryl 4.0 and skin suture with Ethilon 5.0. Final consultation with the anesthesia colleagues and completion of the operation without complications.