After induction of anesthesia by the anesthesia colleagues and intubation, entry with the Kleinsasser C-tube and inspection of the endolarynx. This reveals an extensive mass in the area of the left vocal fold, which macroscopically does not infiltrate the vocal process. The mass extends anteriorly to the anterior commissure and there is no infiltration into the subglottic region or into the depth of the morgue sinus. Now inject 10 ml of Ultracaine solution into a horizontal skin fold and cover sterilely. First make a skin incision approx. 5 cm long. Split the prelaryngeal muscles in the middle. Expose the thyroid cartilage plate and the ligamentum conicum. The ligamentum conicum is incised centrally with the monopolar. The perichondrium, the thyroid cartilage paramedian on the right, is then incised. Now mobilize the perichondrium on the thyroid cartilage plates laterally and perform a median chondrotomy and open up the larynx. The anterior commissure is now split paramedian on the right side in order to safely remove the tumor in a healthy state. Then incision parallel to the vocal fold in the area of the subglottic slope approx. 4 mm caudal to the glottic plane. Mobilization of the vocal fold, including the vocalis muscle in the anterior region. There is no palpable infiltration of the musculature here, so that the muscle is now largely left in place during posterior dissection. Now make another incision cranial to the morgue sinus with the scalpel parallel to the vocal fold plane so that the vocal fold is now completely mobilized from anterior to posterior up to the vocal process. Push off the mucosa medially from the vocal process and then remove the histological specimen, which is sent for final histology. Hemostasis in the area of the vocalis muscle with bipolar coagulation. A branch of the superior thyroid artery is also coagulated with bipolar coagulation. Now take marginal samples. Samples are taken from the right anterior commissure. A strip of mucosa from anterior to posterior is sent in for a frozen section both subglottically and supraglottically. Now take a marginal sample in the area of the medial arytenoid cartilage towards the posterior commissure. Mobilization of the pocket fold, which is now inserted caudally into the former anterior commissure and sutured to the subglottic mucosa. Initially, the entire surgical area is closed, but the intraoperative frozen section reveals an invasive carcinoma in the marginal sample of the arytenoid cartilage. Therefore, reopening of the larynx and case discussion with <CLINICIAN_NAME>. Decision to perform another mucosal resection in the area of the medial ary and posterior commissure and in the area of the cranial ary, which are sent for urgent histology. Resection of the arytenoid cartilage should initially be avoided due to the age of the patient and the resulting right prognosis with regard to aspiration. Now check for bloodlessness, which is present. Insertion of 2 drill holes each in the area of the thyroid cartilage plate. Adaptation of the thyroid cartilage plates using Vicryl 3-0. The ligamentum conicum is also closed and fixed to the thyroid cartilage plates through the drill hole. The mobilized perichondrium is also adapted as far as possible. Suturing of the prelaryngeal musculature after insertion of a flap. Subcutaneous and skin suturing and completion of the procedure. Conclusion: Intraoperative findings show a much more pronounced tumor extension towards the arytenoid cartilage than previously described in the panendoscopy. After removal of the tumor from the vocal process, the marginal specimen unfortunately still shows tumor growth. In a case discussion with <CLINICIAN_NAME>, a resection is performed in the area of the medial arytenoid and a second resection in the area of the cranial arytenoid cartilage. These are sent for urgent histology. Resection of the arytenoid cartilage is not initially performed due to the patient's age and the associated increased risk of aspiration. If further tumor is detected in the post-resectate, laser resection of the arytenoid cartilage with the risk of a functionally necessary laryngectomy in the event of aspiration and radiotherapy as an alternative must be discussed with the patient.