After induction of anesthesia and bronchoscopic intubation by the anesthesia colleagues. Positioning of the patient by the surgeon. Entry with the Kleinsasser tube and inspection of the hypopharynx. No abnormalities here. Adjustment of the larynx. The previously described mass is visible on the left side. The pocket fold is coarsely thickened with transition of the thickening to the vocal fold. This mass extends into the anterior commissure and endoscopically only extends to the anterior third on the right side. No further tumor infiltration can be seen endoscopically, everything is also clear subglottically. Then sterile washing and draping. Repositioning for plastic tracheostomy. Curved skin incision. Dissection down to the infrahyal musculature. Separate the infrahyal musculature at the midline and push aside. Then cut through the thyroid isthmus and expose the trachea. Enter the trachea between the 2nd and 3rd tracheal cartilage. Creation of a Björk flap and reintubation. Zigzag incision in connection with the tracheostoma in the midline of the neck. Dissection down to the prelaryngeal musculature. Splitting of the fascia of the prelaryngeal musculature. Exposure of the larynx. Incision of the perichondrium on the right side. Formation of a perichondrium flap that extends over to the left side. Cutting through the thyroid cartilage with the oscillating saw, initially in the midline in the upper part of the thyroid cartilage below the incisura. Form a triangle with displacement to the left side. Then incise the supraglottic tissue with the scissors through the sawed incision. Open up the thyroid cartilage and insert a small retractor. Inspection of the situs. Call in <CLINICIAN_NAME>, who notes that the tumor is very unclear and begins with the tumor resection. Start on the right side, then move to the left side. The incision is made in such a way that the posterior third of the vocal fold, including the arytenoid cartilage, remains on the right side. On the left side, the ary must be divided and the entire vocal cord and pocket fold removed. Part of the pharyngoepiglottic fold and the lower part of the base of the epiglottis are also removed. A marginal sample is then taken from the pharyngoepiglottic fold up to the arytenoid. The main specimen was removed from the inside of the larynx so that the inner perichondrium remained on the tumor specimen. The specimen is thread-marked for histology. The margin specimen is also sent to histology with a thread marker. The pathologist finds invasive squamous cell carcinoma in the specimen, which is border-forming towards the thyroid cartilage on the left and on the anterior commissure on the right. The patient is referred for resection. A better overview reveals that there is also tumorous tissue subraglottically on the right side. A sample is taken and sent for frozen section and invasive carcinoma with perineural sheath carcinomatosis can be detected in this sample. The findings are therefore discussed with <CLINICIAN_NAME>, who also advises a laryngectomy. To do this, widen the incision in the sense of an apron flap. Complete release of the larynx laterally from the thyroid gland on both sides as well as in the area of the cricoid cartilage. Then release the hyoid bone and perform a pharyngotomy, pull out the epiglottis and detach the laryngeal mucosa of the epiglottis and separate the larynx from the pharyngeal mucosa along the epiglottis, then posteriorly below the arytenoid cartilage and behind the postcricoid region, then place the larynx below the cricoid cartilage. The entire laryngeal preparation is thread-marked for final histology. Neck dissection on both sides. On the right, the entire neck is heavily scarred due to previous parotid surgery. The sternocleidomastoid muscle, the submandibular gland and the digastric muscle are visualized. Exposure of the nervus accessorius, the cervical vascular sheath and free preparation of the internal jugular vein and the facial vein. This is relatively difficult due to a strong scar block. On the right side, the thyroid lobe is massively enlarged and a very hard, irregularly shaped but encapsulated mass can be found at the upper pole. This is carefully incised and sent separately for histological examination. Release of the neck preparation level II a to IV, sparing the plexus branches. Identical procedure on the left side. Exposure of the sternocleidomastoid muscle, the submandibular gland and the digastric muscle. Exposure of the cervical vascular sheath. Dissection of the internal jugular vein. Locating and exposing the accessorius nerve. Release of the neck preparation II a to IV, sparing the plexus branches. Then placement of a Provox prosthesis. To do this, enter the esophagus with the protective tube and create a tracheoesophageal fistula. Then, with the help of the trocar, the Provox prosthesis is pulled through using the thread pull-through method. This is successful without any problems. The edges of the Provox prosthesis are rolled out and the Provox is positioned. It is positioned well, very high up and centered on the posterior wall. A subtle myotomy of the esophagus was performed beforehand so that the esophagus is easily passable. A myotomy was then performed at the base of the sternocleidomastoid muscle on both sides to create a flat stoma. Perform the pharyngeal suture. Initially single button sutures with two layers, then careful adaptation of the constrictor pharyngis muscle in this area where it is still completely intact. Care is taken to ensure that the pharynx is not constricted. Now turn to the tachea. The Björk flap is resected and the trachea is pulled upwards. Form a mucocutaneous anastomosis, initially in the lower area. Then suture the zigzag-shaped median skin incision and insert two 10-gauge Redon drainage tubes on both sides and suture the apron flap into the tracheostoma. Two-layer wound closure and reintubation to a 10-gauge tracheostomy tube. The patient is ventilated due to a cardiac problem and can wake up the same evening. Please present the patient to the tumor conference to plan adjuvant radiochemotherapy. PEG placement was initially dispensed with as the tumor was not as extensive at the start of the operation. The PEG must be inserted secondarily after the pharyngeal suture has healed. Until then, nutrition via the inserted nasogastric tube. As usual, on the 10th postoperative day, please carry out a Rötgen pap smear and build up the diet if there is no fistula. Antibiotics can be discontinued after 24 hours.