After induction of anesthesia by the anesthesia colleagues, attempt at intubation. This is not possible due to the tumor masses. Therefore quick decision to perform an emergency tracheotomy. Brief washing and injection of ultracaine mixture. Skin incision in the usual manner just below the inguinal cartilage. Rapid dissection in depth. Hemostasis by means of bipolar coagulation. Exposure of the thyroid gland. Undermining of the thyroid gland. Bipolar coagulation of the thyroid gland and transection of the isthmus. Exposure of the anterior wall of the trachea. Entering the trachea below the cricoid cartilage and intubation with a laryngectomy tube. Transfer for PEG insertion: insertion with the flexible oesophagoscope and pre-scanning into the stomach. If diaphanoscopy is good, perform the PEG insertion using the thread pull-through method. Enter with the small water tube and inspect the hypopharynx and larynx: The hypopharynx itself is unremarkable. Adjustment of the larynx. Here, an exophytic growing tumor can be seen on the right side with an inconspicuous epiglottis, which completely fills the endolarynx and extends to the other side. The vocal fold plane and pocket folds are no longer visible. The piriform sinus is free on both sides. Sterile washing and draping. Marking of the skin incision. Creation of an apron flap. The platysma is extremely thin and so is the skin. Exposure of the sternocleidomastoid muscle on the right side, the omohyoid muscle, the submandibular gland, the accessorius nerve, the hypoglossal nerve, exposure of the cervical vascular sheath. Free preparation of the internal jugular vein and excavation of neck levels II to V while sparing the plexus branches. Turning to the opposite side. Identical procedure. Exposure of the sternocleidomastoid muscle, omohyoid muscle, submandibular gland, accessorius nerve, lingual nerve. Exposure of the cervical vascular sheath. Dissection of the internal jugular vein and removal of the neck block II to V while sparing the plexus branches. Very little fatty tissue and no conspicuous lymph nodes are visible on either side. Level VI is integrated into the respective sides. Detachment of the cervical vascular sheath from the larynx. Skeletonization of the larynx with exposure of the hyoid bone and detachment of the infrahyal musculature. On the left side and in the middle, the musculature is left on the larynx preparation, as a thyroid cartilage perforation is described in the CT. Exposure of the upper horn of the thyroid cartilage on both sides and release of the piriform sinus. Enter the pharynx at the level of the hyoid bone and pull out the epiglottis. Cut along the edges of the epiglottis in a postcricoid direction while protecting the piriform sinus on both sides. Release of the postcricoid region and removal of the larynx below the cricoid cartilage. It can be clearly seen that the tumor does not extend far into the subglottic region and that the mucosa of the cricoid cartilage is inconspicuous at this point. To be on the safe side, a marginal sample was taken from the pharyngeal area at the pharyngo-epiglottic fold and sent in for a frozen section, as the resection margins were very narrow here. Pathology revealed no invasive carcinoma, no carcinoma in situ and no dysplasia. The esophageal myotomy was performed posteromedially on the left side so that a QF could be passed without any problems. Perform a myotomy on the sternocleidomastoid muscle on both sides to create a wide tracheostoma. Insertion of a Provox prosthesis 1 cm below the tracheostoma posterior edge in the usual manner. Incision of the tracheostoma initially at the front. Perform the pharyngeal suture in the usual manner. Fold back the apron flap and integrate it into the tracheostoma. Insertion of two Redon drains. Two-layer wound closure. The patient goes to the intensive care unit ventilated. Please carry out an X-ray pre-swallow 10 days postoperatively. Until then, the nasogastric tube remains in place as a splint. Unacid 1.5 g for 24 hours.