Induction of anesthesia by the anesthesia colleagues. Entering with 0° optics and inspection of the tumor. The tumor is located on the left side, completely infiltrating the vocal folds. Pass the tumor region and look subglottically. Here, there is a slight extension in the subglottic slope. The subglottis itself and the trachea are tumor-free. Intubation by the anesthesia colleagues transnasally. Entry with the small bore tube and re-inspection of the tumor region. It is clear that the tumor extends very far caudally in the area of the arytenoid cartilage. A visible mucosal infiltration extends as far as the arytenoid cartilage. The arytenoid cartilage itself is distended and thickened, suggesting a submucosal infiltration. Decision to perform a laryngectomy due to the age and extent of the tumor. Esophageal entrance and piriform sinus on both sides are free. Sterile washing and covering after injection. Creation of an apron flap in the usual manner. Start with neck dissection on the left side. Exposure of the sternocleidomastoid muscle, the omohyoid muscle, the submandibular gland and the digastric muscle. Release of the neck levels IIa to Va while sparing the plexus branches. There are several spherical and suspicious masses on all sides, especially in levels II and III. Exposure of the hyoid bone. Detachment of the hyoid bone on the left side. Detachment of the cervical vascular sheath from the larynx and pharyngeal region. Detachment of the thyroid gland. Exposure of the upper laryngeal bundle. Coagulation of the upper laryngeal bundle and transection of the upper laryngeal bundle. Turning to the opposite side. Exposure of the sternocleidomastoid muscle, submandibular gland, omohyoid muscle and digastric muscle. Clearing out the neck levels IIa to Va. There are several suspicious lymph nodes, especially in levels IIa and b. Exposure of the hyoid bone here as well. Release of the hyoid bone. Removal of the hyoid bone. Exposure of the superior laryngeal nerve, A. and V. laryngea. Separation of these. Detachment of the cervical vascular sheath from the larynx and pharyngeal region and detachment of the thyroid gland. Detachment of the infrahyal musculature and the laryngeal musculature. Performing the tracheotomy between the 2nd and 3rd tracheal cartilage. Transfer intubation to a laryngectomy tube. Start skeletonization of the larynx on the right side. Release and push off the piriform sinus, same procedure on the left side. Here the piriform sinus can only be partially released, as this is the tumor side. Enter the pharynx at the level of the epiglottis from the right side. Pull out the epiglottis through the pharyngotomy and incise the mucosa along the edge of the epiglottis up to the arytenoid region. Here, detachment of the mucosa caudally from the arytenoid cartilage. Detachment and separation of the larynx. In the area of the piriform sinus on the left side, the mucosa and soft tissue are resected again and a marginal sample is taken. Unfortunately, this marginal sample still shows carcinoma. Therefore, a large resection and another marginal sample are taken. This marginal sample is ultimately tumor-free. Creation of an esophagotracheal fistula and insertion of a size 10 Provox prosthesis (Provox 1). Perform the pharyngeal suture in a three-layered manner as usual. Reduction of the insertions of the sternocleidomastoid muscle and insertion of Redon drains. Incision of the skin in the area of the tracheostoma and two-layer wound closure. The operation is completed without complications. The patient goes to the intensive care unit in an awake state. Please continue antibiotics for 24 hours. The patient is fed for 10 days via the PEG tube inserted during the operation (no problems with good diaphanoscopy).