First, insertion of the Kleinsasser tube size C again after insertion of the mouthguard and assessment of the tumor. The exophytic tumor, which begins just before the ary on the right, is initially relatively flat, but then becomes significantly thicker and grows towards the supra- and subglottic area until it reaches the anterior commissure, also carcinoma on the opposite side, which could probably be a second separate tumor, because the mucosa directly in the anterior commissure appears to be inconspicuous over a very small area. This tumor also extends to just before the arytenoid region and is clearly thickened in the middle area, in contrast to the right side, where it is thickened in the middle to anterior area. Flat tumor in the dorsal area on the left. First resection of the tumor starting in the anterior commissure, here pushing the tumor away from the cartilage or also below from the area of the ligamentum conicum or up to the cricoid cartilage. Dorsally, the tumor is also resected on all sides with a safety margin of approx. 4 mm, whereby partial muscle tissue is still preserved dorsally, approaching the cartilage cranially, and resection up to the cartilage level at the very front. The tumor is also resected from the left dorsal side, whereby the tumor runs flat on the left dorsal side, mucosa with some soft tissue is resected here so that the muscles are largely preserved, with increasing resection of the soft tissue towards the front until the cartilage is reached again at the very front. The tumor is removed in its entirety and marked basally with sutures. Subsequently, supraglottic and subglottic anterior, supraglottic right and left, subglottic right and left, ary right and left marginal samples are taken. All marginal samples are sent for frozen section. No infiltrates visible in the frozen section, therefore R0 resection. There is still a remnant of soft tissue and vocal fold on both sides. Exposed cartilage or ring cartilage in the front. Therefore, insertion of a Dacron foil, which is fixed in the typical manner using sutures, which are passed outwards and knotted on the outside using a horizontal button. Check the position again. Good position of the Dacron foil. The hemostasis that was previously performed is now performed again. No evidence of bleeding on completion. A tracheostomy can be avoided despite the relatively extensive resection, with overall good adjustability and good intubation. No respiratory distress or dysphagia to be expected. Completion of the procedure without complications. Patient received clindamycin preoperatively. Please continue the antibiotic treatment for one week if the cartilage is exposed at the front. Please leave the Dacron foil in place for 6-8 weeks, preferably removing it at the next MLE check-up after approx. 8 weeks. Wait for the final histology. Patient goes to intensive care unit for one night for monitoring.