Introductory consultation with the anesthesiologist. Repositioning of the patient and repeated endoscopic examination of the tumor region. The above-mentioned tumor extension is confirmed, so that the indication is confirmed. Subsequently, flexible esophagogastroscopy with PEG insertion with positive diaphanoscopy and positive tenting phenomenon using the thread pull-through method. This succeeds loco typico without any problems. Retraction of the esophagoscope and fixation of the PEG tube. Dressing is applied. Subsequent positioning of the patient and injection of local anesthetic with adrenaline in the area of the apron flap. Skin incision and dissection of the apron flap to expose the cervical vascular sheath and the anterior edge of the sternocleidomastoid muscle on both sides. Then start with the neck dissection on the left side. No suspicious lymph nodes are found during the dissection. Neck dissection is carried out in the area of levels Ib, II, III, IV and partially V. During neck dissection, the cervical vascular sheath is exposed over a long distance. Long-distance dissection, displacement and re-embedding of the vagus nerve in the sense of neurolysis. Long-distance dissection, displacement and re-embedding of the accessory nerve in the sense of a neurolysis. Same procedure in the area of the hypoglossal nerve. The entire neck preparation is sent for histopathological examination. Transition to the tumor side. Here, a lymph node conglomerate is seen in the area of the venous angle, which extends into the accessorius triangle. The number and size of the lymph nodes are also conspicuous down to level V. Here, too, the cervical vascular sheath is dissected over a long distance and the vagus nerve, accessory nerve and hypoglossal nerve are exposed, relocated and re-embedded in the sense of a neurolysis. Complete evacuation of the hypoglossal triangle and the accessorius triangle as well as the lateral and medial neck preparation, resulting in a level Ib to V neck dissection. All branches of the internal jugular vein and the external carotid artery can be preserved on both sides during dissection. Exposure of the hyoid bone and thyroid cartilage. Here, the hyoid bone is released from the cranial side by separating the suprahyoid muscles. Subsequent release of the posterior horn of the thyroid cartilage on both sides. This also involves severing the vascular nerve bundle. Exposure of the lateral surface of the thyroid cartilage on the left side and release of the pharyngeal tube. Caudal dissection of the thyroid lobe. It is clear that the thyroid lobe is not covered by the tumor on either side, especially not on the right side. In this case, the thyroid gland has been removed, but a marginal sample was taken for frozen section diagnosis. This was found to be tumor-free during the operation. In addition, the thyroid isthmus is cut, which is cut off on both sides, thus exposing the anterior surface of the trachea. The trachea is opened between the 1st and 2nd cartilage clasps and a visor tracheotomy is prepared, through which the patient is cannulated after extubation. Opening of the pharynx at the level of the epiglottis and preparation of the pharyngeal tube. Care is taken to ensure that the largest possible width of pharynx is retained on the left side. Carefully detach the pharynx from the laryngeal skeleton. This provides a very good view and control of the tumor. The tumor is incised far into the healthy tissue. The tumor extension described above is again confirmed, so that the option of a partial laryngeal resection is now definitively ruled out. The dissection continues caudally by further detaching the pharynx. At the level of the cricoid cartilage, where there is certainly no more tumor infiltration, further detachment of the larynx and subsequent removal of the larynx directly below the cricoid cartilage. Subsequent subtle hemostasis. Taking marginal samples from the tumor specimen. Here, the medial margin sample is infiltrated in a frozen section as a carcinoma in situ. However, due to the fact that the mucosa appears completely free of irritation and there is only a narrow margin of pharyngeal mucosa in the area of the caudal tumor deposit, the decision is made not to take any further margin samples in this area in order to avoid the need for pharyngeal reconstruction using a free flap graft. After subtle hemostasis, insertion of a Provox prosthesis in loco typico. This is also successful without any problems. Pharyngeal closure after performing the myotomy, which is performed laterally on both sides. Subsequent pharyngeal closure with single button sutures and then two layers of continuous sutures. The pharynx is closed at the base of the tongue in a horizontal scar line and otherwise in a vertical line. Dissection of the infrahyoid musculature, which was displaced caudally together with the thyroid gland. This is now also sutured in front of the pharynx and fixed to the base of the tongue. Repeated bleeding control in the area of the neck dissection. Dry wound conditions here too. The apron flap is then folded back and the tracheostoma sutured in place. Closure of the skin incision on both sides with subcutaneous and skin sutures. Insertion of a tracheal cannula. Application of a pressure bandage on both sides. Final consultation with the anesthetist. Completion of the procedure. To splint the pharynx, the nasogastric tube inserted at the beginning of the operation by the anesthesia colleagues remains in place postoperatively. Nutrition should be provided via the PEG. The patient is admitted to the in-house intensive care unit for postoperative monitoring. Swallowing attempt on the 10th postoperative day.