After appropriate preparation, a diagnostic panendoscopy is performed. Here, a tumor originating from the left piriform sinus, which also affects the lateral larynx, can be seen when the larynx is adjusted. Tumor resection alone without removal of the larynx would result in a hypopharyngeal defect that would have to be reconstructed, whereby the reconstruction would extend to the entrance to the larynx with corresponding negative consequences for swallowing ability. The decision was therefore made to perform a total laryngectomy including the left piriform sinus. Subsequent sterile washing and draping. Creation of the apron flap and preparation upwards. Perform the tracheostomy in the area of the 3rd tracheal clasp. Then start with the neck dissection on the left side. The large metastases can be seen here, which safely infiltrate the sternocleidomastoid muscle and the internal jugular vein. The lymph node package is first removed from the cranial side along the anterior belly of the digastric muscle. The resection also includes the caudal part of the parotid gland after exposure of the ramus marginalis mandibulae at its crossing point via the facial vessels. This allows the tumor block to be initially mobilized from the cranial side. Expose the very small internal jugular vein at the base of the skull. Then remove the sternocleidomastoid muscle from its origin at the mastoid. Now skeletonize the cervical vascular nerve sheath starting caudally. The entire length of the common carotid artery, including the carotid bifurcation and the internal carotid artery, can be exposed and mobilized from the tumor masses. The facial artery and the pharyngeal artery must be removed for tumor removal. The vagus nerve remains intact and runs slightly dorsal to the artery. The internal jugular vein is then also exposed caudally, which is removed just above its inflow into the subclavian vein. Resection of the lymph node conglomerate including the muscle then begins. The accessory nerve cannot be saved either. However, the hypoglossal nerve can still be dissected free in a healthy layer and left in place. The lymph node package is thus developed successively from cranial to caudal. Behind the large, easily palpable tumor masses, smaller, coarse lymph node metastases are repeatedly palpated, all of which are also removed. The cervical plexus is completely resected. The phrenic nerve is then exposed and preserved. The resection extends dorsally almost to the scapula, exposing and preserving the brachial plexus. Caudally, the metastasis extends below the clavicle and is dissected free along the subclavian vein. The thoracic duct on the right side at the caudal pole of the huge metastasis is also exposed and opened. This is then ligated at both ends so that there is no more intraoperative chyle leakage. The remaining lymph node metastases that have submerged behind the clavicles are then also removed en bloc, so that a huge lymph node conglomerate is removed from the left neck together with the surrounding fatty tissue. Subsequent removal of the constrictor pharyngis muscle from the lateral thyroid cartilage. Push the thyroid gland laterally, pass under the isthmus and ligate it. Separation of the hyoid bone from its cranial muscle attachments. Minor release of the piriform sinus on the left side. Subsequent evacuation of regions Ia and Ib, including the submandibular gland on the left side. Then transition to neck dissection on the opposite side. Here too, regions I-V are evacuated while preserving all non-lymphatic structures. The thyroid gland is then detached from the larynx and lateralized. Separation of the ansa of the constrictor pharyngis muscle from the laryngeal skeleton and complete release of the piriform sinus. Now remove the larynx caudally under the cricoid cartilage and dissect a caudally pedicled mucosal flap from the inside of the cricoid cartilage plate. This is then used in the usual way to cover the tracheal chimney above. Now dissect the lingual side of the epiglottis up to its upper edge. There, open the pharynx and release the larynx, initially on the right side along the epiglottis and the aryepiglottic fold. This provides an increasing view of the tumor of the left piriform sinus. This is then resected at a safety distance of 1.5 cm together with the laryngeal preparation so that the larynx can finally be completely removed. Removal of frozen section histologies around the now existing hypopharyngeal defect. These all proved to be tumor-free. The myotomy of the constrictor pharyngeal muscle is then performed. Implantation of the voice prosthesis through a Blom-Singer puncture. Suturing of the neopharynx with a continuous Conley suture and a second layer of single button sutures. Placement of Redon suction drains on both sides. Folding back the apron flap and completing the mucocutaneous anastomosis of the tracheostoma. Sterile wound dressing. End of the operation, handover of the patient to anesthesia. Conclusion: Total laryngectomy with partial pharyngectomy for hypopharyngeal carcinoma on the left side. Intraoperative extensive left cervical lymph node metastases, which led to a radical neck dissection on the left side, functional neck dissection of regions I-V on the right, primary voice rehabilitation by Blom-Singer puncture. Implantation of a voice prosthesis after myotomy of the constrictor pharyngis muscle and installation of a tracheal chimney according to Herrmann.