After induction of anesthesia by the anesthesia colleagues through the tracheostoma already in place, first renewed laryngoscopy and confirmation of tumor extension. Then infiltration anesthesia. Sterile wiping, draping. Curved skin incision that includes the old tracheostoma. Creation of an apron flap strictly subplatysmal. This works very well. First start with the neck dissection on the right side. Further dissection of the sternocleidomastoid anterior edge. Dissection along the muscle up to the posterior edge. Exposure of the omohyoid muscle, the digastric muscle and the accessorius nerve. These leading structures are spared during the entire operation. Exposure and dissection along the internal jugular vein and the facial vein. The structures are spared. Multiple lymph nodes are already present in this area, all of which are removed. After mobilization and exposure of the cervical vascular sheath with carotid and vagus, development of the lateral neck preparation. This is very successful. All plexus branches are spared. Now further dissect and develop the anterior neck preparation, including the capsule of the submandibular vein. Expose and protect the hypoglossal nerve and the digastric muscle. Bipolar hemostasis. Neck dissection on the left is performed in the same way. Here too, all important structures such as the internal jugular vein, facial vein, accessorius nerve, hypoglossal nerve and the cervical vascular sheath are exposed and spared. Dissection of the hyoid bone with dissection of the infrahyoid and suprahyoid muscles. Mobilization and retraction of the thyroid gland from the trachea. Successive skeletonization of the laryngeal skeleton and detachment of the prelaryngeal musculature. Exposure of the cornu majus on both sides. Careful, blunt dissection of the pharyngeal tube from the inner sides of the thyroid cartilage on both sides. Further inspection reveals that the tumor is growing into the soft tissue in the area of the hyoid bone on the right side. Entering the pharyngeal tube suprahyoidally. Inspection of the tumor. Here it can be seen that the tumor is occupying the entire laryngeal lumen and appears to be growing submucosally on the right side into the base of the tongue. A generous resection is now performed macroscopically far into the healthy tissue. Ultimately, the complete laryngeal preparation with the tumor can be pushed caudally. Separation of the esophagus from the trachea. The trachea is finally removed at the level of the previously created tracheostoma. This preparation is now sent for final histology. Generous marginal samples are taken from strategically important points and from the base of the tongue, parapharyngeal area on the right and suprahyoidal area on the right side. These are sent for frozen section and are found to be tumor-free on all sides. Careful pharyngeal suturing is now performed, paying particular attention to tension-free adaptation in the area of the base of the tongue. Multi-layer pharyngeal suture. Adaptation of the former prelaryngeal musculature over the pharyngeal suture. Overall, this results in at least three to four layers of closure in this area. Prior to this, a Provox prosthesis was inserted in the typical manner by the phoniatrics colleagues. Insertion of two Redon drains. Pushing back the apron flap. Readaptation in the area of the tracheostoma. Further two-layer wound closure. Application of a pressure bandage. Completion of the procedure without complications. Conclusion: Overall laryngectomy with neck dissection on both sides and placement of a Provox prosthesis for T4 supraglottic laryngeal carcinoma. X-ray pre-swallow recommended in 7-10 days, if the findings are normal, slow diet build-up. Further procedure depending on the histology at our interdisciplinary tumor conference.