Anaesthesia was initially induced by the anaesthesia colleagues and a tracheoscopy was performed using 0° optics. Unobtrusive conditions in the area of the trachea up to the carina. Subsequently, difficult endotracheal intubation and positioning of the patient by the surgeon due to the very narrow endolaryngeal conditions. Flexible endoscopy of the oesophagus and stomach. Advance the endoscope to the stomach. Inconspicuous conditions up to the pylorus. Endoscope inversion and inspection of the esophagogastric junction. Inconspicuous conditions there. Withdrawal of the endoscope and inspection of the esophagus. Inconspicuous conditions there. A laryngoscopy was then performed using a Kleinsasser C-tube. This revealed a circularly growing glottic laryngeal carcinoma extending to the arytenoid region on both sides and into the anterior commissure with slight spread into the subglottis without infiltration of the supraglottis. Otherwise, the piriform sinuses on both sides, the posterior hypopharyngeal wall and the postcricoid region as well as the esophageal inlet were unremarkable. The posterior wall of the oropharynx and the lateral walls were endoscopically unremarkable. The base of the tongue was unremarkable on endoscopy and palpation. Thus, and taking into account the clinical findings (SL arrest on the left and SL immobility on the right), the indication for complete laryngectomy and neck dissection on both sides was determined. Application of local anesthesia cervically on both sides and medially. Skin ablation and sterile draping. Creation of a subplatysmal apron flap in the typical manner. Exposure of the cricoid cartilage and thyroid isthmus, undermining of the same, exposure of the anterior wall of the trachea and incision between the 3rd and 4th tracheal cartilage clasp. Fixation of the tracheal margin at the skin edge and reintubation on a size 8 laryngectomy tube. Subsequent dissection along the anterior sternocleidomastoid muscle on the right side. Exposure of the capsule of the submandibular gland, exposure of the accessorius nerve and the digaster muscle (venter posterior). Exposure of the omohyoid muscle and exposure of the cervical vascular sheath from caudal to cranial, successive dissection along the cervical vascular sheath while protecting it and the plexus branches. Removal of the posterior and anterior neck specimen while protecting the above-mentioned structures. Hemostasis there using bipolar coagulation. Dry conditions. Repositioning of the patient to perform a neck dissection on the left side. Dissection along the anterior border of the sternocleidomastoid muscle on the left side. Exposure of the accessorius nerve in depth. Exposure of the posterior venter of the digaster muscle. Exposure of the omohyoid muscle, exposure of the cervical vascular sheath. Dissection along the internal jugular vein from caudal to cranial. Successive removal of the posterior and anterior neck preparation while protecting the above-mentioned structures and the plexus branches. Hemostasis there using bipolar coagulation and subsequent concentration in the cervical median area. Separation of the prelaryngeal muscles in the midline. Exposure of multiple, conspicuous nodes in region VI. These are then removed and sent for final histology. The prelaryngeal musculature is then cut at the level of the hyoid bone using a monopolar knife. Exposure of the epiglottis after transection of the hyoepiglottic ligament. Exposure of the free edge of the epiglottis. Opening of the pharyngeal lumen and downward retraction of the epiglottis with the hyoid bone. Mucosal incision along the free epiglottis edges and the aryepiglottic folds on both sides. Followed by a scalpel incision along the posterior edge of the thyroid cartilage on both sides. Subperichondral preparation and protection of the piriform sinuses on both sides. Subsequently, union of both vertical mucosal incisions in the area of the plica aryepiglottica on both sides in the postcricoid area. Further submucosal dissection while sparing the mucosa and the submucosa of the anterior esophageal wall. Further dissection between the trachea and esophagus. Dissection at this level and placement of the laryngectomy specimen between the 2nd and 3rd tracheal cartilage clasp. Two marginal samples (tracheal resection margin, anterior wall of the left piriform sinus) were sent for frozen section - both were found to be tumor-free by the pathology colleagues. Subsequently, paramedian myotomy of the cricopharyngeal muscle on the left side and partial resection of the caudal part of the sternocleidomastoid muscle on both sides. Subsequently, a size 10 Provox-Vega was placed retrograde without any problems, followed by a four-layer pharyngeal suture (mucosa, submucosa, pharyngeal muscle layer, infrahyoid muscles). This results in complete pharyngeal closure. Subsequently, to secure the pharyngeal suture, insertion of cut pieces of TachoSil along the entire pharyngeal suture. Hemostasis using bipolar coagulation. Knock back the subplatysmal apron flap and fix its caudal edge to the tracheostoma. Platysma suture. Single button skin suture. Application of a pressure bandage and completion of the procedure without complications. Please provide nutrition via the inserted nasogastric feeding tube for the next 12 days and then perform X-ray gavage. The patient received Unacid 3 g intravenously as a single shot intraoperatively.