Transfer of the patient to the operating theater. Introductory consultation with the anesthesia colleagues and implementation of the team time-out. Induction of intubation anesthesia by colleagues. First start of PEG insertion, for this purpose pre-mirroring with the flexible gastroesophagoscope into the stomach. Locate the anterior wall of the stomach and perform a positive diaphanoscopy. The PEG tube is then inserted in the usual way using the thread pull-through method. Now carefully mirror back. Inspection of the surgical site from the endolaryngeal side with the Kleinsasser tube: This shows a tumorous mass purely endolaryngeal in the area of the left aryepiglottic fold and the left pocket fold extending onto the glottis. The posterior surface of the aryepiglottic fold and the postcricoid region as well as the piriform sinus on the right and left side and the base of the tongue are tumor-free. To be on the safe side, a sample is taken from the base of the tongue and sent for frozen section diagnostics. No tumor infiltration after feedback. The laryngectomy is then started by creating an apron flap. To do this, mark the skin incision on the anterior edge of the sternocleidomastoid on both sides to below the cricoid, extending centrally to the cervix. Separation of the cutaneous-subcutaneous tissue and the platysma. Subplatysmal flap preparation and suturing of the flap at the level of the hyoid bone. Now proceed in parallel on both sides. Neck dissection on the right side. For this, dissect along the sternocleidomastoid muscle to the deep cervical fascia. Here the accessory nerve is exposed and freed from the neck preparation. Expose the digastric muscle at the cranial border and follow the muscle to the hyoid bone. Now identify the omohyoid muscle and dissect along the muscle to the hyoid bone. The neck resectate is carefully detached from the cervical vascular nerve sheath. Now remove the neck dissectate region II to V from cranial to caudal in one piece. Subtle hemostasis using bipolar coagulation forceps and completion of the neck dissection on the right side without complications. The accessorius nerve and all other nerve and vascular structures were preserved. Now the same procedure on the left side. There were also no abnormalities during the dissection. Now freeing of the larynx after performing the tracheotomy in the 2nd to 3rd intertracheal space. Free preparation of the laryngeal skeleton from the thyroid gland. The cervical vascular nerve sheath is also freed from the laryngeal skeleton on both sides. For this purpose, the artery and the superior laryngeal nerve are ligated and clamped on both sides. Dissection of the hyoid bone with the harmonic knife. To do this, detach the suprahyoid and infrahyoid muscles. The hypoglossal nerve can be exposed on both sides of the upper edge of the hyoid bone and safely protected. After resection of the hyoid bone, sharp entry into the base of the tongue just above the epiglottis. Due to the supraglottic extension, it is decided not to dissect the epiglottis sharply. Identification of the epiglottis and dislocation. It becomes apparent that the tumor has a purely endolaryngeal extension that does not extend beyond the aryepiglottic fold or the epiglottis. The tip of the epiglottis is free of tumor. Now carefully dissect along the aryepiglottic fold. For this purpose, a greater distance is used on the left side (tumor side) than on the right side (in the usual manner). Unite the incision postcricoidally and extirpate the larynx while sparing the mucosa of the hypopharynx. The piriform sinus can be easily detached from the thyroid cartilage on both sides and protected. After removal of the larynx, obtain 6 marginal samples (postcricoid, left inferior and superior hypopharynx, right inferior and superior hypopharynx, base of tongue). The tissue samples obtained are sent for frozen section diagnostic evaluation. After feedback, all marginal samples are free. Perform a myotomy of the inferior constrictor pharyngeal muscle. Insertion of a provox prosthesis in the usual manner. Then two-layer pharyngeal suture using a continuous inverted suture and placement of a T-suture. A second single button suture is placed over this to protect it. Incision of the tracheostoma, placement of two Redonda sutures and two-layer wound closure using subcutaneous/cutaneous sutures.