First position the head. Insert the mouthguard. Enter with the Kleinsasser tube size C, later also B. Exposure of the tumor. The tumor extends to the arytenoid cartilage. Large exophytic tumor extending into the morgagnous ventricle and subglottic as well as extending to the anterior commissure. Decision to attempt laser resection. Tumor is successively removed macroscopically in the healthy tissue using the piecemeal technique. In the resectate, the arytenoid cartilage as well as the pocket fold and the entire soft tissue up to the cartilage are removed laterally. Anteriorly with resection of the vocal fold on the front left and the supraglottic soft tissue up to the cartilage. Exposure of the cartilage below with resection of the conus elasticus. The resection extends caudally to the upper edge of the cricoid cartilage. Subsequently, removal of marginal samples on the right in the area of the arytenoid cartilage, whereby a large part of the arytenoid cartilage still remaining in situ is removed except for a remnant lying transversely to the upper back. Caudal removal of the mucosal margin sample at the edge of the cricoid cartilage, is immediately caudal on the right. Remains of the paraglottic muscle tissue or soft tissue above the cricoid cartilage are sent in as a basal marginal sample. Above this, exposed cartilage freed from the perichondrium, above this large soft tissue sample supraglottic on the right. Subsequently, extended supraglottic marginal sample in the area of the anterior commissure. Below this, exposed cartilage and below this, extensive soft tissue margin sample from the area of the conus elasticus or ligamentum chronicum down to the subcutaneous tissue. Careful hemostasis, especially in the area of the transverse artery. Dorsal hemostasis in the area of the inferior laryngeal artery, which could be visualized. Left anterior margin sample from the vocal fold and from the conus elasticus of the left vocal fold. Here too, the edge sample was taken up to the cartilage. Subsequent careful hemostasis. All marginal samples are tumor-free in the frozen section. Due to the extent of the resection, tracheotomy is now indicated. Repositioning of the patient. Skin disinfection. Injection of 5 ml Ultracaine 1% with adrenaline. Skin incision as required. Dissection through subcutaneous tissue to the infrahyoid musculature. This is split. Subsequent exposure of the thyroid isthmus, which is very small, it is supplied with bipolar and severed. Exposure of the trachea and removal of the soft tissue. Enter the 2nd/3rd intercartilaginous space. Exposure of a wide modified Björk flap. Epithelialization of this in a typical manner with Ethibond sutures. Tension-free tracheostoma. Subsequent insertion of an 8 mm tacheal cannula without any problems. Ventilation without any problems. Finally, the larynx was checked again. No significant active bleeding here. Minor mucosal bleeding was again treated monopolarly. Finally, another gastric tube was inserted. Regular position check. The procedure was completed without complications. Overall cT2-3 laryngeal carcinoma resected using the piecemeal technique and R0 resection confirmed using representative and sufficient marginal samples. Due to the extent of the carcinoma, it is essential to plan a follow-up MLE in 8 to 12 weeks.