First consultation with the anesthesia colleagues, skin disinfection, injection of a total of 10 ml Ultracaine 1% with adrenaline into both sides of the neck. Sterile draping. First creation of an apron flap in the typical manner. Then neck dissection on both sides. First on the left: Exposure of the sternocleidomastoid muscle, digastric muscle, omohyoid muscle. Exposure of the internal jugular vein, external jugular vein, internal carotid artery, external carotid artery, superior thyroid artery. Exposure, neurolysis and re-embedding of the vagus nerve, hypoglossal nerve, accessorius nerve and branches of the cervical plexus. This is followed by a level II-IV evacuation as well as level V a and parts of V b. Neck dissection on the right side: This is performed in the same way as on the left side, exposing and preserving the structures mentioned. Level II-V evacuation here too. Subsequent laryngectomy: visualization of the hyoid bone and removal of the hyoid bone with parts of the supragottic musculature due to the pre-epiglottic soft tissue infiltration underneath. The soft tissue can be removed up to the pharyngeal tube. No tumor infiltrates here. Then skeletonize the larynx, first on the left and then on the right. Expose the superior cornu in each case. Separate the infrahyoid muscles and strike them latero-caudally. Dissect the lobe of the thyroid gland and also strike it latero-caudally. Dissect the trachea. Then dissection of the pharyngeal tube and dissection of the piriform sinus on both sides. Then enter the larynx at the level of the epiglottis. Removal of the epiglottis. This is isolated along the mucosal border. The tumor is seen endolaryngeally in corresponding, almost complete filling of the endolaryngeal lumen. Dissection of the pharyngeal tube from the larynx in the postcricoid area. Successive caudal development of the larynx. Prior to this, the trachea was opened and the laryngectomy tube was replaced with a tracheotomy tube. The trachea was first fixed to the skin using two sutures. The larynx can then be removed after the connections to the pharyngeal tube or oesophagus have been completely loosened. Macroscopically far from healthy. The pre-epiglottic soft tissue infiltrations are also well covered with the resected suprahyoid muscle parts. The specimen is suture-marked in the area of the hyoid bone and the pre-epiglottic soft tissue insertion margin and is sent for final assessment. Myotomy is then performed. For this purpose, the left lateral constrictor pharyngis muscle or pars fundiformis is cut through to the mucosa over a length of approx. 3 cm. Provox insertion is then made. For this, a mid-dorsal puncture is made approx. 1 cm below the tracheal margin and a size 8 Provox prosthesis is inserted without complications. The previously removed tracheal tube is then reinserted. Successive pharyngeal suturing. First layer using inverting single-button sutures. Then second layer using inverting single-button sutures, also with Vicyl 3-0 single-button sutures. The third layer involves suturing the constrictor muscles. Subsequently, as after tumor removal, extensive irrigation of the surgical area with hydrogen and Ringer's solution. Careful hemostasis. Wound closure in layers and insertion of a Redon drainage in both sides of the neck. The tracheostoma is epithelized in the typical manner. Final wrap dressing. Final discussion with the anesthetist. Completion of the procedure without complications. Patient goes to the intensive care unit for postoperative monitoring. Please provide post-operative nutrition via the inserted gastric tube for seven to ten days, followed by gruel and, if necessary, a diet. Please continue intraoperative antibiotics with Unacid for approx. one week. Wait for the final histological findings and discuss further in the interdisciplinary tumor conference.