After induction of intubation anesthesia, repeat microlaryngoscopy and check of the tumor extent, which has not changed since the previous examination. Then injection of local anesthetic with adrenaline and transverse skin incision over the thyroid cartilage. Layer-by-layer preparation in depth. Exposure of the thyroid cartilage surface reveals the tumor that has migrated through. This exposes the entire thyroid cartilage surface and the cricoid cartilage. Then open the thyroid cartilage paramedian on the right with the wheel. Then make a vertical incision paramedian on the left with the wheel. Now push off the periosteum, initially on the left side. Then also a little on the right side. Then open the endolarynx paramedian on the right. The tumor on the left is clearly visible here. The tumor is now first removed from the right vocal fold with a safety margin of 2-3 mm and dissected to the left side. There, resection of the entire anterior commissure en bloc with the attached thyroid cartilage and resection of the endolarynx on the left side at the glottis level up to the subglottic level and up to the middle level of the pouch ligament on the left side. It can be seen that the tumor clearly infiltrates the ary, so that this is disarticulated and also removed. The tumor is then removed at the interarytaenoid muscles. A marginal sample is taken here. Similarly, removal of marginal samples in the area of the margin on the right side. It then becomes apparent that the tumor possibly extends to the cricoid cartilage here, so here too cricoid cartilage is initially removed basally and ventrally. The dorsal edge sample and the edge sample in the interarytaenoid area are not diagnosed as reliably tumor-free, so a resection is performed here. A second marginal sample is then taken from the dorsal area of the cricoid cartilage and the interarytaenoid muscles. These are then found to be tumor-free intraoperatively. Therefore, the cricoid cartilage plate and the articular surface of the cricoarytaenoid joint are now abraded. The tumor is thus resected in consideration of the marginal specimens R0. The incision is then made further caudally in front of the trachea and dissected in layers in depth. Separation of the infralaryngeal musculature. Exposure of the thyroid isthmus. This is first undermined and then cut on both sides. Repeated exposure of the anterior surface of the trachea. Then open the trachea between the 2nd and 3rd cartilage rod. Preparation of a Björk flap and subsequent circular mucocutaneous anastomosis of the tracheostoma. Then reintubation. After subtle endolaryngeal hemostasis, readaptation of the pouch ligament on the left side and of the vocal fold and pouch ligament on the right side, which are fixed to the thyroid cartilage framework with PDS sutures. The thyroid cartilage surface is covered with a dorsally pedicled mucosal flap. The same applies to the articular surface of the arytaenoid joint on the left side. Then check the bleeding again. Then adaptation and suturing of the two thyroid cartilage surfaces. A small remaining gap is closed with prelaryngeal muscle pedicled from the left. A wound flap is then inserted and the wound is closed in two layers. After applying a dressing and inserting a nasogastric feeding tube, the procedure is completed. In the case of cN0 neck status, neck dissection is not performed on both sides. The patient was shielded intraoperatively with intravenous antibiotics with Unacid, which should be continued until the 3rd postoperative day. An attempt to swallow is possible after about 8 days. Until then, the patient should be fed via the nasogastric feeding tube. Depending on the result of the swallowing test, the patient can then be given a diet or swallowing training.