Tracheoscopy is performed before the start of the procedure or before intubation. To do this, adjust the entrance to the larynx with the laryngoscope. Insert the 0° scope. The right arytenoid cusp is clearly swollen, oedematous, very narrow glottic gap. The subglottic space, the trachea up to the bifurcation and the visible main bronchi are unremarkable. After intubation, an esophagoscopy is performed and the flexible esophagoscope is inserted into the stomach. Conditions there are unremarkable. No evidence of a tumor in the area of the cardia even when looking backwards. Diaphanoscopy, insertion of the PEG using the thread pull-through method. The esophagus is usually checked again when the endoscope is withdrawn. No evidence of a second tumor. Problem-free PEG placement. Pharyngoscopy: Adjustment of the small bore tube. As described above, the exophytic growing tumor can be seen in the area of the right aryepiglottic fold merging with the upper piriform sinus. The rest of the right piriform sinus and the entire left piriform sinus and the postcricoid region are unremarkable. The esophageal entrance is clear. The base of the tongue, epiglottis and valecula are unremarkable. In addition, microlaryngoscopy only shows edematous conditions on the right side in the region of the laryngeal head. This is probably submucosal tumor growth. The vocal folds are, as far as can be seen, unremarkable. The supraglottic region on the left is also unremarkable. The base of the tongue is soft on palpation. After completion of the panendoscopy, detailed consultation with the anesthesiologist regarding the further procedure. Preparation for laryngectomy. The tumor is resectable. Perioperative administration of Unacid. Continue this postoperatively. Skin disinfection, infiltration anesthesia for the apron flap. Neck dissection on the right side first. Make an incision from the earlobe to the supraclavicular area. Expose the sternocleidomastoid muscle and cut off the external jugular vein. Exposure of the internal jugular vein, facial vein, vagus nerve, accessorius nerve, digasticus muscle, posterior vena cava. Now dissection of the posterior part of the neck from the accessorius area to the supraclavicular area. Overall very difficult dissection conditions due to the very voluminous conditions. At least two suspicious nodes on this side, especially in the vein angle. Further dissection in the direction of the venous angle. Exposure of the hypoglossal nerve, the cervical nerve. This will be cut later. Expose the external, internal and common carotid artery and the superior laryngeal artery. This is stitched. Now complete the anterior neck preparation, including the capsule of the submandibular gland. Separate the common carotid artery, the thyroid gland and the larynx. Now perform the neck dissection on the left side. Also make a skin incision from infraauricular to supraclavicular. Expose the sternocleidomastoid muscle, cut off the external jugular vein. Exposure of the internal jugular vein, the accessorius nerve and the vagus nerve. Dissection of the digasticus muscle, posterior venter and dissection of the posterior neck preparation from cranial to caudal to supraclavicular on the left side. After cutting through the caudal end, repositioning to prevent a fistula. Now expose the common, external and internal carotid artery. Separation and ligation of the superior vein. Exposure of the hyperglossal nerve, completion of the anterior neck preparation including the capsule of the submandibular gland. Very difficult preparation conditions on this side due to the voluminous conditions. Complete the neck preparation on the left side. Now join the two neck incisions and dissect an apron flap cranially up to the hyoid. Expose the laryngeal skeleton on both sides and free preparation of the piriform sinus on both sides, detachment from the thyroid cartilage. Now cut the infrahyoid muscles and enter the pharynx just above the epiglottis. Grasp the epiglottis and resect the mucosa in the area of the aryepiglottic fold on both sides up to the intraaryhaenoid region. The tumor is located on the right side. Here, the piriform sinus is partially incised and the post-crecoid region is then reached again from the other side, from the caudal side. Clinically, the resection is performed in sano. Push the postcrecoid region caudally. Exposure of the cricoid cartilage, separation of the larynx from the pharynx. Sever the connection between the larynx and trachea. The laryngectomy specimen now removed is sent for definitive histology. Representative marginal samples are taken. These are described as mild dysplasia in the frozen section. No carcinoma in situ, no invasive carcinoma. A Provox prosthesis is then placed. This was relatively successful with good visibility. Somewhat difficult threading in the area of the trachea. In the end, however, the Provox prosthesis fits well. Extensive hemostasis with H2O2 and bipolar coagulation. Irrigation with H2O2 solution and Ringer's solution. No more bleeding. Now perform the pharyngeal suture, initially caudally and cranially and then also in the middle section of the pharynx. Complete closure. Repeat several times and three-layer wound closure in the area of the pharynx. Reapproximation of the infrahoidal musculature in the area of the hyoid bone. Suture the trachea as a tracheostoma into the skin flap and supraclavicularly. Now clean the neck again on both sides, rinse with H2O2 and Ringer's solution. No bleeding. Insertion of a Redon drain on both sides. Subcutaneous suture, skin suture and wound dressing. A feeding tube was inserted preoperatively. This should serve as a nasogastric tube for splinting for a few days. Insertion of a tracheal cannula, which is fixed with stitches. Completion of the procedure. No bleeding, no other special features. Pass on antibiotics postoperatively. Finally, another detailed consultation with the anesthetist. The patient is transferred to the intensive care unit for monitoring. Overall difficult preparation conditions due to the very voluminous conditions. Waiting for the definitive histology, then presentation at the tumor conference.