First position the patient after intubation. Insertion of mouth guard. Entry with the spreading laryngoscope. Positioning of the tumor. This appears slightly larger than described with slightly flatter extensions downwards and also medially. Endoscopically controlled laser resection of the tumor is now performed. The tumor is incised on all sides with a safety margin of at least 10 mm and removed macroscopically and microscopically in the healthy tissue. Resection includes the lateral arytenoid fold, anterior piriform sinus wall and lateral piriform sinus wall up to the tip, the piriform sinus caudally and the beginning of the base of the tongue cranially. The tumor is removed in several sections. Subsequently, edge samples are taken caudally from the adjacent piriform sinus, from the arytenoid fold on the left, from the piriform sinus entrance cranially as well as laterally from the area of the pharyngeal wall and laterobasally from the area of the still existing muscular pharyngeal wall. All marginal samples were tumor-free in the frozen section. Thus R0 status. Careful hemostasis is now performed. The operation is completed when the site is free of bleeding. Due to the patient's overall situation, a tracheostomy is initially not performed. The patient should be transferred to intensive care and extubated the next day in a controlled manner; if complications arise here, a tracheostomy is probably unavoidable. Neck dissection necessary on both sides at intervals with N+ status. Feeding via the inserted gastric tube and diet build-up after 5 to 7 days or swallowing training. Tracheotomy by <CLINICIAN_NAME> and <CLINICIAN_NAME>. Marking of the landmarks, sterile abjodation. Skin incision and dissection through the subcutaneous fatty tissue. Now strict perforation in the midline down to the prelaryngeal musculature, where a larger vein is ligated on both sides. Cut through the prelaryngeal muscles and push them aside. Now locate the cricoid cartilage and dissect the thyroid gland below the cricoid cartilage. Careful dissection of the trachea and undermining of the thyroid gland. Bipolar coagulation of the thyroid gland and transection of the thyroid gland. Exposure of the trachea using pedicle swabs. The trachea is now exposed in a clearly visible area. After consultation with the anaesthetist, enter the trachea between the 2nd and 3rd tracheal cartilage and create a visor tracheotomy. Suturing of the tracheostoma in the usual manner. Problem-free reintubation blocked on an 8 mm cannula.