The patient is first taken to the operating theater, followed by active patient identification. Consultation with anesthesia colleagues. Carrying out the team time-out. Induction of anesthesia by the anesthesia colleagues. Subsequent tracheobronchoscopy with 0° optics by the surgeon and <CLINICIAN_NAME>. This reveals the carcinoma described above, which describes the entire vocal fold with infiltration and encasement of the arytenoid cartilage on the left side and also grows into the anterior commissure. The vocal folds cannot be passed. Here is an attempt at anesthesia for transnasal intubation. This is initially unsuccessful due to the extension of the tumor into the subglottic and glottic areas. There is a drop in saturation. Only after considerable effort can the tube be inserted orotracheally by the anesthesia colleagues. The anesthesia is now deepened and a perioperative ultrasound is performed. As can also be seen on the CT scan, the tumor masses surround the arytenoid cartilage. For this reason and due to the panendoscopy findings described above with a minimum submucosal extension of 1 cm subglottically, <CLINICIAN_NAME> decided to perform a laryngectomy. CT and ultrasound also show a wide subglottic extension of the tumor towards the cricoid cartilage. Infiltration of the cricoid cartilage is also highly probable here. Now head positioning by the surgeon. Skin disinfection and infiltration anesthesia in the area of the planned skin incision with a total of 10 ml Ultracaine. Skin disinfection and sterile draping of the surgical area. Marking of the landmarks on both sides of the mandibular angle, mandibular branch, chin, incisura thyroidea, cricoid cartilage, jugulum, sternocleidomastoid and the mastoid as well as the skin incision in the sense of an apron flap. Now creation of an apron flap in a typical manner. Start of neck dissection on the left side through <CLINICIAN_NAME>. Expose the sternocleidomastoid, the omohyoid muscle, the submandibular gland and the digastric muscle and follow them. Exposure of the accessorius nerve, the hypoglossal nerve and release of the neck level II a to V a while sparing the plexus branches and the superior thyroid artery. There are 2 spherical, suspicious masses in the area mainly in level II and in level V below the plexus branches. The vagus nerve is visualized and spared. Also the cervical vascular sheath with the common carotid artery and the internal jugular vein in level IV. Extensive bipolar coagulation. No evidence of chyle fistula. Now exposing the hyoid bone. Release of the hyoid bone on the left side. Detachment of the cervical vascular sheath from the larynx and pharyngeal region. Detachment of the thyroid gland. Undermining of the thyroid isthmus using Pean clamps and ligation of the thyroid isthmus after severing it. Exposure of the superior laryngeal nerve, artery and vein. Dissection of the same and coagulation of the same. Now move to the opposite side to the right and perform right neck dissection by <CLINICIAN_NAME>. Identical procedure. Expose the sternocleidomastoid, the omohyoid, the submandibular gland and the digaster venter muscle posteriorly and anteriorly. Exposure of the nervus accessorius, hypoglossus, ansa and vagus and sparing of the same. Now clearing from level II to level V a, also sparing the plexus branches and the vagus nerve. Exposure of the common carotid artery. Release of the hyoid bone. Removal of the hyoid bone. Skeletonization of the thyroid cartilage on both sides. Exposure of the superior laryngeal nerve, artery and vein. Separation and bipolar coagulation of the same. Detachment of the cervical vascular sheath from the larynx and laryngeal region. Detachment of the thyroid gland and mobilization from the trachea. Detachment of the infrahyoid musculature and the laryngeal musculature. Perform a tracheotomy between the 2nd and 3rd tracheal cartilage and transfer intubation to a laryngectomy tube. Further skeletonization of the larynx on the right side. Release and removal of the piriform sinus. Same procedure on the left side. Enter the pharynx at the level of the epiglottis from the right side. Pull out the epiglottis through a pharyngotomy and incise the mucosa along the edge of the epiglottis up to the arytenoid region. Here, release the mucosa caudally from the arytenoid cartilage. Detachment and separation of the larynx. It can now be seen that the tumor completely surrounds the arytenoid cartilage and extends far into the subglottic region, infiltrating the cricoid cartilage. Overall growth of at least 1 ˝ cm from the glottic level to the subglottic level. Suture mark tracheal posterior wall caudal, lateral wall left, aryepiglottic fold on both sides and arytenoid cartilage dorsal left. Here the frozen section shows free on all sides, in the ary area dorsal left just in sano, here a cone draws close to the resection margin. Now create an oesophagotracheal fistula and insert a size 8 Provox prosthesis. Now perform the pharyngeal suture in three layers as usual, alternating between <CLINICIAN_NAME> and <CLINICIAN_NAME>. Now inspect the wound again. Irrigation with H2O2 and Ringer. Bipolar coagulation. Dry wound conditions. Insertion of a 10 Redon on both sides. Incision of the skin in the area of the stoma and two-layer wound closure. The operation is now completed without complications. The patient goes to the intensive care unit awake. Please continue antibiotics 3x 3 g Unacid. Please feed only via nasogastric tube for 10 days, then X-ray gruel.