First consultation with the anesthesia department. Then insertion of a feeding tube. Abjode and cover the operating area. Then application of local anesthesia in the area of the soft tissues of the neck. Now skin incision in the median line from the hyoid bone to the manubrium sterni. Dissection conditions significantly more difficult due to scarred adhesions. Exposure of the infrahyoid musculature. Exposure of the trachea Exposure of the thyroid gland, exposure of the isthmus of the thyroid gland. Dissection of the isthmus of the thyroid gland. Exposure of the anterior wall of the trachea. Cranial dissection and exposure of the laryngeal skeleton. Exposure of the thyroid cartilage and the cricoid cartilage. Exposure of the ligamentum conicum, exposure of the hyoid bone. In view of the previous operation, clear adhesions which make preparation difficult. Now expose the posterior edge of the thyroid cartilage. Remove the cornu majus of the thyroid cartilage on both sides. Cut the thyrohyoid ligament. In order to keep the pharyngeal defect as small as possible, the epiglottis is partially preserved. Expose supraglottically at the level of the upper edge of the thyroid cartilage. Careful preparation in the larynx and maximum preservation of the mucosa. Dissection along the aryepiglottic fold and exposure of the mucosa postcricoid. Careful preparation anteriorly while preserving the pharyngeal mucosa. Now estimate the distal extent of the tumor and carefully release the larynx. Deposition in the area of the second tracheal ring. As far as can be assessed intraoperatively, the resection here is in healthy tissue. Nevertheless, frozen sections are taken, which still show submucosal tumor growth in the area of the tracheal separation. As a result, two further tracheal clips are resected. The frozen section examination now shows a resection in sano. A mucosal sample in the supraglottic region also showed a resection in healthy tissue, so that an R0 resection can be assumed. Multi-layer closure of the pharyngeal defect. Irrigation of the wound with water and hydrogen. Mobilization of the trachea and suturing of the trachea. Wound closure in layers. Final consultation with the anesthesia department. Transfer of the patient to the intensive care unit.