After induction of anesthesia and intubation by the anesthesia colleagues, the patient is positioned. First of all, the Kleinsasser tube is inserted under dental protection. The oral cavity and oropharynx are inconspicuous, and the hypopharynx is completely free and inconspicuous up to the tips of the piriform sinus and the entrance to the esophagus. Adjustment of the endolarynx. The carcinoma described above can be seen on the left anterior side. Palpably, the tumor cannot be moved towards the laryngeal skeleton, so that the indication for laryngectomy is confirmed in conjunction with the CT diagnosis. The patient was repositioned and xylocaine with adrenaline was injected. First of all, insertion of the PEG tube. Insertion with the gastroscope under laryngoscopic control. Problem-free pre-scanning into the stomach. With good diaphanoscopy, problem-free puncture of the stomach and subsequent insertion of the PEG tube using the usual suture pull-through method. Subsequent elevation of a broad-based apron flap while lifting off the platysma. Exposure of the sternocleidomastoid muscle and omohyoid muscle on both sides. Release of the submandibular gland and exposure of the digastric muscle on both sides. Start with neck dissection in the area of the right side. Clearing of level II to Va with careful exposure and protection of the hypoglossal nerve, superior thyroid artery, cervical artery, internal jugular vein, accessorius nerve and cervical plexus roots. Preservation of the external jugular vein and the facial vein. Macroscopically no suspicious nodules overall. Exactly the same procedure on the opposite side, also level IIa to Va with protection and preservation of the structures already described on the opposite side without macroscopically suspicious nodes. No pronounced facial vein on the left side, otherwise the same procedure. Skeletonization of the larynx is now performed. Detachment of the thyroid cartilage horns and the piriform sinus. Detachment of the infrahyoid musculature, no tumor breakthrough here. Based on the CT diagnosis, however, the perichondrium and the overlying tissue on the left side are completely preserved. Here, too, there is no tumor macroscopically. Visualization of the cricoid cartilage and anterior surface of the trachea, transection of the thyroid isthmus. Laryngeal release on both sides. Treatment of the upper laryngeal bundle in each case, entering enorally via the vallecula mucosa. Economical widening of the access. Sparse resection in the area of the aryepiglottic fold, the arytenoid region itself is also completely tumor-free. Good overview of the tumor, release of the larynx with careful protection of the esophagus and surrounding mucosa and removal of the specimen in toto. No caudal growth towards the trachea. The endolaryngeal carcinoma with destruction of the thyroid cartilage, completely resected in sano, wide removal in the area of the mucosal margins, palpably safe resection in the area of the soft tissue so that the specimen is sent for definitive histology. Subsequent removal of an anterior tracheal clasp to create a raised posterior wall. Easy placement of the Provox prosthesis size 8 mm in loco typica. Left lateral insertion of the upper ......... Cutting through the sternal insertions of the sternocleidomastoid muscle. Subsequent inverting pharyngeal suture in two layers. Final wound inspection and hemostasis with dry wound conditions. Insertion of a 10-gauge Redon drain, insertion of the tracheostoma and careful two-layer wound closure. Subsequent problem-free reintubation to a size 10 low cuff cannula and completion of the procedure without any indication of complications. Note: The patient received intraoperative intravenous antibiotics with Unacid 3 g, please continue this for 24 hours postoperatively. Post-operative X-ray paps on the 9th to 10th postoperative day.