In order for achieving a permanent tracheo-esophageal shunt for the post operative vocal function, the following requirements should be satisfied. 1) technically easy and safe, 2) applicable to almost all cases, 3) one-stage operation, 4) leakage of saliva and/or fluid from the esophagus into the trachea is negligible, and 5) the obtained speech function should at least be equivalent or even exceeding the speech obtained by nonsurgical methods. A new surgical technique reported herein satisfies most of the requirements mentioned above. Techniques <br>1) Skin Incision and Tracheostomy: A U-shaped or I-shaped incision is made and a spindleshaped opening is made at the level of the third and fourth tacheal ring. An endotracheal tube for general anesthesia is inserted through this opening. 2) Laryngectomy: An attention should be paid in order not to separate the posterior wall of the trachea from the anterior wall of the esophagus. The larynx is removed juat above the first tracheal ring. If there is no suspicious growth to the subglottis, a removal just above the cricoid arch using a pair of angulated heavy scissors is preferrable. Otherwise, laryngectomy is performed in an ordinary fashion. 3) Creation of Tracheal Flap and Lower Half of the Tracheostoma: The anterior two thirds of the tracheal wall above the fourth ring is cut off, thus a tracheal flap, measuring 2.5 X 4 cm based inferioly, is obtained. The remainder of the tracheal and the cricoid cartilages on both sides is carefully removed subperichondrally using a pair of small scissors. The lower half of tracheostoma is formed after this procedure. 4) Creation of Side-to-Side Anastomosis and Closure of the Hypopharynx: A 7mm midline vertical incision is made starting 5 mm below the superior margin of the flap to reach the esophageal lumen. A single layer of mucosal inter- rupted 4-0 catgut sutures is used to create a sideto-side anastomosis between the incised margins of the tracheal flap and the esophagus. Closure of the hypopharynx is done in an ordinary fashion. 5) Creation of the Tracheo-Esophageal Shunt: A 5-0 Nelation catheter is inserted through this anastomosed opening into the esophagus before completing the T-E shunt. A single layer of submucosal interrupted 4-0 catgut sutures is made to approximate the both lateral margins of the tracheal flap starting from above or below. Thus a 3 cm mucosal tunnel connecting the esophagus and the tracheostoma is constructed. 6) Creation of Upper Half of the Tracheostoma and Closure of the Skin Incision: After suction drains are inserted on each side and fixed on the chest wall, the upper half of the tracheostoma, the center of which is formed by lower end of the mucosal tunnel, is created starting from midline using 3-0 nylon. After 12-20 days, the inserted Nelation catheter is removed. Voice can be produced after the removal of the Nllation catheter by closing the stoma with a finger and giving an expiratory effort. Results <br> Eleven patients so far underwent this procedure and all of them were able to speak 12-52