Induction of anesthesia at the beginning of the operation. Followed by flexible esophagoscopy and, after positive diaphanoscopy, PEG insertion in the usual manner. No evidence of tumor or stenosis of the esophagus on retraction. Now enter with the spread laryngoscope and expose the tumor in the area of the right base of the tongue. Then use of the operating microscope. An exulcerated tumor of the anterior surface of the epiglottis can be seen, which grows into the base of the vallecula and then upwards into the base of the tongue. Laterally, the pharyngeal wall is not infiltrated. The aryepiglottic fold caudally is also free, so that it is a localized tongue base process. First cut through the tumor to expose the deep infiltration. This is performed with the Co2 laser in cw mode at 10 W. Now cut around the tumor on the left side towards the middle of the tongue base strictly in the tongue base. Then cut around the part of the tongue base tumor on the right side up to the pharyngeal wall and remove this piece. ...copically all musculature on all sides. The epiglottis is now cut in the middle with the laser beam and the epiglottis tumor section is removed. The epiglottis is generously cut away laterally and resected up to the edge of the aryepiglottic fold. Now hemostasis with supratupers and extensive monopolar coagulation. Subsequently, marginal samples are taken from the area of the aryepiglottic fold, from the middle of the tongue base, deep and superficial, from the left and right sides of the tongue base. Samples are sent for frozen section and are all found to be tumor-free during the operation. Later during the operation, during the neck dissection, there is more severe bleeding from the mouth, so that another endoscopy is required and an arterial vessel located at the lateral base of the tongue can be bipolarly coagulated. ..... extends as far as the hyoid bone. Now transfer to neck dissection on both sides. Start with the neck dissection on the right, which has clinical cN2b status. Curved skin incision in the area of the sternocleidomastoid after instillation of 10 ml xylocaine with adrenaline. Cut through the skin tissue and subcutaneous tissue and expose the anterior edge of the muscle. Subsequent exposure of the nervus accessorius and the cervical vascular sheath. It can be seen that an approx. 3 x 3 cm large mass is located in the jugulofacial angle and extends to the submandibular gland. However, this mass can be bluntly dissected away from the gland in a nice shifting layer. First remove the mass. Then completely expose the cervical vascular sheath in the sense of the common carotid artery, internal jugular vein and vagus nerve. The posterior neck specimen is then removed, preserving all the structures mentioned, and deposited at the caudal end after coagulation. The cervical plexus branches can be preserved. Complete the anterior neck dissection after exposing the hypoglossal nerve, taking the capsule of the submandibular gland with it. Now hemostasis. Followed by hydrogen and ring irrigation, insertion of a Redon drain and 2-layer wound closure. Transfer to the opposite side and here, after instillation of 10 ml xylocaine with added adrenaline, another skin incision on the sternocleidomastoid. Expose the anterior border of the sternocleidomastoid muscle and, as on the opposite side, the accessorius nerve, the cervical vascular sheath in the sense of the common carotid artery, internal jugular vein and vagus nerve. First, the posterior neck preparation is then removed from under the accessorius nerve and all the structures mentioned, including the cervical plexus, are removed without damaging them. A lymph node is then also removed in the jugulofacial angle, as on the opposite side. However, this is significantly smaller here and could also be reactive. Furthermore, removal of the capsule of the submandibular gland and completion of the anterior neck. Exposure of the hypoglossal nerve. Now hemostasis, hydrogen and ring irrigation and insertion of a Redon drain. Followed by another demonstration of findings on <CLINICIAN_NAME> and 2-layer wound closure. Now proceed to tracheotomy. Modified Kocher collar incision. Cut through the subcutaneous tissue and the prelaryngeal muscle tissue and dissect the cricoid cartilage. Exposure of the thyroid isthmus. Undermining of the same and removal of the same after repositioning. Entering the trachea between the 1st and 2nd tracheal clasp and, after creating a small Björk flap, suturing or epithelizing the tracheostoma in the usual manner. An 8 mm cannula is inserted. Finally, another enoral inspection and removal of the previously inserted swabs. Re-coagulation in a few places. If the wound is dry, the patient receives 250 mg SDH and has received intraoperative antibiotics with Unacid 3 g, which should be continued postoperatively with 3x 1.5 g.