After intubation anesthesia, initially extremely difficult adjustment of the epiglottis with the size B small bore tube. The tumor is then resected together with the base of the tongue and the entire epiglottis using support autoscopy and the CO2 laser, with repeated and extremely laborious repositioning of the small water tube. During dissection, the most careful hemostasis is always performed in the event of diffuse bleeding. The tumor is then removed together with the epiglottis, initially above the anterior commissure. Here, further resections are performed in the area of the lower left, lower right and lower front margins. The same marginal samples are then taken and sent for frozen section diagnostics. All marginal samples are found to be tumor-free by the pathology colleagues. After further careful hemostasis, the patient is repositioned, initially for tracheotomy: injection of local anesthetic with adrenaline and disinfection of the skin. Then door leaf incision and layer-by-layer dissection in depth. This reveals an extremely pronounced thyroid isthmus, which is cut on both sides and then lanced. Then expose the anterior surface of the trachea. Then insertion between the 2nd and 3rd cartilage clasp into the trachea. Then creation of the Björk flap and suturing of the flap. Then circular epithelialization of the tracheostoma. The patient is then intubated and receives a size 7 endotracheal tube. The patient is then repositioned for PEG insertion: the flexible instrument is inserted into the esophagus without difficulty. Then visual endoscopy into the stomach. If the diaphanoscopy is positive, the PEG is then placed in the typical position using the thread pull-through method. This is done without complications. After injection of local anesthetic with adrenaline and skin disinfection on both sides of the neck and repositioning of the patient, the operation is continued with neck dissection on both sides: Start on the right side first. To do this, make a skin incision along the front edge of the sternocleidomastoid muscle. Then dissect in depth in layers and expose the neck sheath. Then develop the lateral neck preparation while preserving the structures of the cervical vascular sheath and the accessorius nerve. Suspect enlarged lymph nodes are not revealed during dissection. Then clear the hypoglossal triangle while protecting the branches of the external carotid artery, the hypoglossal nerve and the branches of the facial vein. Then develop the anterior neck preparation while sparing the branches of the internal jugular vein. Problem-free dissection here too. Then most careful hemostasis and insertion of a Redon drainage. Multi-layer wound closure. Then identical procedure on the left side. Here, too, the dissection is carried out while protecting all structures of the cervical vascular sheath and the accessorius nerve. A paired arrangement of the internal jugular vein can be seen here. This divides cranially of the omohyoid muscle into a medial and a lateral branch. In the cranial course, the hypoglossal nerve crosses the two branches. This makes dissection extremely laborious and time-consuming. Ultimately, however, the dissections of the lateral neck and the hypoglossal triangle can be spared, while sparing the branches of the external carotid artery, facial vein and both branches of the internal jugular artery as well as the accessorius nerve. Then complete the neck dissection with the anterior neck preparation, sparing the branches of the medial internal jugular branch. The most careful hemostasis is then applied here too. Also insertion of a Redon drain and multi-layer wound closure. After dressing and insertion of a size 7 tracheostomy tube, the procedure is completed without complications. The patient is transferred to the in-house intensive care unit for monitoring.