First confirm the findings described above. Then placement of the LARS retractor and docking of the da Vinci robot. This provides a good overview of the tumor. The main tumor mass is located in the vallecula of the left side. The epiglottis appears somewhat infiltrated up to the midline. However, the midline is not crossed. The resection is then performed from the base of the tongue, cranially to caudally. The resection reaches the hyoid bone at the front. The epiglottis is bisected in the middle. Due to the extent of the tumor and for a better overview, the upper part of the tumor must first be removed. The resection is then continued. During hemi-epiglottectomy, the tumor is found to have grown supraglottically and endolaryngeally. The resection is therefore performed up to the supraglottis at the level of the pocket crease on the left side. Dorsally and laterally, the resection reaches the pharyngoepiglottic fold, which can be completely resected. The left ary remains intact. The tumor can then be completely removed. Representative samples are taken from the margins of the cranial and lateral resection area. Likewise, marginal samples are taken from the epiglottic margin, the supraglottic margin and the caudal margin at the base of the tongue. All marginal samples are examined intraoperatively as a frozen section and found to be tumor-free. During resection of the tumor, venous bleeding is seen in the area of the base of the tongue. This bleeding can be stopped using several vascular clips. Repeated careful hemostasis after taking a marginal sample. Then dry wound conditions. Due to the extent of the tumor and the resection area, the decision is made to perform a protective tracheostomy. Removal of all instruments and the blocker and undocking of the da Vinci system. Repositioning of the patient for the tracheostomy. Injection of local anesthetic with adrenaline in front of the trachea. Subsequent transverse incision and layered preparation in depth. Exposure of the pretracheal neck vessels and veins. These are undermined and ligated. Exposure of the prelaryngeal and infrahyoid musculature. Finding the midline. Dissection of the midline and separation of the musculature. Exposure of the thyroid isthmus. This is then undermined and cut on both sides after ligation. Then expose the anterior surface of the trachea. Entering the trachea between the second and third cartilage clasp. Preparation of a Björk flap. Circular suturing of the tracheostoma and epithelialization. Then insertion of an 8 mm tracheostomy tube. Completion of the procedure after bandaging. The patient is transferred to the ENT intensive care unit for monitoring. After checking the swallowing function, the patient may have to be fed nasogastrically with a feeding tube for the next few days in the event of aspiration. The patient should always remain under intensive medical supervision over the weekend.