Introductory consultation with the anesthesia department. Positioning of the patient. Laryngoscopic insertion of the flexible esophagoscope into the esophagus. Mirroring under visualization into the stomach, where a regular folded relief can be seen. If the diaphanoscopy is positive, the PEG tube is placed in the typical position using the thread pull-through method. This was successful without any problems. The patient was given an antibiotic cover intraoperatively. When withdrawing the esophagoscope, careful inspection of the esophageal mucosa, which is normal and inconspicuous. Dressing is applied. Reposition the patient for transoral laser resection. To do this, adjust the supraglottic plane with the spreading laryngoscope. The tumor extends laterally over the entire right arytenoid cusp up to the pharyngoepiglottic fold and the medial piriform sinus wall. The tumor is cut around with the CO2 laser and carefully dissected in a circular fashion with a sufficient safety margin. Vascular inflows are repeatedly monopolar coagulated during the dissection. Part of the pharyngoepiglottic fold is successfully preserved. It is also possible to preserve most of the cartilaginous arytenoid and only partially resect it. The tumor certainly does not reach the tip of the piriform sinus and can also be removed here with a sufficient safety margin far above the esophageal entrance level. In the area of the Arys, take a representative sample of the edge, which is described intraoperatively as tumor-free. In the area of the other resection margins, the tumor appears to be resected far in sano, so that only marginal samples are sent for final histology. These completely depict the tumor resection. Subsequent subtle hemostasis using monopolar coagulation. Dry wound conditions and very good aspect. If the wound conditions are dry and the arytenoid is standing, the tracheostomy can be omitted here. The patient should be fed via the PEG tube for the first few postoperative days. Then slowly build up the diet with porridge. Transfer the patient for neck dissection on both sides. Start with the neck dissection on the right side. Make an incision along the sternocleidomastoid muscle. Dissect in depth in layers and expose the cervical vascular sheath. Separate the neck preparation over the cervical vascular sheath. A conglomerate of enlarged lymph nodes can be seen in the area of the vein angle. Exposure of the resection borders with the omohyoid muscle, the submandibular gland and the digaster. Exposure and protection of the accessorius nerve. Long-distance dissection of the cervical vascular sheath with long-distance dissection of the vagus nerve. Displacement and, at the end of the operation, re-embedding of the accessory nerve, hypoglossal nerve and vagus nerve in the sense of a neurolysis. Subsequent resection of the lateral neck preparation together with the accessorius triangle. Removal of the hypoglossal triangle and then the ventral neck preparation. The final result is a resection of levels Ib to V. All outlets of the internal jugular vein and external carotid artery can be preserved during dissection. Careful irrigation of the wound. Dry wound conditions. Insertion of a size 10 Redon drain. Two-layer wound closure. Application of a pressure dressing. Neck dissection of the left side. Almost identical procedure here. This also results in the dissection of levels Ib to V. All vessels in the sense of the branches of the internal jugular vein and the external carotid artery can also be preserved here. Displacement and, at the end of the operation, re-embedding of the vagus nerve, accessorius nerve and hypoglossal nerve in the sense of a neurolysis. No conspicuous nodes were found in the area of the left neck during dissection. Dry wound conditions. Irrigation of the neck and insertion of a size 10 Redon drain. Two-layer wound closure. Application of a pressure dressing. Final consultation with the anesthetist. Completion of the procedure.