At the beginning of the operation, the surgeon positions the patient. Subsequent entry with rigid endoscopy. Inspection of the subglottic slope and trachea. Unobtrusive conditions. Now nasal intubation. Subsequent inspection of the oropharynx, hypopharynx and larynx, also under the microscope. The previously described tumor of the right tonsil is seen, which ends at the lower tonsil pole, but extends palpatorily, as already recognized on CT, far to the submucosal cranial side and infiltrates here into the palate on the right side, but does not cross the midline here. Subsequent flexible esophagoscopy. Unobtrusive conditions as far as the stomach. After performing the diaphanoscopy and insertion of the troicart, the PEG is inserted in the typical manner using the thread pull-through method. The tumor is then positioned with the tonsil retractor and cut around with the electric needle. Dissection from cranial to caudal, cutting around the tumor with a large safety margin. Laterally, the tumor does not appear to be growing beyond the capsule of the tonsil, so that the tumor can be removed in toto from the pharyngeal wall with the raspatory without difficulty. Removal of the tumor caudally. Subsequent formation of a resectate in the cranial part, which is also sent for final histology. Finally, the edge samples are taken. These are found to be tumor-free. Now turn to the neck dissection on the left side: To do this, make a skin incision in the typical manner along the anterior edge of the sternocleidomastoid. Expose the same. Dissection of the neck sheath. Exposure of the accessory nerve, vagus nerve and hypoglossal nerve. Dissection of the lateral neck preparation from the digaster to the omohyoid, sparing the above-mentioned structures and the main plexus branches. Careful hemostasis. Evacuation of the medial neck preparation, taking the capsule of the submandibular gland with it and again careful hemostasis, H2O2 irrigation and insertion of a Redon drain. Finally, two-layer wound closure. Now neck dissection on the right side: identical procedure here. Also dissection from the digaster to the omohyoid. Expose the cervical vascular sheath, the vagus nerve, the accessorius nerve and the hypoglossal nerve. Clearing out the lateral neck preparation while protecting the structures and the plexus branches. Careful hemostasis. Dissection along the capsule of the submandibular gland in a medial direction and removal of the medial neck preparation. Subsequent careful hemostasis. H2O2 irrigation. Finally, this wound is left open and the vascular trunk of the superior thyroid is explored. This can be seen at the level of the bulb, leaving the externa and sufficiently wide and pulsating well; the internal jugular vein is also visualized. Insertion of H2O2 swabs and turning to the tracheotomy: For this purpose, skin incision with dissection through the subcutis and pushing apart the prelaryngeal muscles. Undermining of the thyroid gland. Insertion of clamps. Cutting of the same in the midline. Subsequent repositioning. After locating the anterior wall of the trachea, the incision is made between the 2nd and 3rd tracheal cartilage. Form a Björk flap in the typical manner and skin adaptation to the trachea to form an epithelialized stoma. Now reintubation with an 8-gauge Rügheimer cannula. Then lift the radial flap. To do this, cut around the skin preparation. Remove the fascia from the musculature. Locate the radial artery. Then follow it into the crook of the elbow and release it from its bed. The radial artery is deposited in the antecubital fossa before the interosseous artery leaves. The accompanying veins are placed in a confluence. Careful hemostasis is then performed. Heparin irrigation. Attachment of the perfusor. Due to ABC intolerance, full heparinization is performed here. Now lift the split skin from the groin. This defect is sutured primarily after careful hemostasis and insertion of a Redon drainage. Split skin coverage of the forearm. The skin is then sutured down to the crook of the elbow. Application of a forearm splint. Fitting of the skin preparation into the defect. Reconstruct the palatal arch and, after undermining, pull the flap pedicle through towards the neck. Anastomize the radial artery with the superior thyroid artery microscopically. Then end-to-end, then end-to-side anastomosis of the accompanying veins in their confluence with the jugular artery. After careful hemostasis and checking for good flow, H2O2 irrigation is performed again and the wound is closed in two layers. Check the wound again at the end of the procedure. No evidence of bleeding. Flap vital.