After active patient identification, the patient is brought into the operating theater. Carry out the team time-out. Introductory consultation with the anesthesiologist. Induction of anesthesia and transition to rigid tracheoscopy. Problem-free passage of the non-irritated glottis and endotracheal entry. Mucosal conditions are unremarkable on all sides up to the bifurcation. Intubation of the patient by the surgeon. Transition to esophagogastroscopy. Insertion of the endoscope under visualization and constant air insufflation into the stomach. This reveals a typical gastric mucosal relief without irritation on all sides. Inversion and inspection of the gastroesophageal junction. This also appears unremarkable. After desufflation, slow withdrawal of the endoscope with circular inspection of all sections of the esophagus. Here, too, there is no evidence of a tumor. Remove the endoscope and position the patient in head reclination. Insert the mouth guard and enter with the size C small bore tube. First, adjust the endolarynx. This is inconspicuous. The same applies to the hypopharynx on both sides, the postcricoid region and the esophageal entrance. Inspection of the oropharynx, the oral cavity and the oral vestibule. In the area of the left tonsil at the caudal tonsil pole, there is a clearly contact-vulnerable, highly visible change in the mucosa. However, this appears to be limited to the tonsil. Therefore, insertion of the MvIvor oral spatula while protecting the teeth, lips and tongue and proceeding to tumor tonsillectomy. The entry is cranial, parauvular. A tumor tonsillectomy is then performed, taking away the muscles in the area of the palatal arches and the lateral tonsil lobe. Due to the clearly medialized position of the internal carotid artery, extreme care must be taken during dissection. There is moderate pulsating arterial bleeding in two places, which can be treated primarily by bipolar coagulation and later by repositioning. The caudal dissection is continued to the base of the tongue in order to ensure an in sano resection macroscopically. After removal of the tumor specimen, the sutures are marked in the area of the anterior palatal arch, the posterior palatal arch, the lower tonsil pole and the base of the wound. Macroscopically, the tumor is relatively close to the margin of the resection in the area of the caudal resection margin. Therefore, a corresponding resection specimen and a margin specimen are taken. The samples are sent for frozen section diagnostics. The tumor is sano-resected when the findings are transmitted by telephone. Only in the area of the wound bed towards the lateral side is the resection barely in sano. It was therefore decided to take a corresponding marginal sample here. As the internal carotid artery is directly adjacent to the area of the resection, all preparatory steps are extremely meticulous. Removal of an extensive resection so that parapharyngeal fat is partially exposed. During the post-resection, there is also heavy arterial bleeding in two places, which can initially be coagulated bipolarly. The post-resection specimen is sent for definitive histology. Due to the repeated increase in bleeding in the area of the lateral tonsil bed and the position of the internal carotid artery already described, the decision is now made to adapt the musculature in the area of the lateral tonsil lobe in two layers. The same is done again at the mucosal level in the area of the anterior and posterior palatal arch. The sutures here are made with Vicryl 3.0 RB1. At the end of the operation, persistently dry wound conditions. Final consultation with the anesthesiologist. Completion of the operation without complications.