Detailed consultation with the anesthesia department before intubation. Intubation with a laser tube. After intubation, first of all the hypopharyngeal carcinoma on the right. This extends from the arytenoid hump, the aryepiglottic fold caudally into the postcricoid region, towards the entrance of the piriform sinus on the right and up to the pharyngoepiglottic plica cranially. Very good adjustability with the laser. The laser is now used to successively cut through the mucosa in the healthy area, including the caudal edge of the deposit. Further successive cutting around the tumor, also in depth. Part of the posterior pocket fold and part of the arytenoid cusp must also be resected. Further resection laterally. Here, the margin of resection is clinically clearly visible in healthy tissue. Repeated hemostasis and aspiration of smoke. Hemostasis with monopolar coagulation. Finally, no more bleeding. The tumor can finally be removed in toto with difficult dissection. Circular margin samples are taken and sent for frozen section. All marginal samples are found to be tumor-free. An R0 resection can be assumed. Hemostasis with H2O2 swabs. No more bleeding. Now setting of the cT1 vallecula carcinoma on the left. This tumor is also resected in toto and in a healthy state using the laser, if possible sparing the epiglottis. The entire section removed is marked with sutures and also sent for frozen section. In the frozen section, all margins are without tumor. The hypopharyngeal tumor on the right is sent in toto for definitive histology. Clinically, it is safely resected in sano. Now insertion of the flexible esophagoscope. Advance into the stomach. Good diaphanoscopy. Placement of the PEG in the usual way. Very good aspect. External fixation. Removal of the esophagoscope. Repositioning of the patient. Skin disinfection. Infiltration anesthesia in the area of the right neck. Skin incision on the anterior edge of the sternocleidomastoid muscle. Dissection of the muscle. Exposure of the internal jugular vein, the accessorius nerve and the posterior digastric venter muscle. Displacement, neurolysis and re-embedding of the accessory nerve. Exposure of the vagus nerve. Displacement, neurolysis and re-embedding of the vagus nerve. Exposure of the external and internal carotid arteries. Finally, dissection of the posterior neck preparation from the digaster to the omohyoid muscle. Set off caudally after repositioning. Finally, dissection of the facial vein. Dissection of the anterior neck preparation with exposure of the cervical nerve, the hypoglossal nerve and the facial vein. Displacement, neurolysis and re-embedding of the hypoglossal nerve. Removal of the capsule of the submandibular gland. Removal in toto while sparing the previously mentioned structures. Sending for definitive histology. Hemostasis with H2O2 swabs and bipolar coagulation. Irrigation with NaCl. No bleeding. Insertion of a Redon drainage. Subcutaneous suture, skin suture, pressure bandage. Repositioning for neck dissection on the left: Skin incision on the anterior border of the sternocleiomastoid muscle after infiltration of Ultracaine. Exposure of the muscle. Dissection of the internal jugular vein, the external and internal carotid arteries and the vagus nerve. Displacement, neurolysis and re-embedding of the vagus nerve. Cranial exposure of the accessorius nerve and the posterior digastric venter. Displacement, neurolysis and re-embedding of the accessory nerve. Development of the posterior neck preparation from cranial to caudal. Separation slightly below the omohyoid muscle after ligation of the caudal separation margin to prevent a fistula. Now dissect the anterior parts of the neck. Exposure of the hypoglossal nerve. Displacement, neurolysis and re-embedding of the hypoglossal nerve. Exposure of the capsule of the submandibular gland, the facial vein. Further caudal dissection and completion of the neck dissection. Hemostasis with H2O2 swabs and bipolar coagulation on this side as well. Insertion of a Redon drainage. Subcutaneous suture, skin suture, pressure bandage. Due to the extensive resection of the right hypopharyngeal carcinoma and the risk of aspiration, indication for tracheotomy. A star-shaped incision was made over the trachea and the cricoid cartilage. Dissection of the subcutaneous tissue. Exposure of the infrahyoid musculature. Entering the linea alba. Exposure of the thyroid isthmus and the cricoid cartilage. Undermining of the thyroid isthmus, cutting through it and repositioning it. The trachea can now be viewed very clearly. Performing the tracheotomy due to the deep trachea between the 1st and 2nd tracheal cartilage and epithelializing the tracheostoma. Difficult preparation due to the highly ossified conditions in the trachea. Finally extubation and insertion of a 7.0 cannula. Patient is easy to ventilate. Wound dressing. Finally, perform another microlaryngoscopy and pharyngoscopy to assess the wound resection. No current bleeding. End of the procedure. Perioperative administration of Unacid. Please continue this for at least 24 hours postoperatively in the intensive care unit. Final consultation with the anesthesia department.