First induction of anesthesia, transoral-endotracheal intubation by the anesthesia colleagues. Positioning of the patient by the surgeon. Subsequent adjustment of the findings in the area of the right tongue base with the spreading laryngoscope. Setting the CO2 laser to continuous mode with a power of 6 watts and successive traversing of the findings in the area of the right base of the tongue. The tumor specimen is removed in toto. Three marginal samples are then taken (right glossotonsillar groove, lingual epiglottis, medial resection margin). All three are found to be CIS and tumor-free by the pathology colleagues. Hemostasis there by means of monopolar coagulation. Dry conditions. Removal of the spreading laryngoscope. Application of local anesthesia cervically on both sides. Cervical skin ablation on both sides and sterile draping. Repositioning of the patient for neck dissection on the right side. Skin incision along the anterior border of the sternocleidomastoid muscle. Exposure and ligation of the external jugular vein. Exposure and sparing of the auricularis magnus nerve. Exposure of the digaster muscle and the cranial accessorius nerve as well as the caudal omohyoid muscle. Exposure of the capsule of the submandibular gland and the hypoglossal nerve. Subsequent exposure of the internal jugular vein from caudal to cranial and complete dissection of the cervical vascular sheath from the multiple metastases on the right side. Repeated hemostasis using bipolar coagulation. The multiple cervical metastases on the right side can be completely removed while sparing the plexus branches of the accessorius and hypoglossal nerves. Dry conditions. Wound irrigation with hydrogen peroxide and Ringer's solution. Insertion of a 10-gauge Redon drain. Two-layer wound closure. Repositioning of the patient to perform a neck dissection on the left side. Skin incision along the anterior edge of the sternocleidomastoid muscle. Cut through the subcutaneous tissue and the platysma. Exposure and ligation of the external jugular vein. Exposure and sparing of the auricularis magnus nerve. Exposure of the omohyoid muscle caudally as well as the submandibular gland of the digastric muscle and the cranial accessorius nerve. Dissection along the cervical vascular sheath from caudal to cranial up to the digaster muscle. Successive removal of the posterior neck specimen while sparing the accessorius nerve and the plexus branches as well as the anterior neck specimen. There, suspicious lymph nodes in regions II and III on the left side. Hemostasis using bipolar coagulation. Wound irrigation using hydrogen peroxide and Ringer's solution. Insertion of a 10-gauge Redon drain. Two-layer wound closure. Application of a pressure bandage. Completion of the procedure without complications. Please feed via PEG for the next 10 days. Suture removal on the 10th postoperative day.