After active patient identification, the patient is taken to the operating theater. Introductory consultation with the anesthesia department. Carry out the team time-out. Start of transoral resection: ( Dictation <CLINICIAN_NAME> ) Positioning of the base of the tongue with the spread laryngoscope, the histologically confirmed tumor in the area of the left base of the tongue can be clearly identified with the help of the spread laryngoscope. Adjust the position so that the tumor is clearly visible. Then use the laser to cut around the process in the area of the left base of the tongue, taking the lower edge of the left tonsil with it. As far as can be assessed intraoperatively, the resection is performed macroscopically in the healthy tissue, including parts of the base of the tongue, the lateral pharyngeal wall and resection of the vallecula. The epiglottis itself remains untouched in both the lingual and laryngeal epiglottis areas. Careful hemostasis. Now take marginal samples, which are found to be tumor-free in the frozen section. Finally, re-inspect the wound bed. If the blood is dry, the procedure is ended. Neck dissection: Dictation <CLINICIAN_NAME> After completion of the transoral resection, the patient is repositioned for neck dissection. For this purpose, superficial skin disinfection and infiltration anesthesia with 10 ml Xylonest in the area of the planned incision. Abjode the surgical area and cover it sterilely. Marking of the mandible and the ascending mandibular branch. Marking of the jugulum and the clavicle on the left side. Mark the planned incision in the area of the front edge of the sternocleidomastoid muscle. Sharply cut through the cutis and the subcutaneous fatty tissue. Then cut through the platysma using the 15 mm scalpel and further subplatysmal dissection. The anterior edge of the sternocleidomastoid muscle and the omohyoid muscle are then exposed. Exposure of the digastric muscle as the cranial border and the accessorius nerve. Displacement, neurolysis and re-embedding of the accessorius nerve. Insertion of the retractors below and above. Turning towards the cervical vascular sheath. Exposure of the internal jugular vein and the venous angle. Overall, the internal jugular vein is extremely weak in caliber. Exposure of the common carotid artery and the bifurcation. Exposure and protection of a relatively large vagus nerve. Displacement, neurolysis and re-embedding of the vagus nerve. Turning to the approx. 3.5 x 2.5 cm cervical lymph node metastasis in level II. This can be separated from the cranial part of the internal jugular vein with laborious dissection. There is still a small displacement layer here. Level IIb is then cleared out while carefully protecting the accessorius nerve. Develop the lateral neck preparation. Expose and protect the plexus branches. Palpatory exploration of level V. Smaller coarse nodules can be seen in depth here. These are selectively dissected out of level V while sparing the surrounding plexus branches. Furthermore, an approx. 1.5 cm large, suspicious mass is seen in level IV. Therefore, level IV is also dissected out. Before the specimen is placed in level IV, it is grasped with the Overholt clamp and ligated, as the dissection extends far caudally. Then turn to the medial neck preparation and develop it. Protect the branches of the cervical nerve. Palpatory exploration of level I. There is no evidence of further lymph node metastases. As part of the exploration, also visualization and protection of the hypoglossal nerve. Displacement, neurolysis and re-embedding of the hypoglossal nerve. Subsequent hemostasis using bipolar coagulation. Wound irrigation with H2O2 and NaCl. Insertion and suturing of a 10-gauge Redon drain and wound closure with Vicryl 4.0 and Ethilon 5.0. Application of a pressure dressing. Completion of the operation without complications. Final consultation with the anesthetist.