Introductory consultation with the anesthetist. Induction of anesthesia. Performing a tracheoscopy: insertion of the 0° scope. Advance into the trachea and main bronchi. No evidence of tumor. Main bronchi clear. Unremarkable conditions on retraction of the endoscope. After intubation, perform a flexible esophagoscopy: advance the endoscope into the stomach. The esophagus is completely normal. Inconspicuous conditions in the stomach. Very good diaphanoscopy and decision to insert a PEG. Placement of the PEG using the puncture method in the usual way. Very good aspect. When the endoscope is withdrawn, the esophagus is unremarkable and the esophageal inlet is also unremarkable. Performing a microlaryngoscopy: An ulcerated lesion measuring approx. 1.5 x 1.5 cm can now be seen in the left piriform sinus, which could correspond to a tumor. The lesion sits on the thyroid cartilage with relatively good mobility and does not reach the arytenoid cusp medially. The lesion is in principle laser resectable. A PE is removed with a frozen section. The remaining microlaryngoscopy and pharyngoscopy are otherwise unremarkable. The base of the tongue is also soft on palpation. In the PET-CT, the left tonsil is also described as a reservoir. Insertion of the tonsil retractor and grasping of the left tonsil with grasping forceps. Dissection of the upper pole, visualization of the capsule. Dissect caudally at the transition to the base of the tongue and remove the tonsil after bipolar coagulation. Send for frozen section. This was found to be inflammatory. Hemostasis with H202 swabs and bipolar coagulation. Then no more bleeding. Repositioning of the patient for neck dissection. Infiltration anesthesia. Sterile wound covering and skin disinfection. Skin incision on the anterior edge of the sternocleidomastoid muscle over the large lesion. Dissection of the subcutaneous tissue. The metastasis clearly extends into the sternocleidomastoid muscle. In addition, the jugular vein can be seen supraclavicularly, which also infiltrates into the tumor. The vagus nerve is clearly visible here, as is the common carotid artery. Minor bleeding is stopped here. Now dissect along the common carotid artery into the bulb area. The tumor can be easily detached from the common carotid artery, further cranially also from the internal carotid artery. Very difficult dissection of the individual external branches, but the tumor can also be completely detached here. Further dissection cranially. The jugular vein is also exposed here. Now clamp the jugular vein cranially and caudally and resect and ligate it. Further dissection of the tumor laterally. Resection of the sternocleidomastoid muscle with the tumor. Further dissection of the vagus nerve. It can now be seen that the tumor is infiltrating the vagus nerve, so the nerve cannot be preserved. It is resected cranially and caudally and the underlying muscle tissue is also resected laterally. Finally, the tumor can be detached macroscopically in toto and completely from the neck. Dissection of the accessorius triangle and the anterior ............................. triangle with removal of the capsule of the submandibular gland and dissection of the anterior part of the neck. This results in a radical neck dissection. Finally, extensive hemostasis with H2O2 and bipolar coagulation. Insertion of a Redon drainage. Subcutaneous suture and pressure dressing. Because of the planned laser resection, indication for tracheotomy. Incision and preparation of the subcutaneous tissue. Exposure of the isthmus of the thyroid gland. Cutting through and stitching around it. Exposure of the anterior wall of the trachea. Insertion between the 2nd and 3rd tracheal cartilage. Creation of a Björk flap. Insertion into the trachea and creation of an epithelialized tracheostoma. Later, an 8 mm Rügheimer cannula is inserted here. Repositioning of the patient and positioning of the hypopharyngeal tumor on the left with the small ear. The visible tumor is now cut around with the laser. The cranial part of the left hypopharynx is resected, leaving the caudal esophageal entrance wide open. Successive resection of the tumor and division into two halves. The removed material is sent for definitive histology. Circular margin samples are now taken and sent for frozen section. These are all described as tumor-free in the frozen section. Check again. Removal of the inserted H2O2 swabs to stop bleeding. No more bleeding. Insertion of a feeding tube for splinting. Intraoperative administration of Unacid. Please continue this for a few days postoperatively. Change or insertion of tracheostomy tube No. 8 according to Rügheimer. After waking up, the patient goes directly to the intensive care unit for further monitoring. Awaiting definitive histology. Note: Intraoperatively, the thoracic duct was also briefly seen and opened in the area of the neck on the left. In this area, several repositioning and ligation procedures were performed. No more chyle leakage was visible. To be on the safe side, the patient was monitored with a pressure bandage for a few days and fed intravenously. Detailed consultation with the anesthesia department regarding the postoperative procedure.