Induction of anesthesia and intubation using a laser tube transorally by the anesthesia colleagues. First inspection of the tumor. The tumor infiltrates the entire right side of the vallecula, moves over to the opposite side, infiltrates deep into the base of the tongue on the left side as well, moves over to the side wall of the pharynx, thus progressing in size to the previous findings. Positioning of the tumor and demonstration on <CLINICIAN_NAME> and <CLINICIAN_NAME>. Joint consultation and decision on the planned laser resection. Preparation of the laser and start with 5 watts on the right side wall of the pharynx, then transition to cutting in the base of the tongue. The tumor is completely cut around the base of the tongue and also completely cut around the base of the tongue on the left side. Then removal of the epiglottis. The tumor can be resected en bloc and is suture-marked for a frozen section: carcinoma in situ in the lateral set-off area and at the base of the tongue. A generous resection is performed and marginal samples are taken from the middle of the tongue base, laterally and also from the lateral pharyngeal wall. Finally R0. Neck dissection on the left: Skin incision at the anterior margin of the sternocleidomastoid. Exposure of the sternocleidomastoid, the omohyoid, the cervical vascular sheath and the digaster as well as the submandibular gland, the accessorius and the hypoglossus. Unfortunately, the facial vein must be severed. Removal of the neck block II a to V a, sparing the plexus branches. Turning to the opposite side: Here also skin incision at the anterior edge of the sternocleidomastoid. Exposure of the sternocleidomastoid. It quickly becomes clear that a thick metastasis in the level II transition level III area is infiltrating the sternocleidomastoid. Therefore exposure of the cervical vascular sheath in the caudal region and removal of approx. ľ of the sternocleidomastoid muscle and dissection from caudal to cranial along the cervical vascular sheath. In the area of the tumor, it can be clearly seen that the tumor also infiltrates the jugular vein. This must therefore be removed here. On the opposite side, the jugular vein could be kept completely intact. The tumor is pushed away from the internal carotid artery. The superior thyroid vein infiltrates completely into the metastasis and is deposited at the exit from the external carotid artery. The hypoglossus, which can be pushed away by the tumor, and the digaster of the submandibular gland are then shown. Finally, the entire metastasis can be removed, taking the internal jugular vein with it. The internal jugular vein is thrombosed and closed so that it no longer bleeds in the cranial area even when it is removed. Nevertheless, the cranial area is ligated. Then removal of the remaining neck preparation level II b, III, IV and V, sparing the remaining plexus branches, although a large part of the plexus branches including the accessorius nerve were also removed. The facial vein and external jugular vein were also ligated. Insertion of Redon drains. Two-layer wound closure on both sides. Tracheotomy: The tracheotomy, as well as the neck dissection on both sides, is difficult with a short, very fatty neck. Ligation of the anterior jugular vein on both sides. Exposure of the musculature. Dissection of the musculature. Exposure of the thyroid isthmus and undermining of the thyroid isthmus. Coagulation of the thyroid isthmus and visualization of the trachea. Insertion between the 2nd and 3rd tracheal cartilage. Creation of a visor tracheotomy and reintubation. The patient goes to the intensive care unit tracheotomized. Please feed via nasogastric tube for 1 week, then attempt to swallow and build up diet.