First insertion of the mouth guard. This already reveals a massively loose tooth and a bridge on the right lower jaw. Consultation with the anesthetist, who confirms that the prosthesis was already massively loose before the procedure. Suturing of the tongue and now presentation and exposure of the tumor. The tumor is then cut around with the electric nasel with a safety margin of between 0.5 and 0.8 mm. A clear crater appears in the center of the tumor towards the depth. Particularly deep resection in this area. A marginal sample is then taken from this area for a frozen section after the tumor has otherwise been safely removed macroscopically in healthy tissue. The frozen section is found to be tumor-free intraoperatively. Several larger vessels are exposed during dissection and ligated after transection. The resection now extends over the entire edge of the tongue on the left side. The tip of the tongue remains untouched. The base of the tongue also remains untouched. Repeated subtle hemostasis. Then removal of all instruments and repositioning of the patient for hypopharyngeal carcinoma resection. First insertion of the small irrigation tube. The tumor cannot be sufficiently exposed with this. This is followed by laborious insertion of the torso retractor. This allows the tumor to be exposed very well. The tumor extends over the entire lateral wall of the hypopharynx and moves over the lateral wall here into the lateral wall of the piriform sinus. It also slightly touches the anterior wall of the piriform sinus. In the upper part and the plica pharyngoepiglottica. Now cut around the tumor with the CO2 laser with a sufficient safety margin of about 0.5 cm. The tumor is resected down to the pharyngeal musculature and then remains strictly in this plane up to the entrance of the piriform sinus. Partial resection of the plica phayngoepiglottica. The arytenoid cartilage remains completely intact. The tumor is then also incised in the caudal area and then removed. Subtle hemostasis. Representative marginal samples are then taken from the entire area of deposition and the wound bed. One of these marginal samples, called the anterior piriform sinus, is then found to have a carcinoma in situ in the frozen section, so that a further resection and another marginal sample is taken. This marginal sample is then found to be tumor-free intraoperatively, which means that the tumor R0 appears to be resected. Further subtle hemostasis. The resection now reaches into the middle of the piriform sinus. If the wound is dry, remove all instruments. Insertion of a naso-gastric feeding tube. Then reposition for neck dissection on the left side. First injection of local anesthetic with adrenaline at the anterior edge of the sternocleidomastoid muscle. Then skin incision and layer-by-layer dissection in depth. Exposure and transection of the platysma. Exposure of the cervical vascular sheath. From there, long dissection of the cervical vascular sheath from caudal to cranial. Dissection of the landmarks with the omohyoid muscle in the caudal region and the digaster muscle, venter posterior in the cranial region. Also expose the capsule of the submandibular gland. Then expose the accessorius nerve. Clearing of the accessory triangle and preparation of the caudal neck preparation with long-distance preparation of the vagus nerve and the plexus branches of the cervical plexus. Subsequent dissection of the ventral neck preparation, also sparing all branches of the internal jugular vein and external carotid artery, and removal of the hypoglossal triangle, sparing the cervical sinus and hypoglossal nerve. Here, too, all branches of the external carotid artery are spared. Finally, subtle hemostasis. The result is a neck dissection level Ib to V. In the course of the dissection, several enlarged lymph nodes were found, some of which appeared suspicious. If the wound was dry, a Redon drain was inserted followed by two-layer wound closure and dressing. Repeated endaural bleeding control. If the wound is dry, the procedure is ended after a final consultation with the anesthesia colleagues, which was also held at the start of the operation. Further procedure depending on the final histopathological findings as decided by the interdisciplinary tumor conference.