PEG insertion: Performing flexible oesophagogastroscopy: Careful endoscopy under visualization into the stomach. The esophageal mucosa is without irritation. The gastric mucosa is also unremarkable, no evidence of ulcer or tumor growth. After a positive diaphanoscopy, a PEG tube is inserted in the typical manner using the thread pull-through method, without complications. Withdrawal of the gastroscope. Dictation <CLINICIAN_NAME>: After positioning the patient, inspection of the primary tumor region. A circumscribed exophytic tumor is seen in the area of the left tonsil. This is mainly localized in the caudal part of the tonsil, just exceeds the tonsil border caudally, but otherwise remains limited to the tonsil lobe. After exposure of the tonsillar lobe, insertion of the retractors and positioning of the robotic arms. A robot-assisted tumor resection in the form of a tumor tonsillectomy is now performed. Deep removal of the surrounding musculature. Subtotal removal of the anterior palatal arch. Resection up to the base of the tongue. Macroscopic in sano resection. The specimen is thread-marked for frozen section diagnostics. This shows an R0 situation with a somewhat unclear situation in the area of the caudal margin. Therefore, after discussing the case with the pathologist, a resection is performed, which is sent for definitive histology. Subsequently dry wound conditions and continuation with neck dissection. Dictation <CLINICIAN_NAME>: Rearrangement for ND left. <CLINICIAN_NAME>, <CLINICIAN_NAME> in alternation: landmark marking, infiltration with Ultracaine 2% with added Suprarenin. Signs of the swollen skin incision. Separation of skin and platysma. Exposure of the anterior border of the sternocleidomastoid muscle, then the omohyoid muscle, then the submandibular muscle and digaster muscle. Finding the internal jugular vein. Visualization of the accessorius nerve. An approx. 2 cm large suspicious lymph node is found in level IV above the VJI. Also an approx. 2 cm large suspicious lymph node in level II. Resection of the two presumed metastases for further dissection on the vein. Now the posterior neck preparation is released from cranial to caudal along the cervical vascular sheath from levels II, III and IV. Bleeding from an artery in level IIb, presumably the lingual artery. Ligation of the same. Blustilla. Further ligation of another vessel. Hemostasis. Protection of the accessorius nerve during level IIb evacuation. Exposure and sparing of the hypoglossal nerve and the facial artery/vein, the carotid artery and the vagus nerve. The bifurcation contains enlarged LK, which do not appear clinically suspicious. Protection of the plexus branches. Removal of the anterior neck preparation. Finally, hemostasis with the bipolar. Insertion of a Redon drainage, two-layer wound closure. Dictation <CLINICIAN_NAME>: Transfer to ND right: On the right side there is a previous operation in the sense of a carotid operation, therefore the incision is essentially made in the old scar. Only in the very cranial area is the incision moved slightly dorsally, as the scar area extends very far into the parotid gland. Exposure of the sternocleidomastoid muscle. This is somewhat more difficult due to scarring from the previous operation. Exposure of the omohyoid muscle and the submandibular gland. Finding the cervical vascular sheath. This is slightly altered by the previous operation and has moved further medially. Free preparation of the internal jugular vein. Locating the accessorius nerve and clearing Level IIb, aIII and IV while sparing the plexus branches. Insertion of a 10 Redon drain. Two-layer wound closure.