Induction of anesthesia and intubation transnasally via the anesthesia colleagues. Then first resection of the carcinoma of the floor of the mouth with the monopolar needle, bipolar forceps and scissors. The specimen is placed on cork, including edge samples for a frozen section. Carcinoma in situ is still visible in 2 places, on the lateral edge of the tongue at the transition to the floor of the mouth and in the middle on the underside of the tongue. On the underside of the tongue, a further 2 x resection is required until the edges of the carcinoma in itu are free. This results in an 8 x 5 cm defect in the floor of the mouth and the underside of the tongue. The ostium of the Wharton's duct on the left side is also covered by the tumor, as is the duct, so that no duct probing could be performed here and the duct and ostium as well as parts of the sublingual gland were resected. The remaining parts of the gland are coagulated in a bipolar fashion and later left open. The right ostium of the Wharton's duct is not affected by the tumor resection. Now turn to the neck. Creation of an apron flap in the usual manner, then parallel neck dissection on the right <CLINICIAN_NAME>, on the left <CLINICIAN_NAME>. Right: visualization of the sternocleidomastoid muscle, the omohyoid muscle and the submandibular gland, the cervical vascular sheath, hypoglossal nerve, accessorius nerve and vagus nerve. Free preparation of the internal jugular vein. Then removal of the neck preparations IIa to Va while sparing the plexus branches. Then release of the submandibular gland and evacuation of neck levels Ia and b. Several enlarged lymph nodes are seen in all levels, but none of them are macroscopically suspicious. Left: Visualization of the sternocleidomastoid muscle, the digastric muscle, the omohyoid muscle and the submandibular muscle. Exposure of the accessorius and hypoglossal nerves. Now exposure and dissection of the internal jugular vein. Clearing out the neck levels I-Va while sparing the plexus branches. Here too, several enlarged lymph nodes, but none of them macroscopically suspicious. Now turn to the larynx. The larynx is released on both sides. To do this, the hyoid bone is removed, releasing the infrahyoid muscles, which are beaten downwards. Then place the oblique laryngeal muscles and release the upper thyroid cartilage horn. Then release the piriform sinus and the thyroid cartilage on both sides. Be more careful on the left side due to possible tumor infiltration through the pharyngeal wall. Then enter with the Kleinsasser tube and inspect the localization of the tumour again. Then incision of the pharynx above the tumor 2 cm safety margin. Opening of the pharynx. This shows that there are 2 separate tumors. One on the lateral pharyngeal wall, which is 1.5 cm in size with a central ulcer, this ulcer runs through the entire pharyngeal wall. Then medially, a superficial tumor affecting the mucosa on the arytenoid cartilage and in the medial area of the piriform sinus. Both tumors are next to each other, but have healthy mucosa in between. However, they are so close together that both are resected in one block. Then marginal samples are taken and the specimen is sent to the pathology department on cork. All margin samples are R0 in the frozen section, without carcinoma in situ. Now perform the laryngectomy. Proceed from caudal to ventral. Deposition of the larynx at the cricoid cartilage, then dissection along the cricoid cartilage and the entire laryngeal skeleton in a cranial direction so that the larynx is completely released with maximum mucosal preservation. Removal of the vocal folds for the research laboratory and sending the laryngeal preparation for pathology. The base of the tongue was then released and the dorso-lateral left myotomy performed. Prior to this, a Provox Vega prosthesis was inserted in the usual manner. Then three-layer pharyngeal suture by <CLINICIAN_NAME>, insertion of 2 Redon drains and return to the mouth. The defect on the underside of the tongue is covered with split skin. The split skin comes from the right thigh. Stitch incisions are made through the split skin and sutures are applied. At the end, a compress is sutured and the entire procedure is completed without complications. Please present the patient to the tumor conference to plan radiotherapy. The procedure was discussed intraoperatively at each stage with <CLINICIAN_NAME>, <CLINICIAN_NAME>, <CLINICIAN_NAME> and <CLINICIAN_NAME>.  