Transfer of the patient to the operating room. Active patient identification. Introductory consultation with anesthesia colleagues. Sterile wiping and draping of the neck area and performance of the tracheotomy by <CLINICIAN_NAME>: Injection of Supra in the area of the skin incision two transverse fingers above the jugulum. Sterile wiping, draping of the patient. Start the operation with a 1.5 cm long, horizontal skin incision just below the cricoid cartilage. Cut through the cutaneous and subcutaneous tissue. Identification of the infralaryngeal musculature and lateralization of the muscles. Identification of the thyroid isthmus. Dissection above the thyroid isthmus on the cricoid. Undermining the cricoid and performing isthmus splitting. Now identification of the anterior tracheal wall and creation of a visor tracheotomy. Epithelialized tracheostomy sutures and insertion of an 8-gauge tracheostomy tube. Repositioning of the patient for insertion of the PEG tube. Slight head elevation for this. Entering the esophagus with the flexible instrument. Identification of the anterior wall of the stomach. Perform a positive diaphanoscopy. Now insertion of the PEG tube in the usual manner using the thread pull-through method without complications. Repositioning of the patient in a slight head reclination position. Then insertion of the tonsillectomy tube and re-inspection of the region. As described above, a scarred area was found. Then insertion of the DaVinci retractor and introduction of the robotic arms and the camera. The scarred area is now removed superficially in one piece using the robot. Suspicious mucosal tissue is still visible at the caudal edge, which is why a second resection is performed here. The resectate and the complete resectate are thread-marked for the frozen section. All margins free in the frozen section. Repositioning of the patient for neck dissection. Inject Supra into both sides of the neck in the course of the skin incision. Neck dissection is performed on the right side by <CLINICIAN_NAME>. Skin incision, incision of the subcutaneous tissue and the platysma. Subplatysmal dissection of a platysmal flap anteriorly and posteriorly. Now identification of the anterior margin of the sternocleidomastoid. Identification of the omohyoid muscle. Dissection along the sternocleidomastoid muscle in depth. Identification of the digastric muscle and the accessorius nerve. Freeing the digastric muscle from the surrounding lymph node tissue. Identification of the submandibular gland. Sharp dissection along the internal jugular vein from caudal to cranial and mobilization of the neck preparation. This allows the carotid artery and vagus nerve to be safely protected. Safe protection of the hypoglossal nerve. Detachment of the neck preparation from cranial to caudal in the usual manner without damaging the nerve/vascular structures. Followed by wound irrigation with hydrogen and Ringer. Placement of a 10 Redon drain and two-layer wound closure using cutaneous and subcutaneous sutures. Neck dissection on the left side by <CLINICIAN_NAME>: skin incision on the anterior edge of the sternocleidomastoid muscle and exposure of the sternocleidomastoid muscle of the omohyoid and digastric muscles. Visualization of the submandibular gland, visualization of the cervical vascular sheath. Level IIa shows a large metastasis that must be carefully dissected from the internal jugular vein. It can be seen that the internal jugular vein is very thin, but it can be preserved, as can the hypoglossal nerve, accessorius nerve, vagus nerve and cervical nerve. Evacuation of neck levels IIa to Va while sparing the plexus branches. Insertion of a Redon drainage and two-layer wound closure. Please present the patient to the tumor conference for planning either adjuvant radiotherapy or for controls, depending on the histology.