Introductory consultation with the anesthesia department. Positioning of the patient. Insertion of a spreading laryngoscope. Positioning of the supraglottic tumor. Removal of the surgical microscope and CO2 laser. Performing transoral tumor resection with the CO2 laser. The resection margins extend from the roof of the pocket fold on the right side to the level of the pocket fold on the left side, completely eliminating the epiglottis. Removal of representative marginal samples. These are sent in for a frozen section and are found intraoperatively in such a way that the tumor border to the healthy tissue is less than 1 mm in the right side. Therefore, in the case of close in sano resection, a further resection is performed in the area of the right settling area in the area of the pocket crease as well as dorsally and also on the dorsal left side. These marginal samples are sent in again for frozen section and are still assessed intraoperatively as all tumor-free. Subtle hemostasis. Removal of the bulb. Repositioning of the patient for neck dissection on both sides: start with the neck dissection on the right side. If a lymph node metastasis has been removed, slight scarring here, therefore more difficult preparation conditions. Carry out neck dissection levels I b to V. Exposure of the cervical vascular sheath and the accessorius, vagus and hypoglossal nerves. Displacement and, at the end of the operation, re-embedding of the accessory nerve, vagus nerve and hypoglossal nerve in the sense of a neurolysis. The resection is performed while preserving all branches of the internal jugular vein and external carotid artery. In the area of the venous angle, where the metastasis had initially been removed in a first procedure, further lymph node conglomerates are visible. Enlarged lymph nodes can also be seen in levels II and III. All levels are completely removed. Subsequent subtle hemostasis. Insertion of a Redon drain. Multi-layer wound closure. Transition to the left side. Identical procedure here. Here, too, long exposure of the cervical vascular sheath. Exposure of the vagus nerve, accessorius nerve and hypoglossal nerve. Displacement and, at the end of the operation, re-embedding of the vagus nerve, accessory nerve and hypoglossal nerve in the sense of a neurolysis. Here too, the resection ranges from level I b to level V. Preservation of all vascular structures. The extent of the resection is identical to the opposite side. Subtle hemostasis. Insertion of a Redon drainage. Multi-layer wound closure. Performing the tracheotomy. Modified Kocher incision. Exposure and separation of the pretracheal musculature. Opening in the midline. Exposure of the thyroid isthmus. After this has been carefully coagulated, cut through it. Exposure of the anterior wall of the trachea. Performing the tracheotomy between the 2nd and 3rd cartilage clasp. Preparation of a Björk flap. Circular suturing of the tracheostoma and insertion of a size 8 tracheostomy tube. Further ventilation via the tracheostomy tube as the operation progresses. Insertion of the flexible endoscope into the stomach. After a positive diaphanoscopy, insertion of the PEG using the thread pull-through method. Application of a wound dressing. Repeated enoral check. If the wound is dry and the neck is thin, a pressure dressing is applied on both sides. Final consultation with the anesthetist.