After induction of intubation anesthesia, repeated endoscopy and inspection of the tumor. An extensive exophytic mass was found, which covered the entire vallecula, infiltrated the base of the tongue on the left side and also infiltrated the lingual epiglottis up to the base. The tumor extends laterally to the pharyngo-epiglottic fold, but does not pass through it, so that the piriform sinus itself is free. Now add the flexible esophagoscope and endoscopy of the esophagus. Advance the instrument into the stomach. If the diaphanoscopy is positive, PEG insertion using the thread pull-through method and if the tent phenomenon is positive. The insertion is successful without any problems. Then suction out the insufflated air after fixing the PEG and withdrawing the esophagoscope. The patient is then repositioned. Now extremely laborious insertion of the TORS blocker. The tumor is only partially exposed. A complete overview is initially not possible due to the bulging base of the tongue. After insertion and docking of the DaVinci robot. Then first retraction of the base of the tongue. The full extent of the tumor can now be seen. Therefore, first traverse the tumor borders with the monopolar spatula. The tumor infiltrates the base of the tongue on the left side. Therefore, start resection at the base of the tongue. Extremely careful dissection here after the resection extends into the depths. However, the lingual artery is not exposed and remains intact. Then resection laterally and medially. Capture the tumor border in the vallecula. This crosses the midline here. Then further resection of the epiglottis. It can be seen that the tumor has almost completely infiltrated the lingual surface of the epiglottis, so that a complete epiglottectomy must be performed. The pocket folds and the endolaryngeal supraglottis are completely tumor-free. The two arytenoid cartilages are also spared from the resection and remain intact. The resection is then performed laterally via the pharyngo-epiglottic fold. Finally, the tumor can be incised in depth and resected in several parts using a piecemeal technique. Representative marginal samples are then taken from the medial as well as lateral, ventral, dorsal and deep settling areas. Some vascular stumps, particularly on the lateral pharyngeal wall, are first exposed and then clipped. A dry wound surface is then revealed underneath. All frozen sections are diagnosed intraoperatively by the pathology colleagues as tumor-free. If the wound is dry, the DaVinci robot is undocked. The patient was then repositioned for ipsilateral neck dissection on the left side. Injection of local anesthetic with adrenaline. Then incision on the anterior edge of the sternocleidomastoid muscle. Dissection in depth in layers. Exposure of the omohyoid muscle and the posterior digaster venter muscle. Exposure of the accessorius nerve and subsequent insertion of the retractors. Then dissection of the glandular capsule. Clearing of the hypoglossal triangle with exposure of the hypoglossus while sparing all branches of the external carotid artery and internal jugular artery. Followed by a long dissection of the cervical vascular sheath with exposure and protection of the vagus nerve. Subsequent removal of the lateral neck preparation. Then clearing of the ventral neck preparation up to the upper edge of the thyroid gland. Here too, all vessels and nerves are protected. This results in a neck dissection level Ib, II, III, IV and V. A Redon drain is then inserted and the wound is closed in several layers. The patient is then repositioned, initially for tracheotomy. Here too, injection of local anesthetic with adrenaline. Then skin incision in the sense of a modified Kocher incision. Layer-by-layer preparation in depth. Dissection and ligation of several larger pretracheal veins. Then locate the midline and separate the muscles. Further layered dissection in depth. Exposure of the thyroid isthmus. Once this has been undermined, clamp off the thyroid isthmus on both sides and cut through it. The thyroid gland is then repositioned on both sides and the front of the trachea is exposed. Exposure of the cricoid cartilage. Then incision of the trachea between the 2nd and 3rd cartilage clasp. Opening of the trachea. Preparation of a Björk flap. Then suturing of the tracheostoma in the sense of a circular mucocutaneous anastomosis. The patient is then repositioned for neck dissection on the right side. The procedure here is identical to that on the left side. Here too, a skin incision is made along the anterior border of the sternocleidomastoid muscle. Expose the omohyoid muscle and digaster venter posterior muscle. Exposure of the accessorius nerve and insertion of the retractors. Clearing of the hypoglossal triangle while sparing all branches of the external carotid artery, the internal jugular artery and the hypoglossal nerve. Long dissection of the cervical vascular sheath while sparing the vagus nerve. Dissection of the lateral neck preparation and the anterior neck preparation, again sparing all vascular and nerve structures. This also results in a level Ib to V neck dissection. Subtle hemostasis is also performed here. Then insertion of a Redon drain and two-layer wound closure. The patient is then intubated from the transnasal tube to the tracheostomy tube. This is done without difficulty. After applying a cervical pressure bandage on both sides, the procedure is completed. On the ipsilateral tumor side, several enlarged lymph nodes in the sense of an N2b neck status were found. The right side was clinically unremarkable. Therefore, this is at least a T3 hypopharyngeal carcinoma with a clinical N2b neck status. The final further procedure must then be decided at the interdisciplinary tumor conference after receipt of the final histology.