First, after intubation by the anesthesiology colleagues, entry with the flexible gastroesophagoscope and insertion of a PEG in the usual manner. Then, the Kleinsasser C-tube is inserted and the tumor, which occupies the base of the tongue on the right side, is inspected. The previously described, approx. 1.5 x 1.5 cm exophytic mass can be palpated again. Inspection of the rest of the hypopharynx and larynx, which is unremarkable. Now laser laryngoscope and start with laser excision with 5 watts, generous incisions are made. Monopolar coagulation in between. Removal of the tumor without problems and major bleeding. The tumor is marked on a piece of cardboard. The edges are scored differently as follows. 2 notches correspond to the upper end, 3 notches to the medial end, 4 notches to the lateral end and 1 notch to the lower edge. As the tumor extends to the lower right tonsil pole, a right tonsillectomy is now performed. Insertion of the tonsil plug and dislocation of the tonsil at the upper pole. Mucosal incision close to the uvula and successive dissection of the tonsil from cranial to caudal with the bipolar forceps. Removal with bipolar forceps and insertion of a hydrogen swab. No further bleeding. Now repositioning for neck dissection on both sides, starting on the right. After abjoration, infiltration of 10 ml xylocaine plus adrenaline. Curved skin incision from the tip of the mastoid to just above the jugulum. Locate the omohyoid muscle, then the digastric muscle and finally the accessorius nerve. Expose the accessory nerve and detach the posterior neck preparation from the superior triangle of the accessory nerve. Work out successively from cranial to caudal while protecting the plexus branches. At the lower third, a large metastasis is encountered, which rests on the jugular vein and extends anteriorly. Now turn towards the metastasis and successive sharp dissection of the metastasis from the vessel. However, this is not clinically infiltrated, so the jugular vein is removed. After removal of the large metastasis and protection of the surrounding structures, further removal of the posterior neck preparation while protecting the plexus branches. Hemostasis with the bipolar forceps. Now complete the neck dissection in the sense of the anterior neck region II, III and IV. Dissection of the submandibular gland, taking its capsule with it. Now expose the hypoglossal nerve. The vagus nerve and the common carotid artery could be visualized during the preparation without any problems. As the laser resection was performed far laterally and the fatty tissue is already visible, the superior thyroid artery and lingual artery are now selectively ligated to prevent bleeding. Locate the two vessels after identifying the common carotid artery and identifying the external and internal carotid arteries. Now ligature both vessels. This was successful without any problems. Then flush with hydrogen and Ringer. Now turn to the left side. After a curved skin incision, also from the tip of the matoid to just above the jugulum, expose the anterior edge of the sternocleidomastoid muscle, the omohyoid muscle and the digastric muscle. Now dissect the digastric muscle in the direction of the submandibular capsule and remove it. Locate the accessor nerve and expose it. Now work out the posterior neck preparation from cranial to caudal starting at the upper accessorius triangle. The plexus branches can also be spared. Also clearly enlarged lymph nodes despite the sonographic cN2a status. Removal of all lymph nodes. Removal of a lymph vessel caudally ................. Now freeing of the internal jugular vein. Complete the anterior neck preparation and expose the hypoglossal nerve. After removal of the neck preparation, hemostasis with the bipolar, hydrogen irrigation and ring irrigation. Now insertion of 2 Redon drains on both sides and two-layer wound closure. Finally, perform the tracheostomy. First inject 4 ml xylocaine and adrenaline 2 cm above the jugulum. Modified Kocher collar incision and transection of the subcutis. A large prethyroid vein is ligated. Then dissect the trachea and expose the thyroid isthmus, which is massively enlarged. Undermining of the thyroid gland and removal of the isthmus by means of two re-punctures. Entry into the trachea between the 2nd and 3rd tracheal clasp. Creation of a modified Björ flap. Suturing or epithelization of the tracheostoma and insertion of an 8-gauge cannula. Finally, re-inspection of the base of the tongue and the tonsillar larynx, followed by discrete monopolar coagulation. The patient is transferred to the intensive care unit for monitoring.