Induction of anesthesia and intubation with the laser tube by the anesthetist. Then, first of all, entry with the Kleinsasser tube and inspection of the hypopharynx and larynx area. The hypopharynx including the piriform sinus is unremarkable. The tumor is located on the laryngeal surface of the epiglottis, extends downwards at the edge of the right vallecula and merges with the aryepiglottic fold. However, the ary on the right is not affected by the tumor. The base of the tongue is also not affected by the tumor. Insertion of a spreading laryngoscope and preliminary shaping of the laser and with the microscope. Then demonstration of the findings on <CLINICIAN_NAME> and also briefly on <CLINICIAN_NAME>. It is recommended to divide the epiglottis and remove the tumor successively with the laser. The epiglottis is then also divided first. The tumor is surrounded by the laser along its borders with a safety margin of approx. 1 cm. The preparation is then marked with a thread for the frozen section. At two points where the tumor appeared very close to the healthy tissue macroscopically, marginal samples are taken. These margin samples are also tumor-free in the frozen section. Unfortunately, there are still tumor cells in the frozen section in the area of the transition from the vallecula to the pharyngeal side wall, so a large resection is taken there and then another marginal sample, the last marginal sample is then tumor-free. Due to the size of the defect, a tracheotomy is performed in the usual manner. This involves a skin incision, then dissection down to the musculature. Push the muscles aside, expose the thyroid gland, cut through the thyroid isthmus. Exposing the trachea and entering the trachea between the 1st and 2nd tracheal cartilage. Creation of a visor tracheotomy. Omission of a Björk flap. Creation of a mucocutaneous anastomosis and reintubation to an 8 mm tracheal cannula. Neck dissection on the left (<CLINICIAN_NAME>/<CLINICIAN_NAME>): Skin incision on the anterior border of the sternocleidomastoid muscle, exposure of the sternocleidomastoid muscle, exposure of the omohyoid muscle. Visualization of the submandibular gland, visualization of the posterior belly of the digaster muscle. Exposure of the cervical vascular sheath. Dissection of the internal jugular vein. Exposure of the accessorius nerve, clearing of levels IIa, III and IV while preserving all structures. Then neck dissection on the right side (<CLINICIAN_NAME>/<CLINICIAN_NAME>): Similar procedure in principle, skin incision on the anterior border of the sternocleidomatoid muscle, exposure of the sternocleidomastoid muscle. Exposure of the omohyoid muscle. Exposure of the submandibular gland and the posterior digastric muscle. Exposure of the cervical vascular sheath, free dissection of the internal jugular vein, exposure of the accessorius nerve. Evacuation of levels IIa, III, IV and Va while sparing the plexus branches. PEG insertion: very careful insertion with the flexible esophagoscope, as the patient has esophageal varices I°. This is also successful without any problems. The stomach shows a cobblestone-like relief in the sense of erosive gastritis. Diaphanoscopy is good and the PEG is inserted in the usual manner using the thread pull-through method. Please continue antibiotics for 3 days. The patient is admitted to the intensive care unit, but may wake up. The PEG should not be loosened until the 3rd postoperative day. Wait for histology and presentation of the patient at the tumor conference.