After induction of anesthesia by the anesthesia colleagues, first perform a rigid tracheoscopy using O° optics. Inconspicuous mucosal conditions in the area of the trachea up to the carina. The surgeon then performs transnasal and tracheal intubation and positioning of the patient without any problems. Perform a laryngo- and pharyngoscopy using a Kleinsasser tube. The glottis, the supraglottis, the posterior hypopharyngeal wall, the postcricoid region and the piriform sinuses on both sides were unremarkable. The posterior wall of the oropharynx and the right lateral wall were unremarkable. In the area of the left tonsillar lobe, there was an approx. 3 x 2 cm large contact volnerable mass covered with uneven mucosa, occupying the entire tonsillar lobe and a part of the posterior palatine arch, the anterior palatine arch and the palate ....Somit insertion of the oral cavity with the tonsillar retractor. Make an incision cranial to the mass close to the uvula and carefully cut around the mass to perform a transoral tumor tonsillectomy. Targeted, careful hemostasis using bipolar coagulation. Removal of the specimen in toto, which is sent in thread-marked for final histology (short short cranial uvula, short long wound base middle third, long long tongue base caudal), macroscopic clear impression of a complete resection. Three marginal samples were taken (cranial uvula, middle third of the wound bed, caudal towards the base of the tongue), which were sent for intraoperative frozen section examination and found to be free of tumor and dysplasia. This results in an R0 situation (in the frozen section). Repeated inspection and hemostasis using bipolar coagulation. Relaxation of the retractor. Re-inspection of the tonsil lobe on the left side and completion of the tumor tonsillectomy under dry conditions. Subsequent skin spray disinfection on both sides of the neck. Infiltration anesthesia, abjoration of the skin and sterile draping. Start neck dissection on the right side. Make an incision along the anterior border of the sternocleidomastoid muscle, cut through the subcutaneous tissue and expose the platysma. Dissection of the platysma, exposure of the anterior border of the sternocleidomastoid muscle, exposure of the accessorius nerve, exposure of the digastric muscle and the omohyoid muscle. Dissection along the internal jugular vein. Dissection of the cervical vascular sheath. 3 enlarged lymph nodes are carefully removed in toto in the area of region 2a. Subsequent removal of the posterior neck specimen. Hemostasis using bipolar coagulation, protection of the plexus branches. Subsequent removal of the anterior neck specimen. The hypoglossal nerve and the cervical sinus were exposed and spared. Hemostasis using bipolar coagulation. Placement of a 10-gauge Redon drainage, two-layer wound closure. Application of a pressure bandage and repositioning of the patient for a modified radical neck dissection on the left side type III. Application of an incision along the anterior edge of the sternocleidomastoid muscle. Dissection of the subcutaneous tissue, dissection of the platysma, exposure of the anterior margin of the sternocleidomastoid muscle; during the dissection of the posterior surface of the sternocleidomastoid muscle, the space-occupying lesions described in the preoperative sonography, which are suspected metastases, are not touched. Exposure of the N. accessorius and the M. omohyoideus. Dissection along the internal jugular vein from caudal to cranial. The above-described masses can be pushed off very well from the internal jugular vein, the accessory nerve and the sternocleidomastoid muscle and are extirpated in toto. Exposure of the hypoglossal nerve and digaster muscle. Removal of the posterior neck specimen while sparing the plexus branches, removal of the anterior neck specimen while sparing the cervical anlage. Hemostasis using bipolar coagulation. Demonstration of findings on <CLINICIAN_NAME>, placement of a 10-gauge Redon drainage, two-layer wound closure. Completion of the procedure without complications. Conclusion: Panendoscopy with PEG placement, transoral tumor tonsillectomy, modified radical neck dissection type III on the left side and selective neck dissection region II and III on the right side. The intraoperative frozen section examination revealed an R0 situation. After consultation with <CLINICIAN_NAME>, a tracheotomy was deliberately avoided. Waiting for the final histology, cervical suture removal on both sides on the 8th postoperative day and presentation of the patient in our interdisciplinary tumor conference planned for planning adjuvant therapy.