After active patient identification, the patient is brought into the operating theater. Carry out the team time-out. Introductory consultation with the anesthesia colleagues. Induction of anesthesia and intubation of the patient. Transition to esophagogastroscopy. Insertion of the flexible endoscope under visualization and constant air insufflation into the stomach. A typical, non-irritating gastric mucosal relief is seen on all sides. Inversion and inspection of the gastroesophageal junction. This also appears unremarkable. After desufflation, slow withdrawal of the endoscope with circular inspection of all sections of the esophagus. There is no evidence of malignancy here. Remove the endoscope. Positioning of the patient in head reclination. Insertion of the mouth guard. Insertion with the size C small bore tube. First, adjust the endolarynx. This appears unremarkable. Inspection of the hypopharynx on both sides also reveals no evidence of malignancy. The tip of the piriform sinus can be freely unfolded on both sides and is lined with smooth mucosa on all sides. Postcricoid as well as in the area of the esophageal entrance are also unremarkable on all sides. The epiglottis is now adjusted. In the area of the lingual epiglottis on the right side, an area of uneven mucosa can be seen. There is no typical exophytic tumor growth here. Using the surgical microscope, it can be seen that the tumor-specific mucosal changes in the lingual epiglottis are strictly limited to the right side. The patient is now switched to a spread laryngoscope. With the addition of the support autoscope and the surgical microscope, the tumor is first cut around in a circle with the CO2 laser at a power of 5 watts. It can now be seen that the tumor is obviously infiltrating the cartilage centrally and also appears to be partially growing into the cartilage due to the cartilage fenestrations typical of the epiglottis. Hence the decision to perform a hemiepiglottiectomy. Further inspection also reveals a highly visible change in the mucosa in the area of the lateral free edge of the epiglottis up to just before the pharyngoepiglottic fold. Paramedian in the area of the plica glossoepiglottica mediana, the right part of the epiglottis is now resected up to the vallecula. Removal of a marginal sample in the area of the plica glossoepiglottica and in the area of the vallecula. In addition, removal of a marginal sample in the area of the pharyngoepiglottic fold. Sending in the tumor excidate as well as the marginal samples for frozen section diagnostics. This shows tumor-free marginal samples. Hemostasis is performed using the defocused laser and insertion of a suprarenin-soaked laryngeal swab. Subsequently, removal of the small drainage tube and the mouth guard. Repositioning for neck dissection. First, skin spray disinfection and infiltration anesthesia. Skin wipe disinfection and sterile draping. Creation of the skin incision running along the anterior edge of the sternocleidomastoid muscle. Sharp cutting of the cutis as well as the subcutis. Sharp transection of the platysma. Exposure of the anterior edge of the sternocleidomastoid muscle. Exposure and ligation of the external jugular vein. Exposure and protection of the auricular nerve. Turning to the cervical vascular sheath. Here it can be seen that the cervical vascular sheath is heavily scarred due to the previous procedure. Numerous metal clips are visible. First expose the caudal border in the area of the omohyoid muscle. Exposure of the cranial border in the sense of the posterior digastric venter muscle. There are no scars either far cranially or far caudally. Therefore, the internal jugular vein is shown caudally first. In addition, the cranial part of the internal jugular vein is shown at the level of the digastric muscle. The accessorius nerve is also exposed. This is followed by exposure of the common carotid artery, the bifurcation and the internal and external carotid artery. Exposure of the vagus nerve and free preparation of the same from a scar block. With great effort, the lateral neck preparation can now be successively developed. Shortly below the vein angle, a massive block of scar tissue is revealed with nodules inside, which can be identified by palpation. Successive detachment of the scar block from the internal jugular vein. This results in a tear of a larger outlet. As the vein was secured both cranially and caudally using vessel loops, the bleeding can be easily controlled. Clamping out the slit-shaped defect and suturing it over with Vascufil. A Tachosil fleece is also applied. Subsequently, successive development of the lateral neck preparation via levels II b, II a, III and IV. Then turn to the median neck preparation. First expose the hypoglossal nerve. Neurolysis of the same. Exposure and ligation of the facial vein, which is also largely fixed in a scar block. Then development of the median neck preparation and wound irrigation with H2O2 and Ringer's solution. Hemostasis using bipolar coagulation. Insertion of a 10 Redon drain. Subcutaneous suture with Vicryl 4.0 and skin suture with Ethilon 5.0. Application of a wound dressing. Final inspection of the laryngeal wound bed. There is no evidence of further bleeding. If the wound bed is dry, the operation is completed without complications. Final consultation with anesthesia colleagues. The operation is completed without complications.