Initial consultation with the anesthesiologist. After preparation and intubation by the anesthesia colleagues, pharyngoscopy and laryngoscopy again: The tumor is visible, which is located in the area of the left tonsil and slightly exceeds it. However, the tumor is mobile on palpation, so that a transoral resection may be possible without flap coverage. Placement of the PEG: Entering the stomach with the flexible esophagoscope. After diaphanoscopy has been performed, a PEG tube is inserted in a typical manner without complications. Fixation to the abdominal wall in a typical manner. Sterile dressing. Transoral tumor resection: The tumor is macroscopically incised on all sides with an electric needle or scissors at a safety distance of 0.5 - 1 cm. A good layer is found laterally. The posterior palatal arch can be largely preserved, the anterior palatal arch is resected with parts of the adjacent fatty tissue. The resection extends caudally to the level of the epiglottis. The base of the tongue is resected only at the edges with a safety margin. The preparation is marked with a suture. A marginal sample is taken from the area of the mucosa of the posterior palatal arch from the cranial to the caudal end of the tumor. Also a marginal sample from the area from the glossoalveolar junction to the caudal pharynx via the base of the tongue. In the frozen section, tumor removed on all sides in healthy tissue, but with a very narrow safety margin of 0.2 cm in the area of the specimen. Marginal samples, which were taken separately, are free. Despite the fact that the tumor was removed from healthy tissue, further soft tissue was resected cranially and cranial-medially, but this was sent for final histology. Adaptation of the posterior palatal arch with the pharyngeal wall in the most cranial area using two sutures. Overall borderline situation with regard to flap coverage. Overall, however, flap coverage is not absolutely necessary if the posterior palatal arch is preserved. However, extensive resection in the cranial soft tissue area. Transfer to neck dissection on both sides now follows. First disinfect the skin. Injection of a total of 8 ml Ultracaine 1% with adrenaline into the sides of the neck on both sides. Subsequent cranial incision, which ends in a neck fold. Neck dissection on the left: Skin incision as described. Subsequent dissection through the subcutaneous tissue and platysma. A very small external jugular vein is ligated. N. auricularis magnus is preserved. Exposure, displacement and, at the end of the operation, re-embedding of the auricularis magnus nerve in the sense of a neurolysis. Exposure of the sternocleidomastoid muscle, omohyoid muscle, digastric muscle and the infrahyoid muscles. Dissection of the cervical vascular sheath. A lymph node conglomerate is located on this. Clinical evidence of soft tissue infiltration. However, the lymph node conglomerate can be dissected away caudally from the submandibular gland. The same applies to the area of the internal jugular vein, which is not infiltrated. Exposure of the external/internal carotid artery, superior thyroid artery, facial artery and lingual artery. The lingual artery is ligated. Subsequent successive clearing of levels II to V. This largely preserves the branches of the cervical plexus. Exposure, relocation and, at the end of the operation, re-embedding of the vagus nerve, hypoglossal nerve and accessorius nerve in the sense of a neurolysis. Also branches of the cervical plexus, between which the lymph nodes of level V a are removed. Irrigation of the wound area. Careful hemostasis. No evidence of bleeding, chyle flow or other complications. Layered wound closure with insertion of a Redon drain. Application of a pressure dressing. Neck dissection on the right: This is done in the same way as on the left. Level II to V are removed as described on the left side. Enlarged and suspicious lymph nodes are also found here, but not as clearly as on the right side. However, overall there were also suspicious lymph node metastases here. Also presentation, relocation and at the end of the operation re-embedding of the auricularis magnus nerve, vagus nerve, hypoglossal nerve and accessorius nerve in the sense of a neurolysis. Irrigation and hemostasis. Careful revision, no evidence of complications and layered wound closure with insertion of a Redon drain. Application of a pressure dressing. Tracheostoma creation: Small Kocher collar incision. Dissection through the fatty tissue to the infrahyoid musculature. Larger veins are ligated. Exposure of the infrahyoid musculature, which is divided. Subsequent exposure of the thyroid isthmus. This is dissected, which is successful using bipolar coagulation with a thin isthmus. Subsequent exposure of the trachea. Entering the trachea in the 2nd/3rd intercartilaginous space. Creation of a visor flap. This is epithelized using six sutures. Subsequent re-intubation. Insertion of an 8-gauge tracheostomy tube. Lateral skin areas are closed with sutures. Another enoral inspection: Here again careful hemostasis. Two ligatures were placed laterally in the area of the pharyngeal wall as part of the transoral resection. No more bleeding visible here. The procedure was then completed without complications. Final consultation with the anesthesiologist. The patient goes to the intensive care unit for monitoring. Please continue antibiotics as started intraoperatively with Unacid for a total of one week. Total cT2 oropharyngeal carcinoma on the left and lymph node metastases on both sides. Left side probably with soft tissue infiltration or extracapsular infiltration, so radiochemotherapy will most likely be necessary postoperatively. Waiting for the final histology. Planning of the further procedure depending on the final histology. Food should be restored after one week at the earliest, until then nutrition via the inserted PEG.