Detailed consultation with the anesthesiologist regarding the intraoperative procedure. Insertion of the small bore tube towards the base of the tongue. Identification of the biopsy site. A slightly exophytic, ulcerating tumor can be seen. This is now cut around clinically with the laser in the healthy area, starting from cranial to caudal, laterally and medially. Resection of part of the left tongue base up to the direction of the vallecula. There, the laser is deposited caudally and laterally. Finally, the tumor can be completely resected clinically in sano. Relatively little oozing. A smaller ectatic vein, which is not ......................, is additionally coagulated with the double spoon. Finally, take circular marginal samples and from the base of the tongue. These are all found to be tumor-free in the frozen section. Entering the stomach through the esophagus with the flexible esophagoscope. This is relatively easy. Good diaphanoscopy. Insertion of the PEG using the puncture method in the usual way. The puncture and the thread pull-through are successful. No further bleeding here. Intraoperative administration of Unacid perioperatively. Continue this for one day postoperatively. Repositioning of the patient for neck dissection: skin disinfection and sterile wound covering. Infiltration in the area of both sides of the neck on the front edge of the sternocleidomastoid muscle with Ultracaine. Start on the right side. Skin incision on the anterior edge of the sternocleidomastoid muscle. Exposure of the muscle. Very difficult dissection as bleeding always occurs. Exposure of the internal jugular vein, the facial vein, the posterior digastric venter muscle and the accessorius nerve. Displacement, neurolysis and re-embedding of the accessory nerve. Now dissection of the posterior triangle of the accessory nerve from cranial to caudal, sparing the accessory nerve. Dissection along the vein, after exposing the vagus nerve caudally and depositing in the area of the omohyoid muscle. Displacement, neurolysis and re-embedding of the vagus nerve. Some larger lymph nodes are conspicuous, but clinically no evidence of metastasis. Now visualization of the external and internal carotid arteries and the hypoglossal nerve. Displacement, neurolysis and re-embedding of the hypoglossal nerve. Dissection of the anterior neck preparation. Smaller veins repeatedly tear, even directly in the area of the internal jugular vein. This therefore has to be stitched twice. No more bleeding. Exposure of the hypoglossal nerve and the cervical vein, which is left in place. Removal of the capsule of the submandibular gland. Extensive hemostasis with H2O2 swabs and bipolar coagulation. No more bleeding. Insertion of a Redon drainage. Subcutaneous suture, skin suture, pressure bandage. Neck dissection of the left side: A lymph node metastasis was also clinically described in the preliminary findings. Skin incision on the front edge of the sternocleidomastoid muscle. Exposure of the muscle. Overall, recurrent bleeding and abundant vascularization. Difficult dissection conditions. After exposure of the muscle, exposure of the internal jugular vein. The accessorius nerve can be visualized in depth. Dissection of the common carotid artery, the vagus nerve and the internal and external carotid artery cranially and caudally. Displacement, neurolysis and re-embedding of the vagus nerve. Exposure of the digastric venter posterior muscle and dissection of the accessorius triangle. A large cystic lymph node metastasis can be seen here, starting directly under the accessorius nerve. Further lymph nodes are also removed from the accessorius triangle. Dissection is performed along the vein and vagus nerve as well as the common carotid artery from cranial to caudal, down to below the omohyoid muscle. The caudal edge of the sedimentation is stitched several times with Vicryl sutures to prevent a fistula. Now further dissection of the jugular vein anteriorly. Exposure of the hypoglossal nerve. Displacement, neurolysis and re-embedding of the hypoglossal nerve. Dissection of the anterior part of the neck, removal of the capsule of the submandibular gland and dissection from cranial to caudal. This results in a complete neck dissection. No bleeding. Irrigation with H2O2 and Ringer's solution. Minor oozing bleeding is stopped with bipolar coagulation. Insertion of a Redon drain. Subcutaneous suture, skin suture and pressure bandage. Another check of the primary resection with the small water tube: there is no major bleeding here. No swelling either. It is therefore decided not to tracheotomize the patient in the first instance. The patient is extubated and transferred to the intensive care unit for monitoring. Detailed consultation with the anesthesia department regarding the further procedure. Please note: Further perioperative administration of Unacid.