Induction of anesthesia and intubation transnasally by the anesthesia colleagues. Then sterile washing and draping of the neck area and performance of a tracheostomy. Vertical skin incision for this. Exposure of the musculature, exposure of the thyroid isthmus. Dissection of the thyroid isthmus. Exposure of the anterior tracheal wall and insertion between the 2nd and 3rd tracheal ring and intubation onto an LE tube. Then placement of a PEG by Dr. <CLINICIAN_NAME> and <CLINICIAN_NAME>. For this, insertion with the flexible esophagoscope and endoscopy into the stomach. If diaphanoscopy is good, perform the PEG insertion using the thread pull-through method. Then positioning of the patient, sterile washing and draping and start with tumor resection by <CLINICIAN_NAME>. Use a 10 watt diode laser for this and cut around the tumor with a safety margin of 1-1.5 cm. The resection is relatively scarce in the area of the wound bed, therefore a resection is performed here, all edge samples are tumor-free in the frozen section. Neck dissection is then carried out by <CLINICIAN_NAME> on the left side: enter with the 15 mm scalpel and make a skin incision along the anterior edge of the sternocleidomastoid muscle and from the mastoid to the caudal side in a curved line along the anterior edge of the sternocleidomastoid muscle. Sharp cutting of the skin. Subcutaneous tissue and platysma. The external jugular vein is exposed, ligated and cut. The platysmal flap is now dissected with a scalpel. Dissection along the anterior edge of the sternocleidomastoid muscle in depth. The accessory nerve is now exposed and spared. The accessory nerve is followed in a cranial direction. The posterior belly of the digastric muscle can now also be seen, traced further medially. Further medially, the submandibular gland can be seen, which is also easily visualized. The omohyoid muscle is visible caudally and the cervical vascular sheath is visible in the depth below the neck preparation. The internal jugular vein is dissected from caudal to cranial. There is no injury to the structures here. The superior thyroid vein and facial vein are dissected and spared. Medial to the jugular vein, the common carotid artery and the external carotid artery are exposed as well as the vagus nerve and the cervical artery are now dissected in level IIb with detachment of the neck preparation. Level IIa follows, sparing the accessorius nerve. Levels III, IV and V are also detached without difficulty. The plexus branches are exposed and spared. No chyle fistula occurs caudally when the neck preparation is removed. The anterior neck preparation is now also exposed and dissected along the V. facialis and the V. thyroidea superior. Neck dissection on the right side of <CLINICIAN_NAME>: The surgeon repositions the patient in the lateral head position to the left. Make a skin incision on the anterior edge of the sternocleidomastoid muscle, from the mastoid to the lateral edge of the tracheostoma. Make sure to leave a sufficient skin bridge between the skin incision and the tracheostoma. Separation of the subcutaneous tissue. Separation of the platysma. Protection of the external jugular vein and the auricular nerve. Subplatysmal dissection cranially and caudally and exposure of the submandibular gland. Exposure of the posterior venter of the digastric muscle. Exposure of the omohyoid muscle. Insertion of a retractor between the omohyoid and sternocleidomastoid muscles caudally and a retractor under the digastric muscle. Exposure of the anterior border of the sternocleidomastoid muscle and dissection along the muscle in depth until the cervical plexus is exposed. Identification of the accessorius nerve and gentle dissection along the nerve to free the neck preparation from the nerve. The nerve can be completely preserved. Exposure of the internal jugular vein and dissection along the vein from caudal to cranial, dividing the neck preparation into a medial and a lateral part. Removal of the lateral part from cranial to caudal with bipolar coagulation of smaller blood vessels. All vascular and nerve structures can be preserved. Approach to the medial neck preparation. Separation of the neck preparation from the vessels. Release of the submandibular gland. Exposure of the hypoglossal nerve. The hypoglossal nerve can be safely spared. Removal of the medial part of the lymph nodes. Exposure of the bifurcation of the common carotid artery. Exposure of the branches of the external carotid artery. The superior thyroid artery is conditioned for flap anastomosis. Additional conditioning of three branches or three branches of the facial vein for the anastomosis. Completion of the neck dissection on the right side without complications. Then lifting of the radialis graft through <CLINICIAN_NAME> and <CLINICIAN_NAME>. Incision of the skin 11 x 8 cm, visualization of the venous situation in the elbow. Depiction of the V. cephalica, the V. basilica and the venous confluence. Exposure of the brachioradialis muscle. Visualization of the superficial ramus, radial nerve, visualization of the radial artery. Underbinding of the radial artery, lifting of the graft from the tendons and preparation of the vascular pedicle. The radialis graft is then removed and the graft is inserted transorally in the area of the defect. The submandibular gland was removed on the left side. Prior to this, a tunnel was created through <CLINICIAN_NAME> by cutting the digastric muscle and creating a tunnel that encompasses 3 QF. The stalk was pulled through this tunnel and then transferred to the opposite side and connected to the superior thyroid artery, the facial artery, an outlet from the facial artery and another deeper outlet from the internal jugular vein, so that we have 3 venous vascular anastomoses and one arterial anastomosis. The graft is very well supplied with blood. Redon drainage tubes are inserted and the wound is closed in two layers. The patient goes to the intensive care unit intubated via the tracheostoma. Please continue flap control according to the usual schedule and antibiotics for 24 hours.