Induction of anesthesia and intubation by the anesthesia colleagues. Then, entry with the Kleinsasser tube and inspection of the tumor on the right side in the hypopharynx. The tumor is located on the medial wall of the hypopharynx and on the aryepiglottic fold. It is approx. 2 x 2 cm in size and exophytic, it can be easily adjusted, hence the decision to perform laser resection, which is then carried out. The tumor is now positioned with the spread laryngoscope and the edges of the incision are marked with a safety margin of 1.5 cm. The mucosa is then incised with the laser using 2 watts, then the laser intensity is increased to 3.5 watts and the tumor is lasered out. Care is taken to ensure that there is also a sufficient safety margin basally. In some cases, the tumor must be lasered down to the thyroid cartilage. The tumor specimen is then removed and marked in situ using a clip. The specimen is placed on cork and completely thread-marked for the frozen section. All margins are marked as R0 in the frozen section. Neck dissection on the right: repositioning of the patient by the surgeon. Injection in the area of the skin incision two fingers below the lower jaw. Care is taken to cut along the old scar line. Skin incision in the area of the old skin incision. Exposure of the platysma. This is difficult, as a clear scarring of the tissue can be seen in the area of the skin incision in the case of previous surgery. Identification of the platysma margin and subplatysmal dissection at the cranial and caudal wound margins for mobilization. Identification of the anterior margin of the sternocleidomastoid muscle and sharp dissection along the anterior margin in depth. Identification of the omohyoid muscle and sharp dissection along the muscle cranially to the hyoid bone. Identification of the submandibular gland and opening of the capsule. Carefully hold the capsule away cranially and dissect along the digastric muscle to the hyoid bone. The medial neck preparation is subtly detached from the subsurface under constant bipolar coagulation. Identification of the jugular vein and sharp dissection on the vein from caudal to cranial, so that the neck preparation is divided at the lateral-medial part. Removal of the medial neck preparation after ligation of the facial vein. Exposure of the accessory nerve and hypoglossal nerve. Gradual detachment of the lateral neck preparation from cranial to caudal, starting at level IIb while constantly protecting the surrounding structures, especially the accessorius nerve. There is a lymph node metastasis in the area of level IIb as well as in level III on the right side. The neck preparation is detached from cranial to caudal. Minor bleeding is coagulated bipolarly. The basal resection border is formed by the deep cervical fascia and the cervical plexus. The operation is completed without complications despite the overall very difficult dissection conditions due to the significant tissue scarring. Neck dissection on the left: Skin incision in a horizontal skin fold and dissection through the subcutaneous fatty tissue. Separation of the platysma and subplatysmal dissection. Exposure of the anterior border of the sternocleidomastoid muscle and exposure of this. Dissection of the omohyoid muscle up to the cranial side of the digaster muscle. Exposure of the accessorius nerve. Locate the gl. submandibularis and expose the gland. Fold up the gland and expose the digaster muscle. Dissection in the direction of level IIb. Exposure of the VJI and free preparation of the JVJ from caudal to cranial. Problem-free dissection and exposure of the facial vein. Finding and preserving the hypoglossal nerve in the jugulofacial diaper. Careful removal of the medial neck preparation while preserving all structures. Now dissection of the lateral neck preparation and removal of this while preserving the plexus branches. No increased bleeding, no chyle. Tracheotomy: Marking of the landmarks. Skin incision and dissection through the subcutaneous fatty tissue. Dissection in the linea alba on the cricoid cartilage. Move the prelaryngeal muscles to the side. Exposure of the thyroid gland and submergence of the thyroid gland with the peon clamp. Bipolar coagulation of the thyroid gland and careful transection of the thyroid gland. Move the thyroid gland to the side and expose the trachea. Opening of the trachea between the 2nd and 3rd interspace. Visor tracheotomy and suturing of the tracheostoma in the usual manner. Problem-free reintubation.