Introductory consultation with the anesthesiologist. Performing a microlaryngoscopy, where a broad-based tumor is found relatively centrally in the area of the base of the tongue, which here bulges strongly exophytically into the pharynx. The lateral wall of the pharynx is merely adjacent to the tumor, as is the posterior wall of the pharynx, where there is certainly no infiltration by the tumor. Removal of the MLE tube. Perform gastroscopy and PEG insertion. The flexible instrument can be inserted into the esophagus without any problems, and the tube can be advanced under visualization into the stomach, where a regular folded relief can be seen. After distension of the stomach, a positive diaphanoscopy reveals a good puncture site below the costal arch. Here the PEG tube is placed using the thread pull-through method and with a positive tent phenomenon. This is successful without any problems. Fixation of the PEG tube with the holding plate and dressing. Reflect back and inspect the esophageal mucosa, which is unremarkable. Repositioning of the patient and insertion of the size B small bore tube and exploration of the base of the tongue. This is only insufficiently successful, so the small water tube is changed to the TORS barrier. This allows sufficient exposure of the tumor so that laser resection can now be performed successively. The resection is carried out far into the base of the tongue, as there is considerable infiltration of the tumor here. Due to the complexity, a large part of the exophytic part of the tumor must be resected first. It is now possible to expose the base of the tumor better and to laser the tumor out of the base of the tongue. The tumor is located so centrally that the lingual artery is not endangered on either side, even with deep resection. Representative frozen sections are taken, whereby a marginal sample in the area of the base of the tongue proves to be positive. This area is resected again generously and finally another marginal sample is taken, which is found to be tumor-free by the pathologists in the frozen section during the further course of the resection. Subtle hemostasis. The resection is performed via the vallecula up to the lingual epiglottis surface. The base of the epiglottis is also infiltrated by the tumor. However, the cartilage is certainly affected so that the tumor can ultimately be completely resected while preserving the epiglottis. Representative marginal samples for frozen section diagnostics are also taken from the area of the vallecula and the epiglottis, all of which are found to be tumor-free intraoperatively. Repeated subtle hemostasis. Repositioning of the patient for neck dissection on both sides and tracheotomy. Application of local anesthesia on both sides of the neck. Skin ablation of the entire neck and sterile draping. Start on the right side. Creation of a skin incision along the anterior edge of the sternocleidomastoid muscle. Cut through the subcutaneous tissue and platysma. Exposure of the anterior border of the sternocleidomastoid muscle. Exposure of the omohyoid muscle caudally and the digaster muscle (posterior cranial venter). Exposure of the cranial accessorius nerve. Displacement and at the end of the operation re-embedding of the accessorius nerve in the sense of a neurolysis. Exposure of the cranial hypoglossal nerve. Displacement and at the end of the operation re-embedding of the hypoglossal nerve in the sense of a neurolysis. Exposure of the cervical vascular sheath from caudal to cranial up to the digaster. Successive removal of the posterior and then anterior neck specimen containing the lymph nodes. Protection of the above-mentioned structures. Hemostasis using bipolar coagulation. Irrigation of the wound using hydrogen peroxide and Ringer's solution. Dry conditions. Insertion of a 10-gauge Redon drain. Two-layer wound closure. Application of a pressure dressing. Repositioning of the patient for neck dissection on the left. Creation of a skin incision along the anterior edge of the sternocleidomastoid muscle. Dissection of the subcutaneous tissue and the platysma. Exposure of the anterior border of the sternocleidomastoid muscle. Exposure and ligation of the external jugular vein. Exposure of the omohyoid muscle. Dissection along the omohyoid muscle cranially to the hyoid bone and the capsule of the submandibular gland. Cranial exposure of the posterior venter of the digaster muscle. Exposure of the accessorius nerve. Displacement and, at the end of the operation, re-embedding of the accessory nerve in the sense of a neurolysis. Exposure of the cervical vascular sheath. Dissection along the internal jugular vein, the vagus nerve and the common carotid artery from caudal to cranial up to the digaster. Displacement and at the end of the operation re-embedding of the vagus nerve in the sense of a neurolysis. A highly suspicious lymph node is found in the area of the upper venous angle, which is also removed with the neck preparation. Another suspicious lymph node is found in region IV on the left side. Successive removal of the posterior neck specimen while sparing the above-mentioned structures and the plexus branches. Removal of the anterior neck specimen. Repeated inspection. Irrigation of the wound with hydrogen peroxide and Ringer's solution. Dry conditions. Insertion of a 10-gauge Redon drain. Platysma suture. Single button skin suture. Application of a pressure bandage. Subsequent creation of an approx. 3.5 cm long incision below the cricoid cartilage. Separation of the subcutaneous tissue. Exposure of both branches of the anterior jugular vein, which are ligated separately. Exposure of the prelaryngeal musculature. Lateral displacement of the prelaryngeal musculature on the right and left. Exposure of the thyroid isthmus, which is undermined, clamped and severed. Subsequently, both sides are treated by means of re-stitching. Exposure of the anterior wall of the trachea. Creation of a Björ flap in a typical manner after incision between the 2nd and 3rd tracheal cartilage clasp. Creation of a plastic tracheostoma. Skin suture. Re-intubation of the patient to a size 8 tracheostomy tube. Regular conditions. Application of a pressure bandage. Completion of the procedure without complications. Final consultation with the anesthetist.