After active patient identification, the patient is brought into the operating theater. Carry out the team time-out. Introductory consultation with the anesthesiologist. Induction of anesthesia and transition to tracheoscopy. Problem-free adjustment of the glottis without irritation and insertion after endotracheal. The mucosal conditions are unremarkable on all sides up to the bifurcation. Subsequent orotracheal intubation of the patient by the surgeon. Transition to esophagogastroscopy: First advance the endoscope into the stomach under visualization. Insufflation of the same. This reveals a typical gastric mucosal relief without irritation on all sides. Enter in inversion. Inspection of the gastroesophageal junction. This is also completely free of irritation. After desufflation, slow withdrawal of the endoscope with circular inspection of all sections of the esophagus. There is no indication of a synchronous second tumor. Remove the endoscope. Insertion of the mouth guard. Enter with the size B small bore tube. The endolarynx appears completely unremarkable. The hypopharynx is also lined on both sides with smooth mucosa on all sides and can be freely unfolded up to the tip of the piriform sinus. The same applies to the esophageal entrance and the postcricoid region. Insertion of the Jennings retractor and creation of a tongue suture. The massive exophytic, partly necrotic tumorous mass described above can be seen here. This extends from the anterior third to just below the midline as well as into the anterior base of the tongue. Lateral extension to the underside of the tongue and the floor of the mouth. The alveolar ridge appears tumor-free. As there is no clear pathohistological evidence of malignancy to date, the tumor is now circumcised with narrow resection margins. First mark the planned resection margins using the monopolar needle. Then successively cut around the tumorous mass, which is obviously growing very superficially and appears to be infiltrating further into the depths. In the area of the floor of the mouth, there are still extensive leukoplakic extensions, which are not initially included in the resection area. In the course of the resection, there is severe arterial bleeding from a branch of the lingual artery. This is first dissected bluntly from the surrounding tissue, ligated twice and then stitched around several times. The same procedure is carried out on a smaller branch of the lingual artery with a smaller caliber. Further punctual hemostasis using bipolar coagulation. Due to the arterial bleeding from a branch of the lingual artery and the relatively poor general condition of the patient, the decision was made intraoperatively to create a temporary protective tracheostoma. The patient is first repositioned. Superficial skin disinfection. Palpatory identification of the thyroid incisura, the level of the cricoid cartilage and the jugulum. Mark the planned incision in the form of an inverted T. Sharp dissection of the cutis and subcutis. Expose the infrahyoid musculature, which appears very atrophic. Insertion of the retractors. Enter the median line and dissect the severely atrophied infrahyoid musculature to the side. Palpatory identification of the cricoid cartilage. Slightly scarred alterations can be seen here, which may be due to previous thyroid surgery. Clearly more difficult preparation conditions here. Exposure of the anterior tracheal wall up to the 3rd cricoid cartilage. Due to the low laryngeal skeleton and the relatively steeply descending trachea, directly above the jugulum, the decision is now made to create a high tracheostoma. Identification of the individual tracheal clasps and opening of the trachea between the 1st and 2nd tracheal cartilage. Formation of a basal wide-stalked Björ flap. Hemostasis by means of bipolar coagulation. Subsequent successive low-tension epithelialization of the tracheostoma in the sense of a mucocutaneous anastomosis. The patient is then reintubated with an 8-gauge high-volume low-pressure tracheostomy tube. This allows the patient to be ventilated without any problems. Removal of the previously withdrawn tube and completion of the operation without complications. Final consultation with the anesthetist. Transfer of the patient to the local intensive care unit for postoperative monitoring.