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 rigid tracheoscopy. Setting up the glottis without irritation and passing it with the 0° optics. Entry after endotracheal. Mucosal conditions are unremarkable on all sides up to the exit of the segmental bronchi. The patient is then intubated nasotracheally by the anesthetist. Transition to esophagogastroscopy. Insertion of the endoscope under visualization and constant air insufflation into the stomach. There is no evidence of a synchronous second tumor. Inversion and inspection of the gastroesophageal junction. This appears unremarkable. After desufflation, slow withdrawal of the endoscope with circular inspection of all sections of the esophagus. With the exception of small glycogen acanthoses, there is no evidence of malignancy here either. Removal of the endoscope. Insertion of the mouth guard. Insertion with the size C small bore tube. First, adjust the endolarynx. This appears inconspicuous. Subsequently, meticulous inspection of the hypopharynx on both sides. The piriform sinus is lined on both sides by smooth mucosa on all sides and can be freely unfolded up to the tip. Postcricoid as well as in the area of the esophageal entrance are also unremarkable on all sides. Subsequently, inspection and palpation of the base of the tongue. This is also unremarkable. Inspection of the oral cavity. First insertion of the spandex cheek and lip expander. Insertion of the reinforced mouth guard. Applying the tongue suture. An exophytic tumor measuring approx. 1.5 x 1.5 cm can be seen in the area of the anterior third of the tongue on the right, on the underside. In addition, in the dorsal third of the tongue, just before the glossotonsillar groove on the underside of the tongue, there is a further primary suspicious change in the mucosa. Even after meticulous inspection, this does not appear to be in contact with the first mass. A synchronous second tumor must therefore be assumed. The planned resection margins are now marked. Start with the exophytic tumor in the area of the ventral underside of the tongue. Successive resection of the tumor while maintaining the necessary resection margins using the ultrasound-activated scalpel. The specimen is thread-marked for frozen section diagnostics. Hemostasis using bipolar coagulation. Subsequently, the second high-suspect area in the area of the dorsal third of the tongue is also incised on the underside and passes over to the dorsal floor of the mouth. Here too, an invasive procedure must be assumed, which is why meticulous attention is paid to maintaining the necessary safety distances. The second specimen is also thread-marked for frozen section diagnostics. Both invasive carcinomas were resected in sano during the frozen section diagnosis by telephone. Only in the area of the dorsally located second carcinoma are there still extensions of a carcinoma in situ at the molar and anterior margin. A resection and corresponding margin samples are now taken. Hemostasis by means of bipolar coagulation. Finally, instillation of a cumulative 7 ml of ropivacaine for postoperative analgesia. Loosening of the suture. Removal of the spandex and the reinforced mouth guard. Final consultation with the anesthetist. Completion of the operation without complications.