After active patient identification, the patient is brought into the operating theater. Carrying out the team time-out. Introductory consultation with the anesthesia department. Induction of anesthesia and nasotracheal intubation of the patient. Positioning of the patient by the surgeon. Insertion of the mouth guard. Entry with the small water tube and re-inspection of the tumor extension. If the findings are still transorally laser resectable, the decision is now made to resect the tumor with the CO2 laser as initially planned. Before this, however, oesophagogastroscopy and PEG placement are performed. Advancement of the endoscope under visualization and constant air insufflation into the stomach. This shows a typical gastric mucosal relief on all sides. Insertion of the PEG tube using the thread pull-through method in the typical manner. This is performed without any problems after a clear diaphanoscopy. Repositioning of the patient. Insertion of the mouth guard. Insertion of the spreading laryngoscope with the aid of support autoscopy. Endoscopic-assisted laser resection of the tumor. The tumor extensions extend from the caudal tonsil pole on the right side to the middle of the right-sided base of the tongue. From there, extension into the vallecula and microscopically also to the right-sided lingual epiglottis. Furthermore, extension over the glossotonsillar groove and the aryepiglottic fold. During the tumor resection, it is revealed that the tumor corresponds to a T3 finding due to its extensive submucosal growth and is larger than initially suspected. Dissection is considerably more difficult. There is heavy bleeding from the lingual artery in the area of the lateral pharyngeal wall. This can ultimately be stopped with two clips and a re-stitching. Due to the unexpected extent of the tumor, it cannot be resected using the en bloc resection technique, but rather using the piecemeal technique. As a result, a total of 14 marginal samples were meticulously removed. R0 status as part of the telephone frozen section announcement. Due to the extent of the tumor, the decision is made intraoperatively to forego neck dissection of the right side and to perform this in the interval. The patient is repositioned for neck dissection on the left side. Skin spray disinfection and infiltration anesthesia. Abjode the surgical site. Sterile draping. Mark the planned incision from the tip of the mastoid over the anterior edge of the sternocleidomastoid muscle in a curved line. Cut sharply through the cutis and subcutis. Exposure of the anterior margin of the sternocleidomastoid muscle. Exposure of the omohyoid muscle as the caudal border. Exposure of the accessorius nerve and the posterior digastric venter muscle as the cranial border. Displacement and, at the end of the operation, re-embedding of the accessorius nerve in the sense of a neurolysis. Insertion of the retractors. Exposure of the cervical vascular sheath in the sense of dissection of the internal jugular vein, the facial vein, the common carotid artery, the bifurcation and the external and internal carotid arteries. Exposure and protection of the vagus nerve. Displacement and, at the end of the operation, re-embedding of the vagus nerve in the sense of a neurolysis. Development of the lateral neck preparation while sparing all plexus branches. Turning to the medial neck preparation. Exposure of the capsule of the submandibular gland. Exposure and protection of the hypoglossal nerve. Displacement and, at the end of the operation, re-embedding of the hypoglossal nerve in the sense of a neurolysis. Development of the medial neck preparation. Exposure and protection of the cervical nerve. Hemostasis using bipolar coagulation. Wound irrigation with H2O2 and Ringer's solution. Insertion of a 10-gauge Redon drain. Subcutaneous suture with Vicryl 4.0 and skin suture with Ethilon 4.0. Application of a pressure bandage. Transition to protective tracheotomy. Due to the extensive resection area and the bleeding that has taken place in the area of the lingual artery on the right side, a protective tracheotomy is now indicated. Palpatory identification of the level of the cricoid cartilage. Signs of the planned incision in the form of an inverted T. Sharp transection of the cutis and subcutis. Exposure of the infrahyoid musculature. Locate the linea alba. Blunt lateral dissection of the same. Palpatory identification of the lower edge of the cricoid cartilage and a tender thyroid isthmus. Undermining of the tender thyroid isthmus and bipolar coagulation of the same. Entering the trachea between the 2nd and 3rd cricoid cartilage. Performing a visor tracheotomy. Circular tension-free epithelialization of the tracheostoma. Re-intubation of the patient onto a 9-gauge tracheostomy tube. Application of a pressure dressing. Completion of the operation without complications. Final consultation with the anesthetist. The patient is then transferred to the local intensive care unit in a cardiorespiratory stable condition. In the interval of approx. two weeks, the corresponding neck dissection should be performed on the right side.