Advanced polypectomy includes the approach to large polyps, polyps that are difficult to access, and polyps that require special maneuvers for removal. Sessile polyps are considered difficult to remove, the larger diameters falling into the “very difficult” category, requiring advanced polypectomy techniques. Some pedunculated polyps may require advanced techniques. Most polyps in the colon are sessile, and many of these are located in the right colon, from the hepatic flexure to the cecal caput. Pedunculated polyps, with a pedicle of pulled-out mucosa and submucosa caused by the constant action of peristalsis in the colon's attempt to evacuate the polyp, usually are located in the sigmoid colon.