Choosing the Best Equipment for Polyp Removal: Laser vs. Traditional Surgery

Which surgical equipment is best for polypectomy?

1.
The symptom consultation reference chart at your hospital cannot be accessed (difficult to browse fully).
2.
I have a polyp in my rectum (surgery is required for the upcoming examination).
3.
Does your hospital have laser surgery equipment? 4.
Which method is better for surgery, laser or traditional, and which one is less painful? Thank you.

Zhuang Xiansheng, 50~59 year old female. Ask Date: 2011/10/05

Dr. Li Yongming reply Gastroenterology and Hepatology

First of all, regarding the issue you raised about our hospital's "symptom reference chart not being accessible (difficult to browse completely)," I will inform our IT staff to investigate and improve this matter.
Additionally, I would like to provide a preliminary explanation regarding polyps: Colorectal "polyps" are abnormal growths formed by the proliferation of epithelial cells in the colon wall.
Colorectal polyps mainly include hyperplastic polyps and adenomatous polyps.
It is often difficult to visually distinguish between hyperplastic polyps and adenomatous polyps; usually, a biopsy or polypectomy is required, utilizing pathological examination to differentiate between the two.
Small polyps typically do not present symptoms, while larger polyps may cause bleeding.
Some polyps can lead to intussusception, resulting in bowel obstruction, which may present symptoms such as nausea, vomiting, and abdominal pain.
Villous adenomas can sometimes cause severe diarrhea.
Adenomatous polyps are precursors to cancer; if they can be removed before they progress to cancer or at an early stage of cancerous changes, the incidence of colorectal cancer may be reduced.
When polyps are small, they can be removed using forceps.
However, larger polyps require endoscopic polypectomy for removal.
A prerequisite for colorectal endoscopic polypectomy is that the colon must be thoroughly cleaned to clearly identify and observe the polyps and surrounding changes, while also minimizing the presence of potentially explosive gases.
During polypectomy, it is essential to fully observe the entire polyp and its base to determine whether it is sessile or pedunculated.
The removed polyp must be sent for pathological examination; if it is benign, no further treatment is necessary.
If it is confirmed to be malignant, the depth of invasion of the cancer cells must be assessed.
If the cancer cells are confined to the mucosal layer, it is classified as carcinoma in situ, which does not metastasize and does not require further treatment.
The current diagnostic methods for colorectal polyps are: 1.
Colonoscopy.
2.
Lower gastrointestinal barium X-ray imaging.
Overall, the methods for polypectomy include: 1.
Traditional surgery 2.
Laparoscopic surgery 3.
Endoscopic (colonoscopy) electrosurgical polypectomy.
If your polyp is found to be malignant after biopsy or polypectomy, it is likely that it has invaded the submucosal layer, and approximately 5 to 10 percent of patients may have lymph node metastasis.
Unless the patient's health condition is poor, it is generally recommended to remove part of the colon and lymph nodes.
In this regard, the approach is to surgically remove all malignant tissue, which can be done through traditional exploratory laparotomy and tumor resection combined with lymphadenectomy.
Some medical centers may use laparoscopy for minimally invasive tumor resection.
However, there is currently no so-called "laser" surgery for polypectomy in the medical field.
The common approach for larger polyps is to use an endoscopic snare to encircle the stalk of the large polyp, followed by electrosurgical polypectomy.
The removal of larger flat sessile colorectal polyps includes steps such as injecting at the base of the polyp, electrosurgical excision, and hemostasis.
The method used is "electrosurgery," not the "laser" you mentioned.
Most hospitals, including ours, are equipped with colonoscopes and electrosurgical devices, and routine colorectal polypectomy can generally be performed, which is currently the mainstream approach for managing colorectal polyps.
However, if multiple polyps are located within 6 centimeters of the anal verge, performing electrosurgical polypectomy via colonoscopy may be more challenging, and surgical intervention may be necessary, falling under the scope of colorectal surgery.
To my knowledge, most hospitals do not perform "laser" surgery, and even laparoscopic surgery is difficult to apply in this context.
If your rectal polyps fall into this category, please visit a larger medical center or regional hospital to discuss the next steps with a colorectal surgeon.
Regarding your first point, this webpage is not managed by our hospital, and I have forwarded your issue to the responsible unit.
Thank you for your inquiry.

Reply Date: 2011/10/05

More Info

When it comes to the removal of polyps, both laser and traditional surgical methods have their own advantages and disadvantages. Understanding these can help you make an informed decision regarding your treatment options.

Laser Surgery vs. Traditional Surgery
1. Laser Surgery:
Laser surgery utilizes focused light beams to remove polyps. The advantages of this method include:
- Precision: Lasers can target specific areas with minimal damage to surrounding tissues, which can lead to quicker recovery times.

- Reduced Bleeding: The laser cauterizes blood vessels as it cuts, which can minimize bleeding during the procedure.

- Less Pain: Many patients report less postoperative pain with laser surgery compared to traditional methods, as the laser can reduce the trauma to the surrounding tissues.

- Outpatient Procedure: In many cases, laser surgery can be performed on an outpatient basis, allowing patients to return home the same day.

However, there are some considerations to keep in mind:
- Availability: Not all medical facilities have the necessary laser equipment, and the expertise of the surgeon in using laser technology is crucial.

- Cost: Laser procedures can sometimes be more expensive than traditional methods, depending on the facility and insurance coverage.

2. Traditional Surgery:
Traditional surgical methods involve the use of scalpels and other instruments to remove polyps. The benefits include:
- Established Technique: Traditional surgery has a long history of use and is well understood by most surgeons. This can provide peace of mind for patients.

- Versatility: Traditional methods can be used for a wider range of polyp sizes and types, especially larger or more complex polyps that may not be suitable for laser removal.

- Cost-Effectiveness: In many cases, traditional surgery may be less expensive than laser surgery, depending on the healthcare facility and insurance coverage.

However, traditional surgery also has its drawbacks:
- Increased Recovery Time: Patients may experience longer recovery times and more postoperative pain compared to laser surgery.

- Higher Risk of Bleeding: Traditional methods may result in more bleeding during the procedure, which can complicate recovery.

Conclusion
In summary, both laser and traditional surgery have their own sets of advantages and disadvantages when it comes to polyp removal. The choice between the two often depends on the specific circumstances of the polyp, the patient's overall health, and the resources available at the medical facility.
If you are considering polyp removal, it is essential to consult with a qualified gastroenterologist or surgeon who can evaluate your specific situation and recommend the best approach. They can provide insights into the availability of laser equipment at their facility and help you understand the potential risks and benefits associated with each method.

Recommendations
- Consultation: Schedule a consultation with a specialist who can assess your condition and discuss the best options for your polyp removal.

- Research: If you are leaning towards laser surgery, inquire specifically about the availability of laser equipment and the surgeon's experience with this technique.

- Consider Pain Management: Discuss pain management options with your healthcare provider, regardless of the surgical method chosen, to ensure a comfortable recovery.

Ultimately, the best choice will be one that aligns with your medical needs, personal preferences, and the expertise available at your healthcare facility.

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