Emergency retroperitoneal laparoscopic partial nephrectomy for ruptured renal angiomyolipomas: a retrospective single-center series of 15 cases

Abstract

Background: To assess the safety, tumor control and renal function preservation of the emergency retroperitoneal laparoscopic partial nephrectomy (LPN) for ruptured renal angiomyolipoma (AML) and summarize our single-center initial experience. Methods: We performed a retrospective analysis of 15 patients pathologically confirmed renal AML treated with emergency retroperitoneal LPN between January 2016 and May 2019. The patient demographics, operation time, blood loss, transfusion requirements, complications and other surgical parameters were analyzed. Follow-up was performed by serum creatinine and imaging modalities. Results: Fifteen patients were performed with emergency LPN with the median age 41.6 years. The mean size of the renal AMLs was 7.8 cm. The mean size of the retroperitoneal hematomas was 8.5 cm. All the emergency surgeries were performed successfully without any conversion to nephrectomy or open surgery. The mean operative time was 101 min. The mean warm ischemia time was 28 min. The mean estimated blood loss was 311 ml. Five patients required intraoperative blood transfusion (33.3%, 5/15). The mean transfused RBC was 4 U (range 2-6 U), and the mean transfused plasma was 200 ml (range 200-400 ml). The mean drainage duration was 3 days (range 2-5 days). The mean postoperative hospitalization was 4.7 days. No patients experienced intraoperative complications. The mean serum creatine was slightly higher after surgery (53.1 vs. 55.9 μmol/L). One patient had postoperative perirenal fluid collection. No patients needed dialysis. No recurrence was observed in the patients at the median follow-up of 24.1 months. Conclusions: Our initial experience shows that the emergency retroperitoneal LPN is a safe, minimally invasive procedure for emergency patients with ruptured renal AMLs. It could be considered as an effective alternative to renal artery embolization in selected emergency patients.

Canadian Urological Association Best Practice Report: Diagnosis and management of sporadic angiomyolipomas

“…43 A surgical CUAJ -CUA Best Practice Report Guo et al BPR: AML management approach may be considered in patients that are hemodynamically unstable despite adequate supportive care. 44 Acutely hemorrhaging AML in a pregnant woman is an extremely uncommon yet complex emergency that should be treated by a multidisciplinary team. In a hemodynamically stable patient, with no sign of fetal distress, conservative management in a monitored setting can be attempted.…”

Robot-Assisted versus Laparoscopic Partial Nephrectomy for Giant Sporadic Renal Angiomyolipomas of ≥7 cm: A Propensity Score-Matched Analysis

“…Renal AML is a benign mesangial mesenchymal tumor that originated from renal chylous cells [1]. Its incidence is about 0.4% in the general population, accounting for 3% of all renal tumors [2]. It is composed of fat, smooth muscle, and blood vessels and is prone to rupture and bleeding.…”

Management of renal sinus angiomyolipoma: modified robotic nephron-sparing surgery in a single center

“…Laparoscopic NSS is more invasive than SAE, but it enables complete AML resection and offers a low risk of recurrence. Recent studies report almost no recurrence of sporadic AML after laparoscopic NSS [ 6 , 7 ]. Novel strategies have been developed to minimalize destruction of kidney in NSS [ 8 – 10 ].…”