Off-clamp Retroperitoneoscopic Tumour Evacuation for Sporadic Renal Angiomyolipomas with High RENAL Nephrometry Scores: A Novel Surgical Technique and Its Outcomes

Dong, Kai; Shen, Min; Ju, Guanqun; Han, Shuang; Wang, Zhijun; Lu, Kaining; Xu, Danfeng

doi:10.1016/j.eururo.2020.11.020

Cited by 9 publications

(6 citation statements)

References 29 publications

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“…Dong et al performed an off-clamp tumor evacuation for sporadic RAML with high renal nephrometry scores, and their results were encouraging. The GFR did not change signi cantly at 12 month follow-up period and local recurrence and distant metastases did not occurred at 48 month follow-up period [9] . In a review of another article [6] , compared with PN, aspiration for RAML had a similar renal function change and tumor recurrence rates.…”

Section: Discussionmentioning

confidence: 82%

Laparoscopic Resection Combined With Aspiration for Central Renal Angiomyolipoma：Preliminary Outcomes of a Novel Surgical Technique

Dong¹,

Cheng²,

Jiang³

et al. 2021

Preprint

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BackgroundThe purpose of this article was to explore the safety and efficacy of laparoscopic resection combined with aspiration in a selected cohort of 17 patients with central renal angiomyolipoma(RAML). Methods17 patients diagnosed with central RAML by the pathological report and CT/MRI were enrolled in our center from August 2015 to November 2019. The indication for surgery was tumor size more than 4cm or symptomatic tumor such as hemorrhage, backache or hematuria. The main endpoint included operative time, warm ischemia time(WIT), intraoperative blood loss, postoperative hospital time, complications and renal function.ResultsThe average age was 45.3±4.8 years, 12 patients were women, 5 patients were men. Of all cases，10 underwent peritoneal laparoscopic resection and 7 underwent retroperitoneal surgery. All operations were performed successfully without conversion to open surgery. One patient experienced collecting system injury managed by 3-0 barbed self-retaining suture. The average size of the tumors was (6.9±2.3)cm. The average operation time，blood loss, WIT, and postoperative hospital time were (105.3±19.5)min, (145.8±35.7)ml, (25.6±4.2)min and 5-7 days, respectively. No complications happened in the postoperative period, and there were no local recurrence and distant metastases at a 28.5 month follow-up period. Pre-operative and post-operative serum creatinine(SCr) were (67.6±15.8)μmol/L and (65.4±16.8)μmol/L, indicating no significant renal function drop was found. Similarly, no significant difference was found in terms of preoperative and postoperative diseased renal glomerular filtration rate（GFR）value. The main limitation included the sample size and short follow-up time.ConclusionsThe results of this study supported that laparoscopic resection combined with aspiration was a feasible, safe and effective procedure in the treatment of RAML, especially for the large central RAML which is closely related to the collection system and renal blood vessels.

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Section: Discussionmentioning

confidence: 82%

Laparoscopic Resection Combined With Aspiration for Central Renal Angiomyolipoma：Preliminary Outcomes of a Novel Surgical Technique

Dong¹,

Cheng²,

Jiang³

et al. 2021

Preprint

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“…Two patients had ruptured AMLs 3 months prior to surgery: one patient received SAE and the other patient recovered with conservative treatment. The mean RENAL score was as high as 10 [ 10 , 11 ].…”

Section: Resultsmentioning

confidence: 99%

“…AML is composed of varying proportions of fat tissues, smooth muscle, and blood vessels, which make it quite fragile. Previous studies indicate that laparoscopic curettage and aspiration could remove renal AML and avoid injury to the renal parenchyma and collecting system, especially for central renal AML [ 10 , 27 ]. However, it was difficult to remove tumor among blood vessels and collecting system, in the condition of limited working space in renal sinus and abnormal hilar anatomy.…”

Section: Discussionmentioning

confidence: 99%

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

Zhang,

et al. 2024

BMC Urol

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Background Renal sinus angiomyolipoma (RSAML) is a rare and typically complex renal tumor. The objective is to present our single-center experience with a modified technique of robotic nephron-sparing surgery (NSS) for treating RSAML. Methods We retrospectively evaluated 15 patients with RSAMLs who were treated with robotic NSS at the Department of Urology of Tongji hospital, ranging from November 2018 to September 2022. Renal vessels and ureter were dissected. The outer part of RSAML was resected. The rest of tumor was removed by bluntly grasp, curettage and suction. Absorbable gelatin sponges were filled in the renal sinus. The preoperative parameters, operative measures and postoperative outcomes were all collected. Follow-up was performed by ultrasonography and estimated glomerular filtration rate (eGFR). Results Robotic NSS was successfully performed in all the patients, without any conversion to open surgery or nephrectomy. The mean operation time was 134.13 ± 40.56 min. The mean warm ischemia time was 25.73 ± 3.28 min. The median estimated blood loss was 100 [50, 270] ml and 1 patient required blood transfusion. The mean drainage duration was 5.77 ± 1.98 days. The median postoperative hospital stay was 6.90 [5.80, 8.70] days. Two patients experienced postoperative urinary tract infection (Clavien-Dindo Grade II). During the median follow-up of 25.53 ± 15.28 months, patients received 91.18% renal function preservation. No local recurrence occurred in all the patients. Conclusions Robotic NSS for RSAML is a complicated procedure that demands technical expertise and a well-designed strategy is critical in the operation. Treating RSAML with modified robotic NSS is safe, effective and feasible.

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“…PN, whether open surgical, laparoscopic, or robotic assisted, has become a common surgical procedure[ 39 ]. Dong et al [ 43 ] reported an off-clamp retroperitoneoscopic tumor evacuation, which is feasible, safe, and effective for treating complex sporadic RAMLs.…”

Section: Discussionmentioning

confidence: 99%

Fat-poor renal angiomyolipoma with prominent cystic degeneration: A case report and review of the literature

Lu¹,

Lv²,

Liu³

et al. 2023

World J Clin Cases

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BACKGROUND Angiomyolipoma (AML), the most common benign tumor of the kidney, is usually composed of dysmorphic blood vessels, smooth muscle, and mature adipose tissue. To our knowledge, AML with cystic degeneration has rarely been documented. Cystic degeneration, hemorrhage, and a lack of fat bring great challenges to the diagnosis. CASE SUMMARY A 60-year-old man with hypertension presented with a 5-year history of cystic mass in his left kidney. He fell 2 mo ago. A preoperative computed tomography (CT) scan showed a mixed-density cystic lesion without macroscopic fat density, the size of which had increased compared with before, probably due to hemorrhage caused by a trauma. Radical nephrectomy was performed. Histopathological studies revealed that the lesion mainly consisted of tortuous, ectatic, and thick-walled blood vessels, mature adipose tissue, and smooth muscle-like spindle cells arranged around the abnormal blood vessels. The tumor cells exhibited positivity for human melanoma black-45, Melan-A, smooth muscle actin, calponin, S-100, and neuron-specific enolase, rather than estrogen receptor, progesterone receptor, CD68, and cytokeratin. The Ki-67 labeling index was less than 5%. The final diagnosis was a fat-poor renal AML (RAML) with prominent cystic degeneration. CONCLUSION When confronting a large renal cystic mass, RAML should be included in the differential diagnosis.

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Off-clamp Retroperitoneoscopic Tumour Evacuation for Sporadic Renal Angiomyolipomas with High RENAL Nephrometry Scores: A Novel Surgical Technique and Its Outcomes

Cited by 9 publications

References 29 publications

Laparoscopic Resection Combined With Aspiration for Central Renal Angiomyolipoma：Preliminary Outcomes of a Novel Surgical Technique

Laparoscopic Resection Combined With Aspiration for Central Renal Angiomyolipoma：Preliminary Outcomes of a Novel Surgical Technique

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

Fat-poor renal angiomyolipoma with prominent cystic degeneration: A case report and review of the literature

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