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

Abstract

\n 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.