Laparoscopic Aspiration for Central Renal Angiomyolipoma: A Novel Technique Based on Single-center Initial Experience

ObjectiveTo report on the novel technique of laparoscopic aspiration for central renal angiomyolipoma (RAML) in a series of patients treated in our institution and summarize our single-center initial experience.MethodsWe retrospectively reviewed the clinical data of 10 patients (4 men and 6 women) with pathologically confirmed central RAML who underwent laparoscopic aspiration between August 2010 and May 2012. Indications for surgical intervention included 8 (80%) tumors of >4 cm and 2 (20%) symptomatic RAMLs. Patient demographics, intraoperative variables, and postoperative outcomes were reported and analyzed. Follow-up was performed by serum creatinine and imaging techniques.ResultsAll patients were diagnosed with sporadic central RAML. None was affected by tuberous sclerosis. All operations were performed successfully by laparoscopic aspiration without conversion to partial nephrectomy, enucleation, or even open surgery. One complication of perirenal fluid collection occurred but finally recovered only with conservative treatment. No other complication or transfusion was observed. The mean tumor size was 5.1 cm (range 3.2-7.7 cm). The mean operative time was 92.1 minutes (range 67-140). The mean warm ischemia time was 27.5 minutes (range 20-30). The mean estimated blood loss was 53.5 mL (range 10-150). The mean retroperitoneal drainage was 2.3 days (range 1-3). The mean postoperative hospital stay was 4.3 days (range 3-8). The level of serum creatinine were all within normal limits with mean preoperative and postoperative 0.85 mg/dL (range 0.55-1.07) and 1.11 mg/dL (range 0.71-1.26), respectively. No recurrence or new lesions occurred in these patients at a mean follow-up of 7.7 months.ConclusionOur initial experience suggests that the novel technique of laparoscopic aspiration is a feasible, safe, and effective minimally invasive procedure for the treatment of RAML, especially the central RAML. It can be a nephron-sparing alternative and recommended in well-selected patients that might prove to be safer, with equal efficacy, and should be further explored.