Laparoscopic Off-Clamp Unsutured Partial Nephrectomy Using Soft Coagulation for a Large Renal Angiomyolipoma After Transarterial Embolization for Rupture

Abstract

Introduction:

Transarterial embolization (TAE) and partial nephrectomy (PN) are the standard treatments for a symptomatic or large renal angiomyolipoma (AML). ¹ PN for AML has shown high success rates and fewer retreatments than TAE. Recently, indications for laparoscopic PN have been expanded to large renal tumors to preserve renal function. We report a case of large AML effectively treated by laparoscopic off-clamp unsutured PN using soft coagulation ^2,3 after TAE for ruptured AML.

Patient and Method:

The patient was a 53-year-old female with complaints of left flank pain and vomiting. After diagnosis of the spontaneous rupture of the AML (85 × 81 mm), TAE was performed in a community hospital. Since the size of the tumor had not sufficiently decreased, she was referred to our clinic for surgery. Laparoscopic off-clamp PN was performed. The tumor resection was carried out using soft coagulation with the combination of monopolar scissors and bipolar forceps, without hilum clamping. Soft coagulation with a ball electrode was applied to bleeding points. Since no leakage from the urinary tract, nor bleeding, was found, suturing of the resected bed was not performed.

Results:

The operative time and pneumoperitoneum time were 372 and 282 minutes, respectively, including 86 minutes for the resection, and the estimated blood loss was 50 mL. No intraoperative or postoperative complications had occurred. The specimen was 106 g in weight with a diameter of 80 mm. The histopathologic diagnosis was AML and the resection margin was negative. Pre- and postoperative serum creatinine levels were 0.66 and 0.72 mg/dL, respectively. There was no evidence of recurrence 3 months after surgery.

Conclusion:

Laparoscopic off-clamp unsutured PN using soft coagulation for a large AML can be effectively performed even after spontaneous rupture and TAE.

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