Abstract
Renal function can be significantly preserved after nephron-sparing surgery by decreasing the intraoperative ischemic duration or by performing off-clamp surgery. We report the case of a 56-year-old woman diagnosed with a minimal-fat angiomyolipoma arising from the renal capsule, which was successfully treated by retroperitoneoscopic partial nephrectomy without hilar clamping. Computed tomography revealed a 16 × 13 mm homogenous lenticular mass protruding from the lateral aspect of the left kidney. On both T1- and T2-weighted magnetic resonance images, the mass exhibited homogenous low-signal intensity and well-defined margins. Laparoscopic magnification indicated that the exophytic tumor was attached to the renal cortex by a small peduncle. The tumor was resected completely with negative surgical margin. The estimated glomerular filtration rate after surgery was nearly equal to that before surgery. Off-clamp laparoscopic partial nephrectomy is a feasible surgical option to prevent ischemic renal damage in select patients presenting with small, exophytic, and peripheral renal masses.
Highlights
Angiomyolipoma (AML) is the most common benign tumor of the kidney, and it comprises variable amounts of fat, smooth muscle, and abnormal blood vessels
The tumor was isodense compared with the healthy renal parenchyma; it was imaged by contrast-enhanced computed tomography (CT), which revealed a homogeneous mass with well-defined margins and a smooth interface between the mass and kidney (Figure 1)
The tumor bed was virtually free of blood, severe bleeding may occur from the renal parenchymal margin during off-clamp partial nephrectomy
Summary
Angiomyolipoma (AML) is the most common benign tumor of the kidney, and it comprises variable amounts of fat, smooth muscle, and abnormal blood vessels. The tumor was isodense compared with the healthy renal parenchyma; it was imaged by contrast-enhanced CT, which revealed a homogeneous mass with well-defined margins and a smooth interface between the mass and kidney (Figure 1). On both T1- and T2-weighted magnetic resonance (MR) images, the tumor exhibited homogeneous low-signal intensity and well-defined margins (Figure 2), appearing benign. It seemed to originate from the renal capsule. A vascular tape was introduced through the port and passed under
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