Laparoscopy and RoboticsPercutaneous Renal Cryoablation of Angiomyolipomas in Patients With Solitary Kidneys
Section snippets
Material and Methods
Three patients with AMLs involving a solitary kidney were identified at our institution. Two had undergone contralateral nephrectomy secondary to ruptured AMLs and the third because of urolithiasis. The lesions were 1.2-2.5 cm in diameter and located in a lateral/posterior position, allowing for safe access from the skin for cryoprobe insertion. Alternative available treatment options, including angioembolization, laparoscopic or open partial or total nephrectomy, and observation were
Case 1
A 49-year-old woman with a history of right nephrectomy secondary to a ruptured AML was noted to have a 1.6-cm contralateral AML on routine CT examination. Initially, the lesion was managed with observation until a subsequent scan demonstrated an increase in size to 1.9 cm. Percutaneous cryoablation was performed in June 2004. The preoperative BUN and creatinine value was 12 mg/dL and 1.3 mg/dL, respectively. The follow-up BUN and creatinine value at 1 year was 16 mg/dL and 1.4 mg/dL,
Comment
Renal AMLs are uncommon, occurring in approximately 0.1%-0.2% of the population, and generally considered to have a benign clinical course.1 Despite their nonmalignant nature, some lesions (generally those >4 cm) can enlarge and cause symptoms ranging from pain and hematuria to shock after rupture and hemorrhage.1, 2, 3 However, even with a nephron-sparing approach, surgical interventions of larger AML have a greater potential to negatively affect renal function, especially in patients with
Conclusions
The low prevalence of AML and limited prospective data, especially in clinical situations involving a solitary kidney or bilateral tumors, has made absolute treatment guidelines impossible. In the presence of a solitary kidney, lesions >4 cm should be treated, because numerous studies have established the risk of growth and hemorrhage with these lesions. The treatment of tumors <4 cm is controversial; however, variant growth patterns have been reported, and prophylactic treatment should be
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Cited by (17)
Retroperitoneal laparoscopic nephron sparing surgery for large renal angiomyolipoma: Our technique and experience. A case series of 41 patients
2018, International Journal of SurgeryCitation Excerpt :The traditional treatments for RAMLs include renal angioembolization (RAE) and surgical excision of the lesion. Innovations in minimally invasive treatments have resulted in additional nephron sparing approaches, including pure or robot-assisted laparoscopic partial nephrectomy (LPN) [3–5], laparoscopic or percutaneous ablation such as radiofrequency ablation [6], microwave ablation [7] and cryoablation [8], [9]. Open nephron sparing surgery (NSS) has been shown effective for RAML [10–14].
Laparoscopic cryoablation of angiomyolipomas in adolescents and young adults: A report of four cases associated with tuberous sclerosis and 1 case of sporadic origin
2016, Journal of Pediatric UrologyCitation Excerpt :Current treatment modalities of AML primarily consist of super selective angioembolization (SSAE) and partial nephrectomy [6]. Thermal ablative modalities, such as cryoablation, have become a possible alternative for treating AML [2,7,8]. Only one study has evaluated the use of cryoablation in pediatric patients with AML, which involved one 14-year-old asymptomatic and non-syndromic patient [9].
Recommendations for the management of renal involvement in tuberous sclerosis complex
2020, NefrologiaCitation Excerpt :As far as the material used is concerned, particles larger than 150 μm are preferred due to their efficiency and the lower risk of distant emboli.27 The use of ablation by freezing derives from its use in renal tumours of less than 4 cm in size, although it has been used occasionally for larger tumours.28 For the treatment of AML, efficacy of up to 100% has been reported, with the possibility of hospital discharge the next day, but there is insufficient information about complications.24
Application progress of percutaneous ablation therapy of renal angiomyolipoma
2019, Chinese Journal of Interventional Imaging and TherapyCryoablation of Renal Angiomyolipoma: An Evaluation of Safety and Efficacy
2017, Journal of Endourology