A Target-Switching Strategy To Facilitate Retroperitoneal Laparoscopic Partial Nephrectomy For The Management Of Large Renal Angiomyolipoma (>= 6 Cm)

Retroperitoneal laparoscopic partial nephrectomy has been increasingly applied to treat large renal angiomyolipoma. We hereby propose a target-switching strategy to facilitate this surgery. For this new strategy, the kidney was resected from the angiomyolipoma, rather than resecting the angiomyolipoma from the kidney. The shrunken tumor without blood supply was then taken out. Large angiomyolipoma (>= 6 cm) patients who had retroperitoneal laparoscopic partial nephrectomy between April 2011 and May 2015 were reviewed in this study. Twenty-six patients underwent target-switching strategy. The average tumor size was 8.6 +/- 2.3 cm, and average Nephrectomy score (R.E.N.A.L score) was 7.4 +/- 1.6. Twenty-eight patients underwent traditional surgery. For these patients, the average tumor size was 8.2 +/- 2.1 cm, and average R.E.N.A.L score was 7.8 +/- 1.4. In target-switching group, shorter operation time and less blood loss were observed (p<0.05). The new target-switching strategy is technically feasible and may reduce operation time and blood loss. No major complication was observed in experimental group, and after one year, no tumor recurrence was observed by ultrasound or CT scan. Further randomized studies are needed to confirm our findings.