Introduction

To evaluate a multicenter series of robotic assisted partial nephrectomy (RAPN) performed for the treatment of large angiomyolipomas (AMLs).

Methods

Between 2005-2016, 40 patients with large or symptomatic AMLs underwent RAPN at 5 academic centers in the United States. Patient demographics, AML characteristics, operative and postoperative clinical outcomes were recorded and analyzed. Surgical outcomes were compared between patients who underwent selective arterial embolization (SAE) before RAPN and patients who did not undergo pre-RAPN SAE.

Results

Median tumor diameter was 7.2 cm (interquartile range [IQR]: 5–8.5 cm), and the median nephrometry score was 9 (IQR: 7-10). Six patients (15%) had a history of tuberous sclerosis, and 11 (28%) had previously undergone SAE. Median operative time and median warm ischemia time were 207 minutes (IQR: 180-231) and 22.5 minutes (IQR: 16-28), respectively. Non-clamping technique was applied in 8 (20%) patients. Median blood loss was 200 ml (IQR: 100-245), and 4 patients (10%) received blood transfusion postoperatively. One intraoperative complication occurred (2.5%), and 7 postoperative complications occurred in 6 patients (15%). During a median follow-up time of 8 months (IQR: 1-15), none of the patients developed AML-related symptoms. The median eGFR preservation rate was 95%. There were no differences in operative or perioperative outcomes between patients who underwent SAE before surgery and those who did not.

Conclusions

RAPN appears to be a safe primary or secondary (post-SAE) treatment for large AMLs, with favorable perioperative morbidity profile and excellent functional preservation. Longer follow-up is required to fully evaluate therapeutic efficacy.

Funding

none