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COMMENTARY
Year : 2014  |  Volume : 6  |  Issue : 2  |  Page : 178-179  

Robotic nephrectomy for angiomyolipoma


Department of Urology, Wales Deanery, Cardiff, Wales, UK and Islamic University of Gaza, College of Medicine, Gaza, Palestine

Date of Web Publication15-Apr-2014

Correspondence Address:
Omar M Aboumarzouk
Department of Urology, Wales Deanery, Cardiff, Wales, UK and Islamic University of Gaza, College of Medicine, Gaza
Palestine
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PMID: 24833838

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How to cite this article:
Aboumarzouk OM. Robotic nephrectomy for angiomyolipoma. Urol Ann 2014;6:178-9

How to cite this URL:
Aboumarzouk OM. Robotic nephrectomy for angiomyolipoma. Urol Ann [serial online] 2014 [cited 2020 Aug 10];6:178-9. Available from: http://www.urologyannals.com/text.asp?2014/6/2/178/130664

Angiomyolipoma (AML) is generally considered a benign solid lesion, composed mainly of adipose tissue, dystrophic vessels, smooth muscles, and lack of epithelial component. [1],[2] AML has been reported to extend into the renal vein or vena cava leading to surgical intervention to exclude malignant potential in addition to removing the risk of fatal cardiopulmonary embolism leading to death. [1]

Though AML is a benign lesion, there have been reports of malignant transformation. [1] These lesions must be carefully interpreted when seen on CT scans, as carcinomas may contain fat as well and inflammatory conditions such as pyelonephritis, perinephric abscesses can also mimic AML appears on imaging. [2],[3] The optimal treatment for AML lesions that have extended into the vessels is radical nephrectomy and tumor thrombectomy. [1]

Since the development of robotic surgery in urology, numerous centers are adopting various surgical techniques with robot assistance. [4],[5]

With these advancements in technology and increasing skills of surgeons in using the robot for various urological procedures, the treatment of AML lesion which extends into the vessels is a logical next step in its development. In fact, Patel et al. have reported a case of partial nephrectomy of an epithelioid-AML lesion with successful outcomes in a young lady. [2]

The increased hand − eye co-ordination and precise movement of the robotic arms, coupled with the endowrist technology and 3D high definition screens, have made nephrectomy procedures using robots feasible and safe. [2],[4],[5] These features also allow for the surgical thrombectomy of the lesion from inside vessels, allowing precise suturing.

Numerous studies have shown a decreased hospital stay and quicker convalescence in patients that underwent robotic donor nephrectomy compared to both open and laparoscopic approaches. [6] Nonetheless, patients that present with vascular invading lesions need to be surgically operated on; the risk of death due to an embolic event necessitates this. While open nephrectomy is established and is the gold standard of treatment for renal cancers, the rapidly increasing skills in the use of robotics with the increased dexterity of the arms leading to precision surgery can potentially provide a safe alternative with less morbidity in patients with vessels invading AML. [6]

 
   References Top

1.Mittal V, Aulakh B, Daga G. Benign renal Angiomyolipoma with inferior vena cava thrombosis. Urology 2011;77:1503-6.  Back to cited text no. 1
    
2.Patel TH, Sirintrapun SJ, Hemal AK. Surgeon controlled robotic partial nephrectomy for a rare renal epithelioid Angiomyolipoma using near-infrared fluorescence imaging using indocyanine green dye: A case report and literature review. Can Urol Assoc J 2012;6:e91-4.  Back to cited text no. 2
    
3.Hélénon O, Merran S, Paraf F, Melki P, Correas JM, Chrétien Y, et al. Unusual fat containgin tumours of the kidney: A distnostic dilemma. Radiographics 1997;17:129-44.  Back to cited text no. 3
    
4.Dasgupta P, Jones A, Gill I. Robotic Urological surgery: A perspective. BJU Int 2005;95:20-3.  Back to cited text no. 4
    
5.Kumar R, Hemal A, Menon M. Roboic renal and adrenal surgery: Present and future. BJU Int 2005;26:244-9.  Back to cited text no. 5
    
6.Krambeck A, Gettman M. Robotic renal surgery: Radical and partial nephrectomy. Arch Esp Urol 2007;60:462-70.  Back to cited text no. 6
    




 

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