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Resumen Objetivo Los casos de angiomiolipoma renal gigante (> 9 cm) son un reto terapeutico por su baja frecuencia y su tamano. El objetivo del tratamiento de los pacientes con angiomiolipoma renal debe ser la extirpacion completa del tumor, con una tecnica quirurgica conservadora de nefronas, sin complicaciones y mediante un abordaje minimamente invasivo. Material y metodos Presentamos 3 casos de angiomiolipoma gigante (14, 12 y 10 cm) tratados mediante abordaje combinado: embolizacion supraselectiva y posterior nefrectomia parcial laparoscopica, en 3 hospitales diferentes. Resultados Ningun caso preciso reconversion a cirugia abierta, en uno de los 3 pacientes se realizo clampaje arterial y ninguno experimento complicaciones. Conclusiones El abordaje combinado permite una cirugia con criterios de minima invasion, conservadora de nefronas, con escaso sangrado y disminucion del tiempo de isquemia caliente.

Objective Cases of giant renal angiomyolipoma (>9 cm) are a therapeutic challenge due to their low frequency and large size. The treatment objective for patients with renal angiomyolipoma should be complete tumor extirpation, with a nephron-sparing surgical technique, without complications and using a minimally invasive approach. Material and methods We present 3 cases of giant angiomyolipoma (10, 12 and 14 cm) treated with a combined approach: superselective embolization and subsequent laparoscopic partial nephrectomy, in 3 separate hospitals. Results None of the cases required conversion to open surgery. One of the 3 patients underwent arterial clamping, and none of the patients had complications. Conclusions The combined approach provides a procedure with the criteria of minimal invasiveness, nephron sparing, little bleeding and reduced warm ischemia time.

Cases of giant renal angiomyolipoma (9cm) are a therapeutic challenge due to their low frequency and large size. The treatment objective for patients with renal angiomyolipoma should be complete tumour extirpation, with a nephron-sparing surgical technique, without complications and using a minimally invasive approach.We present 3 cases of giant angiomyolipoma (10 12 and 14cm) treated with a combined approach: superselective embolisation and subsequent laparoscopic partial nephrectomy, in 3 separate hospitals.None of the cases required conversion to open surgery. One of the 3 patients underwent arterial clamping, and none of the patients had complications.The combined approach provides a procedure with the criteria of minimal invasiveness, nephron sparing, little bleeding and reduced warm ischaemia time.