With the development and popularization of modern imaging techniques such as renal ultrasound, CT and MR, the detection rate of asymptomatic, small-sized, early renal tumors confined to the kidney is increasing. It is generally believed that RAML is a benign tumor composed of mature or immature fat, thick-walled blood vessels and smooth muscle in variable proportions.RAML is rarely malignant, and for those with a clear diagnosis, surgical treatment is mainly aimed at resecting the tumor to prevent it from growing further, eliminating the symptoms, preserving the renal function, and preventing spontaneous rupture and hemorrhage. Surgical treatment of 4 cm or symptomatic patients is usually done by preserving the renal unit, i.e., local enucleation of the tumor or selective vascular embolization, and Kessler et al. suggest that even very small RAMLs may cause symptoms or intratumoral hemorrhage, and suggest that all of them should undergo surgical treatment. Conventional open nephrectomy requires a 20-cm-long incision in the lumbar region and extensive separation of retroperitoneal tissues in the process of isolating the renal hilum, which results in a large amount of surgical injury and is limited by a narrow operating space and a single viewing angle, which makes haemostasis cumbersome and bleeding more. Laparoscopic technique can make up for the defects of traditional open partial nephrectomy and expand the indications of the operation due to its minimally invasive, multi-angle observation, enlarged field and precise operation, combined with the rapid and steady cutting and hemostatic effect of ultrasonic knife and the wide application of absorbable hemostatic gauze. In our department, dozens of patients underwent laparoscopic tumor enucleation, and the operation time and intraoperative bleeding were significantly less than that of traditional open surgery, and the postoperative recovery was fast, the hospitalization time was short, and the results were good. Recently, however, a case of renal central angiomyolipoma with a size of about 2.5×2.5cm was admitted, which was generally considered to be under follow-up observation. However, considering that the tumor was located at the renal hilum, and that it was difficult to operate once the tumor was enlarged, and that there was a possibility of nephrectomy, the patient and his family communicated with him and the patient was treated with open enucleation of the tumor, and it was found that the tumor was close to the renal vein, and the surgery went very smoothly. Through this case, it was realized that different treatment methods should be adopted for renal vascular smooth muscle lipoma according to different cases.