De novo tumors in renal allografts are rare and their prevalence is underestimated. We therefore analyzed renal cell carcinomas arising in renal allografts through a retrospective French renal transplant cohort. We performed a retrospective, multicentric survey by sending questionnaires to all French kidney transplantation centers. All graft tumors diagnosed after transplantation were considered as de novo tumors. Thirty-two centers participated in this study. Seventy-nine tumors were identified among 41 806 recipients (Incidence 0.19%). Patients were 54 men and 25 women with a mean age of 47 years old at the time of diagnosis. Mean tumor size was 27.8 mm. Seventy-four (93.6%), 53 (67%) and 44 tumors (55.6%) were organ confined (T1-2), low grade (G1-2) and papillary carcinomas, respectively. Four patients died of renal cell carcinomas (5%). The mean time lapse between transplantation and RCC diagnosis was 131.7 months. Thirty-five patients underwent conservative surgery by partial nephrectomy (n = 35, 44.3%) or radiofrequency (n = 5; 6.3%). The estimated 5 years cancer specific survival rate was 94%. Most of these tumors were small and incidental. Most tumors were papillary carcinoma, low stage and low grade carcinomas. Conservative treatment has been preferred each time it was feasible in order to avoid a return to dialysis.

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The objective of the present study was to describe kidney temperature variations during transplantation and to identify the factors responsible for kidney warming. Kidney temperature was recorded steadily during transplantation. Kidney weight, body mass index (BMI), second warm ischemia time (t), and kidney temperature at the time of being placed in the recipient were analyzed so that we could evaluate their influence on kidney temperature and on kidney warming during transplantation. Kidney temperature at the time of removal from the container was 1.6 "C and 6.3 "C when the kidney was placed in the recipient. Kidney temperature in the recipient depended on kidney temperature after serum washing ( P < O.OOOl), but was independent of kidney preparation time ( P = 0.94). Then, kidney temperature (T) increased according to the logarithmic curve given in the following equation: T = 7.2 ln(t)-0.6. Kidney temperature at the end of anastomosis was 26.7 "C. Kidney warming speed was 0.48 "/min and was dependent on the length of time of vascular anastomosis ( P < 0.0001). Kidney weight decreased the kidney warming speed (P= 0.02). In conclusion, kidney warming increases slowly during ex vivo preparation. Kidney temperature stays below the damaging ischemic temperature of 18°C. Because of its major impact on kidney warming, it is desirable that vascular anastomosis time be reduced, and, consequently, ex vivo kidney preparation needs to be meticulous.

Authors from France describe their experience, in a small series of patients with pelvi‐ureteric junction obstruction, of laparoscopic robotic‐assisted pyeloplasty, and present their operative results with a 1‐year follow‐up. The accuracy of MRI renal angiography and venography in predicting vascular anatomy before donor nephrectomy is presented by authors from the UK. They present evidence suggesting that this technique has the advantage over CT of having virtually no side‐effects, and felt it was a good investigation. OBJECTIVE To report our experience with laparoscopic robotic‐assisted management of pelvi‐ureteric junction obstruction (PUJO) in patients with horseshoe kidneys. PATIENTS AND METHODS Between January 2002 and May 2003, two men and a woman with horseshoe kidneys (mean age 44.6 years) had laparoscopic dismembered pyeloplasty with robotic assistance for PUJO with no division of the isthmus. Two patients had renal stones which were extracted during surgery. None of the patients had had previous abdominal surgery. RESULTS The mean operative duration was 148.3 min, the mean estimated blood loss was <100 mL and the mean hospital stay was 7.6 days. Renal function was preserved in all three patients during the immediate and long‐term follow‐up as measured by intravenous urography. The three patients had durable clinical and radiographic success during a mean follow‐up of 21 months. One patient needed complementary extracorporeal shockwave lithotripsy, and one had an episode of pyelonephritis, which was treated successfully. There were no other significant complications before or after surgery. CONCLUSION Laparoscopic robotic‐assisted pyeloplasty for horseshoe kidney is safe and feasible, offering the advantages of minimally invasive surgical procedures with enhanced laparoscopic skills related to the use of the robot.

RALD nephrectomies were associated with very low morbidity among donors, in which both the operative and warm ischaemia times were of longer duration, but had no observable adverse effects upon short-term graft function.

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The attraction of using the Da VinciTM robotic system is considerable, despite the great costs involved. The three‐dimensional view and the wide degree of freedom of movement allows, as we are told, a procedure which can be learned more quickly than standard laparoscopic surgery. The authors from France describe their early experience with the technique and provide an overview of other robotic methods. OBJECTIVE To evaluate the experimental feasibility of laparoscopic computer‐assisted pyeloplasty for pelvi‐ureteric junction obstruction. MATERIALS AND METHODS Fourteen pyeloplasties were undertaken in pigs using a laparoscopic transperitoneal approach and the robotic surgical system (da VinciTM, Intuitive Surgical Inc., Sunnyvale, CA, USA). RESULTS The robotic surgical system provides real‐time three‐dimensional stereoscopic vision. Manipulating the intracorporeal endo‐wristed instruments from a remote console allows laparoscopic manoeuvres that are as easy as those during open surgery. Surgeons with no particular experience in laparoscopic surgery could learn complex surgery easily and quickly. CONCLUSION This technique provides faster training and the possibility of undertaking complex laparoscopic procedures, especially reconstructive, with less fatigue for the surgeon.

Our results demonstrate the safety and feasibility of robot-assisted laparoscopic cystoprostatectomy with ileal-conduit urinary diversion in two tetraplegic patients.