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Background: computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are both used in the preoperative assessment of vascular anatomy before donor nephrectomy. Our objective was to determine retrospectively and to compare the sensitivity of CTA and MRA imaging in preoperative renal vascularisation in living kidney donors., Patients and Methods: between 1999 and 2007, 42 kidney donors were assessed in our center: 27 by MRA, 10 by CTA, and five by both techniques. Images were interpreted using multiplanar reconstructions. Results were compared retrospectively with peroperative findings; discordant cases were re-examined by an experienced radiologist. Numbers of vessels detected with imaging methods was compared with numbers actually found at the operating time., Results: MRA showed 35/43 arteries (Se 81.4 %) and 33/34 veins (Se 97.1 %), and CTA showed 18/18 arteries (Se 100 %) and 15/16 veins (Se 93.8 %). The presence of multiple arteries was detected in only one third of cases (3/9) on MRI scans; this difference was statistically significant. The missed arteries were not detected on second examination of the MRI scans with the knowledge of peroperative findings., Conclusion: MRA is less sensitive than CTA for preoperative vascularisation imaging in living renal donors, especially in the detection of multiple renal arteries., (2010 Elsevier Masson SAS. All rights reserved.)

Introduction: The authors participated in the development of an innovative endoscope robot in laparoscopic surgery designed by TIMC-GMCAO, providing a solution to the disadvantages of currently available systems, i.e. their cost and large dimensions., Material and Methods: A compact robot (LER) placed on the patient's skin that can be used in the lateral and dorsal supine position was tested on cadavres and laboratory pigs in order to allow successive modifications. The current control system is based on voice recognition. The amplitude of vision is 360 degrees with an angle of 160 degrees. Twenty three procedures were performed (2 radical prostatectomies, 4 pelvic lymph node dissections, 6 nephrectomies, 2 adrenalectomies, 3 cholecystectomies, 1 small bowel resection-anastomosis, 1 cystectomy, 1 splenectomy, and 3 appendicectomies)., Results: Among the various control systems tested, we adopted voice recognition on the basis of its intuitive nature and the fact that it leaves one hand free. In the light of these studies, several aspects of the prototype were modified: reliability, fixation, ergonomy and dimensions. The ease of installation, which takes only 5 minutes, and the easy handling of the robot allowed 21 out of 23 laparoscopic procedures to be performed without the need for an assistant., Conclusion: The LER robot is an endoscope robot guided by the surgeon's voice that can eliminate the need for an assistant to hold the camera during laparoscopic surgery in the lateral and dorsal supine positions. The ease of installation and manufacture should make this an effective and inexpensive system. The gain in operating time was not evaluated during these trials on cadavres and pigs, as various prototypes were tested and several problems of reliability were successively resolved. Ongoing randomized, prospective clinical trials should soon validate this robot prior to marketing.

Objective: The objective of this study is to assess the results of our therapeutic management of blunt kidney trauma in patients hospitalised over the last 10 years., Materials and Methods: From January 1993 to January 2003, 105 patients were hospitalised in our department for blunt kidney trauma. We retrospectively studied age, gender, injured side, mechanism of trauma (direct, indirect or deceleration), aetiology, presence of associated lesions (visceral, orthopaedic), and clinical and laboratory signs on admission (haematuria, blood pressure, haemoglobin and serum creatinine). The grade of the lesions was defined by radiological assessment, specifying the presence or absence of devascularized fragments and urine extravasation. All complications were noted and studied according to the initial therapeutic management and grade. Follow-up was clinical (BP and search for renal pain) and radiological (CT and/or DMSA scan)., Results: 105 cases of blunt trauma of the kidney were hospitalised between January 1993 and January 2003 in our department. The mean age of the patients was 28.7 years (range: 7-75 years). Trauma was classified into 5 grades on the basis of the radiological assessment according to the ASST (American Society of Surgery of Trauma): 51 (49%) cases of grade 1 (n = 26) and grade 2 (n = 25) trauma, and 54 (51%) cases of major grade 3 to 5 trauma: 17 grade 3 (16%), 28 grade 4 (27%) and 9 grade 5 (8%) were diagnosed. Among the cases of major trauma, 7 (13%) were operated urgently during the first 24 hours: 4 cases of grade 5 trauma with renal artery dissection and 3 cases of grade 4 trauma with immediate uncontrolled bleeding. The nephrectomy rate (partial and total), when major renal trauma (grade 3, 4 and 5) (n = 47) was managed conservatively was 23% (11 nephrectomies) with the loss of 9.5 renal units (20%); this rate was 57% for grade 4 trauma presenting urine extravasation and devascularized fragments (n = 14). Twelve patients (7 with grade 4 trauma and 5 with grade 3 trauma) were reviewed by DMSA scintigraphy with a mean follow-up of 63 months (range: 26-108 months). Traumatized kidneys presented a mean function of 41.8% (range: 26.4-50%)., Conclusion: Blunt kidney trauma is usually managed conservatively. The development of interventional radiology, endourological drainage techniques and medical intensive care helps to maintain this attitude by decreasing the need for surgery, even in the most severe trauma.