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At least 595 records · Page 33Linked to original sources
PubMed2004

Laparoscopic live donor nephrectomy in a patient with duplex inferior vena cava.

BACKGROUND: Modern imaging, such as CT and MRI, improves the preoperative assessment for variants of renal vasculature. We present a kidney donor with a duplex inferior vena cava. In conjunction with CT and hand-assisted laparoscopic surgery, live donor nephrectomy was performed successfully. METHODS: A 35-year-old woman wished to donate a kidney to her son. Preoperative CT showed normal functional kidneys without uretal duplication. A duplex inferior vena cava was noted below the level of the left renal vein. A hand-assisted transperitoneal laparoscopic left nephrectomy was performed. Blood loss was minimal and the warm ischemia time was 3 minutes. Renal transplantation was performed with good initial perfusion and urine output. RESULTS: The donor was discharged in good condition at 3 days postoperatively. Both donor and recipient are alive with good renal function and without late surgical complications at 9 months. CONCLUSIONS: Live donor nephrectomy is unique as it involves two different patients. Benefits from laparoscopic operation include less pain, shorter hospital stay, earlier resumption of normal food intake, and earlier return to full activity. Graft function was not deleteriously affected and the survival of graft and recipient was not affected. Vascular anomalies, although uncommon, had a significant influence on live renal transplantation. Our patient represents a case of a rare venous anomaly, which has an an incidence rate of 0.5% to 3%. Helical CT with reconstruction of vascular anatomy helped in evaluating donor vasculature. In conjunction with modern imaging techniques and laparoscopic operation, live donor nephrectomy can be performed safely, even in patients with vascular anomalies.

Adolescent↗
PubMed2004

Retroperitoneoscopic live donor nephrectomy: extended experience in a single center.

INTRODUCTION: Retroperitoneoscopic live donor nephrectomy (RPLDN) was performed because it is considered to be less invasive than open live donor-nephrectomy (OLDN) or transperitoneal laparoscopic live donor nephrectomy. PATIENTS AND METHODS: Between July 2001 and May 2003, 118 consecutive live donor kidney grafts were procured using RPLDN or OLDN. The patients who underwent RPLDN were divided into 2 groups: an initial group 1 (n = 38) and a subsequent group 2 (n = 48).Thirty-two patients who underwent OLDN during the same period were used as controls (group 3). The patients were placed in the lateral position. Three retroperitoneoscopic ports were inserted. The kidneys were retrieved through a 5-cm flank incision just below the 11th rib in group 1. In group 2, a 5-cm Pfannenstiel incision was used to extract the kidney. RESULTS: The operative time was 307 +/- 88 minutes, 245 +/- 42 minutes, and 215 +/- 70 minutes in groups 1, 2, and 3, respectively (group 1 vs group 2 or 3, P < .01). The mean postoperative pentazocine (painkiller) requirements were 12 mg, 4.4 mg, and 22 mg in groups 1, 2, and 3, respectively (group 2 vs group 1 or 3, P < .01). The hospital stay was 6.6 +/- 1.6, 4.9 +/- 0.7, and 7.0 +/- 0.1 days in groups 1, 2, and 3, respectively (group 2 vs group 1 or 3, P < .01). There were no serious complication, such as massive bleeding or bowel injury. CONCLUSIONS: RPLDN may be safer and less invasive than open donor nephrectomy.

Humans↗
PubMed2005

Telementoring facilitates independent hand-assisted laparoscopic living donor nephrectomy.

Laparoscopic living donor nephrectomy is a major advance but a challenging procedure to learn even after laparoscopic training. It requires significant previous training in both laparoscopic and transplant surgery. Telementoring has been shown to reduce the laparoscopic learning curve in other fields. Of six cases of hand-assisted laparoscopic (HAL) living donor nephrectomy at our institution, an on-site mentor supervised the initial two. We present the subsequent four cases as the first documented examples of telementored HAL live donor nephrectomy. Telelink was established with a Comstation (Zydacron, UK) incorporating a Z360 telementoring codec and four ISDN lines (512 kb/s) with time delay of 500 ms for both audio and video. The remote surgeon in Minnesota (USA) could change independently between the laparoscopic and external views. The operating surgeons were able to look at the mentor and converse with him throughout. There were no adverse events in recipients and graft function was excellent. With regards to the telementored group the mean operative time was 240 minutes, the mean warm ischemic time 189 seconds, the mean estimated blood loss 171 mL, and the mean length of hospital stay 3 days. Telementoring for laparoscopic donor nephrectomy is feasible, effective, and likely to aid independent practice by providing continued supervision and reducing the learning period.

Adult↗
PubMedDate not supplied

Laparosopic hand-assisted living donor nephrectomy: the Niguarda experience.

Perioperative donor morbidity, a barrier to living organ donation, may be mitigated by the laparoscopic approach. From September 2002 to September 2004, 15 living donors, of ages ranging from 36 to 59 years, underwent laparoscopic nephrectomy. We used a hand-assisted device to increase the safety of the procedure. The average operating time was 200 minutes. The average blood loss was about 100 mL. The patients resumed oral intake and started walking within 1 day. The average postoperative hospital stay was 6 days. Although laparoscopic operating times were longer than those for traditional surgery, we showed benefits to the laparoscopic donor to be less postoperative pain, better cosmesis, shorter recovery time, and faster return to normal activities. We therefore consider laparoscopic nephrectomy a good alternative to traditional surgery for selected patients. Despite a lack of strong evidence, such as large prospective randomized studies, laparoscopic donor nephrectomy is likely to become the gold standard for donor nephrectomy in the near future.

Adult↗
PubMedDate not supplied

Hand-assisted laparoscopic nephrectomy versus transperitoneal anterior approach in living donors for renal transplantation.

The objective of this study was to compare two surgical approaches for living donor nephrectomy: transperitoneal anterior approach and the hand-assisted laparoscopic nephrectomy. Between January 2001 and October 2003 we performed 63 kidney transplantations from living donors. The transperitoneal anterior approach was used in 36 cases and the hand-assisted laparoscopic nephrectomy in 27. Outcomes were compared in terms of hospital stay, postoperative analgesia, and graft quality. Mean hospital stay was 4.7 days in the transperitoneal anterior approach group and 3.7 days in the hand-assisted laparoscopic group (P < .005). Postoperative analgesia dosage was significantly lower in the hand-assisted laparoscopic group (P < .001). Surgical complications and graft quality were similar. We concluded that hand-assisted laparoscopic nephrectomy patients had shorter hospital stays and less pain in the postoperative period, with better cosmetic results and equivalent graft quality compared to transperitoneal anterior approach patients.

Adult↗
PubMed2005

Laparoscopic nephrectomy: safe and comfortable surgical alternative for living donors and for good results of graft function.

Laparoscopic nephrectomy for kidney donation from living related donors has the advantages of a less invasive surgical access, better cosmesis, and a shorter hospital stay for the donor. However, some workers have reported up to 10% life-threatening complications for the donor using this technique. The purpose of our study was to evaluate hand-assisted laparoscopic nephrectomy for living donors of kidney transplants in terms of graft function. Thirty donors who underwent open nephrectomy (ON) were compared with 27 who had hand-assisted nephrectomy (HALN). Surgery and ischemia times, hospital stay, bleeding, graft function, remaining kidney function, and complications were compared in both groups. Mean surgery time was 126.9 minutes for ON and 98 minutes for HALN (P = .0005), warm ischemia time was 3 minutes versus 6 for ON vs HALN, respectively (P = .02). Hospitalization stay was 6.3 days for ON versus 4.8 days for HALN (P = .0015). Differences in change in hematocrit and in serum creatinine levels were not significant; graft outcomes were also similar. Complications were minimal. We conclude that HALN is a valid, safe technique to obtain kidneys from living related donors, significantly reducing the hospital stay and allowing return to normal activities sooner, with risks falling within those reported in the literature.

Female↗
PubMed2005

Modifications of renal blood flow and serum interleukin levels induced by laparoscopic and open living donor nephrectomies for kidney transplant: an experimental study in pigs.

The increase of intraabdominal pressure (IAP) during laparoscopy modifies renal blood flow (RBF). However, laparoscopic techniques are less invasive than open procedures. The use of interleukins (IL) to evaluate operative trauma of different surgical techniques is controversial. The aim of the study was to analyze the, modifications induced by laparoscopic and open nephrectomies on RBF, renal function and IL levels. Thirty pigs underwent left nephrectomy, 15 by laparoscopy and 15 by an open approach in an experimental autotransplant model. A significant reduction in RBF was observed among the laparoscopic (80 +/- 27 mL/min) versus the open group (263 +/- 3 mL/min, P < .05). Laparoscopy reduced glomerular filtration (GF) (37.6 +/- 1.1%) to a greater extent than an open technique (80.5 +/- 0.4%; P < .05). Serum levels of IL-2, IL-6, IL-10, and tumor necrosis factor (TNF) were lower during laparoscopic than open nephrectomy: 6.8 +/- 0.6 versus 13 .9 +/- 1.1 pg/mL for IL-2, 46.2 +/- 2.3 versus 84.4 +/- 2.5 pg/mL for IL-6, 26.1 +/- 2.4 versus 92.8 +/- 12.6 pg/mL for IL-10, and 17.6 +/- 2.1 versus 38.5 +/- 4.8 pg/mL for TNF (P <.001). In conclusion, laparoscopic nephrectomy for living donor kidney transplant induced significant reductions in RBF and GF. However, there was less increase in IL levels during laparoscopic than the open approach. The influence of these circumstances on graft function after kidney transplantation is not clearly established.

Animals↗
PubMed2006

Outcome of laparoscopic live donor nephrectomy in 2005: National survey of Japanese transplantation centers.

The increased acceptance of laparoscopic nephrectomy (LN) has been a driving force for live donor kidney transplantation. However, the outcomes of LN in live donors has not yet been clarified in Japan. In this study, we surveyed 125 Japanese kidney transplantation centers to investigate the current status of live donor LN. Of 125 centers, the 98 that responded had performed 695 live donor nephrectomies. Among these centers, 43 had performed LN. Among the 695 nephrectomies, 441 donors had undergone LN and 254, open nephrectomies. In 43 centers, 16 were performed as hand-assisted (HA) LN; 20, non-HA; 3, both HA and non-HA; and 5 laparoscope-assisted. Ten centers used a peritoneal approach; 30, a retroperitoneal; and 3, both. In 441 LN donors, 1 had a life-threatening complication of deep venous thrombosis and survived. Blood transfusions were performed in 7 donors. Open conversions from LN were necessary in 24. Minor complications not requiring prolonged hospital stay were reported in 52. The mortality of LN was zero. In contrast, among the 441 recipients, 1 case was reported as primary nonfunction after venous misadventure in the operation and 30 recipients needed hemodialysis after transplantation because of delayed graft function. Urinary tract complications were noted in 11 recipients. This survey presented the current status of the procedure, providing a base for informed consent from potential donors.

Blood Loss, Surgical↗
PubMed2003

Long-term outcome of laparoscopic radical nephrectomy for pathologic T1 renal cell carcinoma.

OBJECTIVES: To evaluate the oncologic adequacy of laparoscopic radical nephrectomy in patients with pathologic Stage T1 renal cell carcinoma, we analyzed the long-term results in those treated with laparoscopy and those undergoing open surgery. METHODS: The renal tumor of 263 patients was confirmed to be Stage T1 by pathologic examination of the radical nephrectomy specimen between January 1992 and June 2002. Of the 263 patients, 195 were treated laparoscopically and the remaining 68 by open surgery. The patient follow-up lasted until July 31, 2002. RESULTS: The follow-up period of the laparoscopy group was 2 to 121 months (median 40). A total of 183 patients survived, 5 died of renal cancer, 7 died without any recurrent disease, and 7 were lost to follow-up. Seeding of the port sites did not develop in any of the patients. Ten patients had metastatic or recurrent disease within 3 to 110 months, and 5 of these patients died of cancer within 12 to 86 months. The 5-year disease-free and patient survival rate was 91%, and 94%, respectively. The 68 patients who underwent open surgery were followed up for 11 to 126 months (median 65). Of the 68 patients, 56 survived without any recurrent disease, 4 survived with metastasis, 6 died of metastatic disease within 8 to 49 months, and 6 were lost to follow-up. The 5-year disease-free and patient survival rate was 87% and 94%, respectively. CONCLUSIONS: Laparoscopic radical nephrectomy is an alternative technique with comparable oncologic results to open nephrectomy in patients with localized pathologic Stage T1 renal cell carcinoma.

Aged↗
PubMed2004

Comparison of retroperitoneal laparoscopic and open nephrectomy for benign renal diseases in children.

OBJECTIVES: To compare the results of retroperitoneal laparoscopic versus open nephrectomy for benign renal diseases in children. METHODS: From January 1999 to February 2003, retroperitoneal nephrectomy or nephroureterectomy was performed in 23 consecutive children (7 girls and 16 boys). The median patient age was 4 years (range 1 to 13). The disease was on the right side in 9 children and on the left side in 14. Operative and convalescence parameters, including operative time, blood loss, transfusion rate, resumption of oral intake, hospital stay, and complication rate, were evaluated in both groups. RESULTS: All laparoscopic cases were completed successfully without conversion to open surgery. The median operative time and estimated blood loss were not statistically different between the two groups. No major perioperative complications occurred in any child, but a wound site complication occurred in 1 child who had undergone open surgery. The median hospital stay of the open group was 4 days (range 3 to 14), significantly longer than that of the laparoscopic group (median 2.5 days, range 2 to 6; P = 0.018). The cosmetic results of the laparoscopic group were excellent; the scars from the trocar sites were barely discernible at the initial postoperative visit. Convalescence was uneventful in all patients. CONCLUSIONS: Retroperitoneal laparoscopic nephrectomy and nephroureterectomy may be performed for benign disease in children with minimal morbidity, improved cosmetic results, and a short hospital stay. Our findings indicate that retroperitoneal laparoscopic nephrectomy is appropriate in children and superior, in some instances, to open surgery.

Adolescent↗
PubMed2004

Nephrectomy for multicystic dysplastic kidney: if and when?

OBJECTIVES: To evaluate the criteria for conservative versus surgical treatment of multicystic dysplastic kidneys and to attempt to specify the optimal timing for surgery, when considered indicated. METHODS: The study population comprised 48 antenatally or neonatally detected consecutive patients with unilateral multicystic dysplastic kidney. The fate of the affected renal conglomerate was regularly analyzed by ultrasonography. All cases were primarily followed up conservatively. In the patients who eventually underwent nephrectomy, the decision to operate was made after a minimum of 18 months (median 25). RESULTS: Ultrasound follow-up showed complete involution in 13 cases (27%); in 35 cases (73%), the renal conglomerate persisted throughout the study period (mean 46 months). Of the 48 patients, 32 (67%) eventually underwent nephrectomy. The size of the affected mass among the involuted cases was significantly smaller throughout the study period than in those requiring nephrectomy. The difference between the two groups continuously increased during follow-up, with a mean involution rate of 2.5 cm/yr versus 0.6 cm/yr (up to 18 months) for the involuted versus noninvoluted cases, respectively (P <0.0001). From 18 months on, no statistically significant involution was observed in those who eventually underwent nephrectomy. CONCLUSIONS: Patients with antenatally or neonatally detected multicystic dysplastic kidney can primarily be followed up conservatively. Involution occurs in approximately one fourth of the cases, usually within about 14 months. In our experience, no significant involution can be expected to occur after 18 months. If surgery is decided on, we recommend an age of about 2 years. Late complications (eg, Wilms' tumor and renovascular hypertension) are rare.

Age Factors↗
PubMed2004

Retroperitoneoscopic partial nephrectomy with transient occlusion of renal artery for treatment of small renal tumors.

OBJECTIVES: To evaluate the results of retroperitoneoscopic partial nephrectomy with transient occlusion of the renal artery for treatment of patients with small renal tumors. METHODS: From May 2002 to March 2003, 12 consecutive patients with T1N0M0 renal tumors with a median diameter of 3.0 cm underwent retroperitoneoscopic partial nephrectomy. The renal artery was clamped transiently without occlusion of the renal vein and the tumor was excised with scissors. Intracorporeal renal cooling was achieved by cold saline perfusion of the renal pelvis through a single-J ureteral catheter. Hemostasis was achieved by approximating the renal parenchyma over the perirenal fatty tissue using a retroperitoneoscopic suturing technique. RESULTS: Of the 12 patients, 11 successfully underwent partial nephrectomy retroperitoneoscopically. The median operative time, renal ischemic time, and amount of blood loss in the successful procedures was 220 minutes (range 132 to 340), 50 minutes (range 16 to 115), and 150 mL (range 50 to 800), respectively. The renal calix was opened and repaired in 10 patients. The surgical margin was negative in all patients. The postoperative course was uneventful in all patients, and the return to work was achieved in a median of 18 days (range 9 to 39). The renal function of the affected kidney was well preserved postoperatively, when examined by renal scintigraphy. Neither local recurrence nor distant metastasis was found during the median follow-up period of 10 months (range 1 to 18). CONCLUSIONS: Retroperitoneoscopic partial nephrectomy with transient occlusion of the renal artery is a useful and less-invasive method for resection of small renal tumors. Additional technologic developments to reduce ischemic times and to cool the kidneys laparoscopically are required.

Aged↗
PubMed2005

Canine model of surgical stress response comparing standard laparoscopic, microlaparoscopic, and hand-assisted laparoscopic nephrectomy.

OBJECTIVES: To compare the postoperative stress induced by standard laparoscopic, microlaparoscopic, and hand-assisted laparoscopic (HALS) nephrectomy in an animal model. METHODS: A total of 39 dogs underwent standard laparoscopic (n = 19), microlaparoscopic (n = 11), or HALS (n = 9) left nephrectomy. The serum cortisol levels were measured preoperatively, at skin closure, and 2, 4, and 6 hours postoperatively. RESULTS: Compared with the preoperative level, a sharp rise was noted in the serum cortisol taken at skin closure that correlated with both operative time (P = 0.003) and method (P = 0.009 for HALS versus microlaparoscopy and P = 0.02 for HALS versus standard). HALS had the lowest cortisol increase and shortest operative time, and microlaparoscopy had the greatest cortisol increase and longest operative time (P = 0.03 for cortisol increase, HALS versus microlaparoscopy). Two hours postoperatively, HALS was the only method associated with a continuing increase in cortisol levels (P = 0.01 and P = 0.02 compared with the other methods) and had the greatest cortisol level relative to baseline. The cortisol level decreased at all postoperative points in the other groups. By 4 hours, all methods were associated with similar and falling cortisol levels. CONCLUSIONS: HALS nephrectomy was associated with a greater operative stress response in the first 2 postoperative hours in dogs compared with standard laparoscopic and microlaparoscopic nephrectomy that was partially ameliorated by the lower intraoperative cortisol production in the more rapid HALS procedure. Microlaparoscopy provided no benefit in terms of reduced surgical stress. The stress differences among the techniques were insignificant by 4 hours postoperatively.

Animals↗
PubMed2006

Proposed classification of complications after live donor nephrectomy.

OBJECTIVES: A standardized classification for the potential complications of living donor nephrectomy is an essential step in establishing a construct for monitoring and reporting the outcomes of this procedure. It is also helpful in informing potential donors about the inherent risks of the donor operation as part of the informed choice process. METHODS: We reviewed 600 laparoscopic live donor nephrectomies performed at our center. A modification of the Clavien classification system describing procedure-related complications was developed and used to grade the severity of all complications. RESULTS: We observed 43 complications (7.2%) in our series of 600 patients. Grade 1 defines all events that, if left untreated, would have a spontaneous resolution or needed a simple bedside procedure (39.5%). Grade 2 complications differ from grade 1 in that they are potentially life-threatening and usually require some form of intervention, but do not result in ongoing disability. We subdivided grade 2 complications (55.8% in our study) into 2a, 2b, and 2c. The latter describes complications requiring open conversion of laparoscopic donor nephrectomy for patient treatment. Grade 3 complications are events with residual or lasting disability (4.7% in our review). Grade 4 events are those resulting in renal failure or death because of any complication (none occurred in our series). CONCLUSIONS: A graded classification scheme for reporting the complications of donor nephrectomy may be useful for maintaining registry information on donor outcomes and when informing potential donors about the risks and benefits of this procedure.

Humans↗
PubMed2006

Partial nephrectomy using a monopolar radiofrequency device: an animal model.

OBJECTIVES: To compare the use of radiofrequency (RF) and electrocautery in partial nephrectomy without renal artery clamping for bleeding and tissue destruction. METHODS: Sixteen adult rabbits were randomized into two groups. Partial nephrectomy using a monopolar RF device without renal artery clamping was performed in 8 rabbits (RF group) and partial nephrectomy using electrocautery was performed in the rest (cautery group). Four rabbits in each group (rabbits 1, 3, 5, and 7) were kept for follow-up, and the operated kidneys of the rest were removed for histopathologic evaluation. The tissue samples were placed in 10% formalin solution and sent to the pathology laboratory. The groups were compared in terms of bleeding and tissue destruction. RESULTS: The mean blood loss was 3.6 +/- 1.2 mL in the RF group and 8.3 +/- 2.7 mL in the control group (P = 0.003). A rabbit in the control group died on postoperative day 3 because of bleeding. Others were followed up for 3 months postoperatively. The amount of thermal destruction was comparable between the two groups. Varying degrees of thermal destruction were observed at the cutting margins in both groups. No difference was found between the two groups in terms of the deepness of thermal injury (1 to 2 mm). CONCLUSIONS: The findings of our experimental study showed that the use of the RF electrode in partial nephrectomy without renal artery clamping resulted in less intraoperative bleeding without differences in terms of tissue destruction.

Animals↗
PubMed2006

No evidence of disease after radiofrequency ablation in delayed nephrectomy specimens.

OBJECTIVES: Computed tomography and magnetic resonance imaging are routinely used during follow-up of radiofrequency ablation (RFA) of renal masses. Widespread acceptance of needle ablation is limited by the need to rely on radiographic criteria to confirm effective ablation. In this report, we correlated the long-term radiographic appearance of RFA with the histologic findings in three delayed nephrectomy specimens. This should enhance our understanding of the histopathologic features of successful RFA and highlight potential shortcomings of modern imaging after ablation. METHODS: Radiographic and histologic data were analyzed in 3 patients who underwent delayed partial or total nephrectomy after RFA, performed for complications or misinterpretation of postablation surveillance imaging findings. RESULTS: Two delayed nephrectomies were performed for new enhancement at the periphery of the ablation zone margin and one for RFA-related ureteropelvic junction obstruction. At the initial ablation, all 3 patients had biopsy-proven renal cell carcinoma, and the mean time to delayed nephrectomy was 18 months. Histologically, all three demonstrated absence of residual cancer within the ablation zone. In the patients with enhancement at the periphery of the ablation zone, a granulomatous foreign body giant cell reaction was found. CONCLUSIONS: RFA is an effective technology for eradicating small renal cell carcinomas. However, proper image interpretation after ablation is a crucial component of patient care. New enhancement at the peripheral margin of the tumor ablation zone does not invariably suggest malignant recurrence, but a benign granulomatous reaction. Additional experience with interpretation of cross-sectional imaging is required to better understand the radiographic evolution of radiofrequency-ablated renal tumors.

Aged↗
PubMed2006

Single-surgeon laparoscopic donor nephrectomy and renal transplantation.

OBJECTIVES: To demonstrate the feasibility of single-surgeon performance of laparoscopic donor nephrectomy and recipient living renal transplantation. METHODS: Fifteen consecutive donor-recipient pairs were performed from August 2003 and July 2004 by a single surgeon at one institution. Routine donor and recipient outcome measures were prospectively assessed. RESULTS: The mean donor height and weight was 66 in. and 151 lb, respectively. All donors underwent left nephrectomy. Renal arteries were paired in 3 (20%) of 15 donors. No donors underwent conversion or transfusion. No donor complications occurred. The mean operating room time, estimated blood loss, and hospital stay was 195 minutes, 200 mL, and 2 days, respectively. The mean recipient height and weight was 65 in. and 158 lb, respectively. The mean recipient age was 46 years (range 21 to 69). Of the 15 recipients, 3 (20%) had previously undergone transplantation. The mean operating room time, blood loss, and hospital stay for the recipients was 155 minutes, 100 mL, and 4.5 days, respectively. No recipient operative complications occurred. All allografts functioned immediately. The median recipient creatinine nadir was 1.1 mg/dL. Of the 15 recipients, 3 (20%) had postoperative complications during follow-up, including reintubation in 1, pneumonia in 1, and acute rejection in 1. The patient and graft survival rate were both 100%, and the mean serum creatinine was 1.16 mg/dL at a mean and median follow-up of 187 and 164 days (range 18 to 350), respectively. CONCLUSIONS: We report the first series evaluating the performance of single-surgeon laparoscopic donor nephrectomy and living renal transplantation. Single-surgeon performance of both laparoscopic donor nephrectomy and living renal transplantation is technically feasible and logistically straightforward. The donor and recipient outcomes are consistent with those reported in published reports.

Adult↗