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Can thoracic sympathectomy and lumbar sympathectomy be done at the same time?

So far these two procedures have not been done at the same time. There are a few reasons for this.

  1. We do not have the ability to judge what will be the response of the sympathetic system when two locations (thoracic and lumbar) are affected at the same time. We do not have any way to ascertain what reaction the body would have.
  2. Lumbar sympathectomy is usually a longer and more demanding procedure. As far as it is known so far these two procedures have never been done together. Dr. Reisfeld believes the procedures should be done separately.
  3. So far very limited clinical experience has been obtained in regards to doing both lumbar sympathectomy and thoracic sympathectomy at the same time. Those cases were done with one side thoracic sympathectomy and the same side lumbar sympathectomy on one day, and the other sides were done at a later date. The results were good but the final clinical recommendation at this point is not to perform both procedures at the same time because we still have some unanswered physiological questions such as blood pressure and adjustments of sympathetic system to this new approach.
  4. A general rule in surgery says that no two elective operations on different parts of the body should be done at the same time. This rule is based on pure logical considerations and most importantly patient safety.
  5. As long as the exact neuro-physiological functions and anatomy is not yet totally understood and deciphered it is better to give the body time to adjust to one procedure before conducting a second operation.

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