With the outburst of the use of video-endoscopic assisted techniques in the early nineties, thoracoscopy was one of the
most privileged domains. This is due to the already formed cavity maintained by the bony framework. This encouraged the performance of many of the "open sky" surgeries in the thoracic cavity to be included in a minimal invasive approach. In this study, we compared the results of upper thoracic sympathectomy that had been done either by the supraclavicular approach or by video-assisted thoracoscopic surgery. It was found that the thoracoscopic approach was easier to perform and less painful than the supraclavicular approach. Exposure was better, operative time and hospital stay were also reduced. The long-term success rate (one-year follow-up) was more than 90% in both groups. As thoracoscopic sympathectomy resulted in achieving similar long-term results as the supraclavicular approach, thus the endoscopic approach is the operation of choice when upper thoracic sympathectomy is contemplated.