Background: Primary hyperhydrosis (PH) is a pathological condition that impacts the quality of life by inducing excessive, uncontrollable sweating in the palmar, axillary, and/or plantar regions. Objective: We aimed to evaluate the effectiveness of undergoing B-VATS in the treatment of patients with hyperhidrosis. Methods: This prospective cohort trial was carried out on 60 patients who were subjected to B-VATS for primary palmar hyperhydrosis (HH). All patients were subjected for grading of palmar HH on the hyperhidrosis disease severity scale, full history taking, preoperative scores level of participants activity, associated axillary/plantar HH, and family history. Results: Regarding the outcome, the average hospital stay was 35.1 ± 6.84 days, the average follow-up period was 8.98 ± 1.74 months, the incidence of compensatory sweating (CS) was 17 (28.33%), the cure rate was 54 (90%) and no recurrence or mortality was detected. Concerning the patients' satisfaction, the majority of the studied patients were satisfied [35 (58.33%)], 5 patients (8.33%) were very satisfied, 5 patients (8.33%) were neutral, and 6 patients (10%) were very dissatisfied. Conclusions: BVTS was an effective therapeutic method in treatment of hyperhidrosis had a higher cure rate, no recurrence or mortality with high patients' satisfaction. Early after VATS, CS was a significant health concern that impacted a considerable proportion of patients.