Hyperhidrosis is characterized by excessive sweating unrelated to heat or exercise. Primary hyperhidrosis is diagnosed based on patient history and physical examination. Treatments include topical, oral, surgical, and non-surgical options, with thoracoscopic sympathectomy favored for its low morbidity, mortality, and minimally invasive approach. This study aims to assess if thoracoscopic sympathectomy is a reliable and effective treatment for palmar and plantar primary hyperhidrosis accompanied with less complication and more success by improving the quality of life. This prospective study included 50 patients with severe primary palmar and plantar hyperhidrosis who underwent thoracoscopic sympathectomy at the General Surgery departments of Al-Zahraa Hospital, Al Azhar University and Kobri-Elkobba Military Hospital. All patients underwent a thorough history, physical examination, routine preoperative tests, ECG, and chest and cervical X-rays to exclude cervical ribs and lung anomalies.  The duration of hyperhidrosis ranged from 2 to 6 years, with a median of 3 years. The palmar region affected by (56%), preceded by the plantar (90%) finally the axillary regions (34%). No intraoperative complications were reported. Postoperatively, 62% of patients reported a very good quality of life, 36% excellent, and 2% good, a significant improvement compared to preoperative assessments. Satisfaction rates were high, with 86% completely satisfied, 12% partially satisfied, and 2% unsatisfied. For palmar hyperhidrosis, 78.6% had completely dry hands one week after surgery, decreasing to 50% in six months. For plantar hyperhidrosis, 62.2% had completely dry feet at one week, decreasing to 40% at six months Thoracoscopic sympathectomy is currently considered the optimal technique for managing primary hyperhidrosis.