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 any of the open sky surgeries in the thoracic cavity to be included in a minimal invasive approach. In this retrospective study 20 patients with hyperhidrosis affecting the upper limb were treated by endoscopic thoracoscopic sympathectomy. The traditional open approach which produces much truma, pain and significant morbidity has been replaced by this thoracoscopic approach, which provides detailed visualization of the sympathetic ganglia and is associated with minimal postoperative morbidity.