Background: Hyperhydrosis is a disorder that is characterized by excessive sweating in disproportion to that required for thermoregulation. In most cases, this may be aggravated by emotional factors. Hyperhydrosisis most commonly seen in the palms of the hands, axillae and feet. The principal characteristic of this disease isthe intense discomfort of patients, which affects their socialand professional life. Treatment modalities include topical application of aluminum chloride, iontophoresis, anticholinergics, botulinum toxin injection and thoracic sympathectomy. Methods: Between October 2009 and September 2011, a prospective study of endoscopic thoracic sympathectomies for palmar and axillo-palmar hyperhydrosis was undertaken based on case histories and a prospective pre- and postoperative assessment. The sample comprised of 20 patients with age ranging from 18 to 25 years. Bilateral simultaneous thoracoscopic sympathectomy in prone position was done in all cases. Excision of T3 was done in 10 cases, T3 and T4 in 4 cases and sympathotomy (disconnection) was done in 6 cases. Results: All patients had immediate cessation ofhyperhydrosis. The postoperative stay ranged from 12 to 24 hours. Compensatory sweating was found to be the most troublesome side effect. It was seen in 20% of the patients. This varied obviously according to the surgical technique used. Conclusion: In view of the low morbidity and zero mortality rate of this surgical technique, it is considered as one of the best methods of treatment for palmar andaxillo-palmar hyperhydrosis.