With recent advances in minimally invasive surgery, many thoracic procedures can now be performed via the video-assisted thoracoscopic approach, which is ideally suited for upper thoracic sympathectomy. From August 1992 to January 1995, 29 sympathectomies were performed at our unit on 15 patients suffering from palmar hyperhidrosis. Sympathetic chains with T2 and T3 ganglia were excised using an endoscopic diathermy hook. There were 10 women and 5 men with a mean age of 22 years (range, 17-31 years). The mean operating time for bilateral sympathectomy was 64 minutes (range, 40-95 minutes). All patients had dry hands and none developed Horner's syndrome. Mean post-operative hospital stay was 2.0 days (range, 1-4 days). Video-assisted thoracoscopy is the approach of choice for upper thoracic sympathectomy. Patients suffering from palmar hyperhidrosis can now be offered a safe and effective operation.