Primary hyperhidrosis is a condition that commonly occurs in adolescents and young adults and is characterized by excessive sweating on the hands, feet, and axillae. In the past, it was often treated by internal medicine, Chinese medicine and dermatology, with poor and unsustainable results. Excessive sweating of the hands is the most important manifestation of hyperhidrosis and has a significant impact on life, learning, socialization and work. Non-surgical therapies have little efficacy, are not long lasting, or have significant side effects and relapse when the medication is discontinued. Traditional surgical treatment via supraclavicular or axillary approach or bilateral dissection has the risk of large trauma, poor exposure, difficult dissection, large scars affecting aesthetics, and potential damage to vascular nerves. Thoracoscopic sympathectomy is performed through three “keyholes” in the chest of 5 mm, 3 mm and 2 mm to remove the thoracic sympathetic ganglion of thorax 2-4, thus achieving the goal of treating hand sweating. Thoracoscopic sympathectomy has the advantages of minimal trauma, good exposure, accurate positioning, fast and safe operation, definite and long-lasting results and small scars.