Endoscopic thoracic sympathectomy was first described by British surgeon Hughes in 1942. After decades of development, TV thoracoscopic thoracic sympathectomy has gradually become the preferred modality for upper thoracic sympathectomy and a safe and effective surgical method for the treatment of hand sweating. With the application and popularization of TV thoracoscopic technology in China, thoracoscopic technology has been successfully used in the field of surgery for the diagnosis and treatment of some diseases under local anesthesia. We performed TV-assisted thoracoscopic bilateral thoracic sympathetic nerve trunk dissection under local anesthesia in 18 patients with hand sweating from 2007.5 to 2008.4, which is reported as follows. 1. Clinical data and methods 1.1 General data 1.2 Surgical method Preoperative fasting 4h, emptying the bladder before entering the operating room. Patients were monitored with continuous ECG, noninvasive blood pressure and oxygen saturation, and oxygen was administered by mask. Intravenous access was established for intraoperative drug administration. Intramuscular dulcolax 50 mg, promethazine 25 mg and codeine 10 mg were administered, and fentanyl 0.1 mg + fluparidol 5 mg was administered intravenously if necessary. Firstly, the patient was fixed in the left lateral position (the same method was used for left-sided surgery), disinfected and toweled according to the routine chest surgery; after local infiltration anesthesia with 0.75% bupivacaine in the right mid-axillary intercostal space, a 1-cm-long incision was made, and a passage into the pleural cavity was separated by a vascular clamp, and an 18-gauge venipuncture needle was inserted into the pleural cavity, the needle core was removed, and a cotton pad was used to block the external mouth of the cannula, and the cotton pad was released intermittently to make the gas enter the pleural cavity slowly. The trocar with a closed trocar device was quickly poked into the chest cavity to form a stable closed pneumothorax; a 30° thoracoscope was placed to observe whether there were adhesions in the chest cavity, and then two incisions were selected between the anterior and mid-axillary lines between the ipsilateral Ⅳ ribs under thoracoscopic guidance at a distance of about 3 cm, and the trocar with a closed trocar device was poked into the chest cavity with the same method of anesthesia, and a separator was placed near the anterior axillary line, and another one was placed. The separator was placed near the anterior axillary line, and the electrocoagulation hook was placed in the other place, so that all three places could achieve a good sealing effect to maintain a satisfactory closed pneumothorax; the separator poked the lung tissue to help expose the paravertebral sulcus and the T2-4 sympathetic nerve trunk in front of the small head of the ribs, and the T2-3 was cut off by cautery for those with head sweating, and the T3-4 was cut off for combined axillary sweating; and 4cm-5cm incisions were made along the surface of the ribs on both sides of the nerve trunk to ensure that the possible After the completion of intra-thoracic operation, the upper incision was firstly sutured, and 2 stitches of suture were left at the muscular layer of the cavity without knotting for the time being, and a negative pressure suction tube was put in and the anesthesiologist was instructed to continue masking the lungs while suctioning, and the suction tube was quickly removed and the suture was knotted after the gas was exhausted, without leaving the closed chest drain. Intradermal absorbable suture was closed and covered with a band-aid. Primary hand sweating is a sweating disorder of unknown origin, caused by abnormalities in the exocrine glands due to hyperfunction of the thoracic sympathetic nerves, ranging from moderately moist to dripping hand sweat. It usually begins in childhood or adolescence and becomes obvious at the age of 20 to 30. Thoracic sympathectomy is the only effective and long-lasting treatment for hand sweating, except in cases secondary to endocrine disorders, obesity, central nervous system disorders, and anxiety disorders.