Primary hand sweating is a manifestation of hyperhidrosis due to excessive sweating of the palms of the hands caused by autonomic dysfunction, with the degree of hyperhidrosis ranging from moderately moist to sweaty hands in droplets, and the cause of the onset of the disease is still unknown. This dysfunctional disorder, which occurs since childhood, can cause many inconveniences to the patient’s study, work, life and social interactions, and even affects the student’s academic performance, resulting in psychological depression and social disorders. The incidence of hand in the general population is 2.8%, and 30% to 50% of patients with hand sweating have a family genetic predisposition. It is now believed that hand sweating is caused by abnormal hyperfunction of the sympathetic nervous system. Based on the amount of sweat in the palm of the hand is divided into: none: dry palms; mild: moist palms; moderate: palm sweat can wet handkerchiefs; severe: palm sweat is dripping. Moderate and severe cases are identified as hand sweating by experienced physicians. It has long been recognized that removal of the thoracic sympathetic nerve can treat hand sweating. Currently, thoracoscopic thoracic sympathectomy is the most effective and long-lasting treatment for hand sweating. The treatment mechanism is to cut off or remove the thoracic sympathetic nerve chain, blocking the postganglionic fibers sent out by it and distributing them to the upper limbs to innervate the sweat glands of the skin, so as to achieve the purpose of treating excessive sweating of the hands. Surgery is performed in a semi-sitting position (30°), with arms abducted in a cross, in the order of right side first and then left side, simultaneously and bilaterally, with only two one-centimeter incisions, with good results. No chest drains were placed postoperatively. The patient’s hands became dry and warm immediately after surgery. He got out of bed the next day after surgery and was discharged from the hospital on the third postoperative day.