Due to advances in minimally invasive thoracoscopic techniques and continuous improvements in surgery, thoracoscopic sympathectomy in patients with hand sweats has become very safe and effective, with a cure rate approaching 100%. If the patient has a history of previous thoracic surgery or a severe infection in the lungs, this can make the procedure less successful because severe pleural adhesions may have been created in the thoracic cavity, making it difficult to find the sympathetic nerve trunk during surgery. Possible complications include hemothorax due to chest hemorrhage, pneumothorax due to rupture of the pleura and blisters of the lung layers, and compensatory hyperhidrosis. Compensatory hyperhidrosis is the most common of these complications, but now that we have improved the surgical approach (from cutting the T2 sympathetic trunk in the past to cutting the T4 sympathetic trunk now), this complication has also been greatly reduced, and intolerable compensatory hyperhidrosis rarely occurs.