Hand sweating is an exocrine gland-induced hyperhidrosis that often causes psychological and social distress to patients and affects their work, study and life. Its pathogenesis is mostly thought to be related to sympathetic hyperactivity. Traditional conservative therapies include oral aluminum chloride preparations, anticholinergic drugs, iontophoresis, botulinum toxin BTX-A injections, etc., but all have limited efficacy, while taking thoracoscopic sympathectomy is effective and minimally invasive, and is a treatment method for hand sweating that is widely carried out worldwide. The surgical methods include three-hole, two-hole, single-hole surgery with mediastinoscope or pleural biopsy, and single-hole surgery with 2.5mm thoracoscope and 5mm electrocoagulation hook, which has reduced the trauma to a minimum. However, minimally invasive surgery is not only to pursue the smallest incision, but also to treat the disease thoroughly with minimum disturbance to the body, physiology and psychology. Therefore, the selection of the appropriate anesthesia and the selection of the surgical position to shorten the surgical time are all factors to be considered in minimally invasive treatment of hand sweating. The vast majority of minimally invasive hand sweating procedures are performed under general anesthesia, with different types of tracheal intubation including double-lumen tracheal intubation, single-lumen tracheal intubation, bronchial balloon tube, and laryngeal mask ventilation. The physiological disturbance to the patient is much greater with general anesthesia than with local infiltration anesthesia, and the patient needs to undergo a period of postoperative awakening, which undoubtedly prolongs the hospitalization and observation time, and the cost of anesthesia accounts for almost half of the overall treatment cost. Therefore, simplifying the anesthesia method can promote the simplification of thoracoscopic underhand sweating treatment surgery, reduce the cost, and make it more acceptable to patients. Because thoracoscopic surgery requires access to the chest for operation, local anesthesia is generally unfavorable for respiratory management due to concerns about respiratory interference and mediastinal oscillation. However, considering that patients with hand sweats are mostly young and strong with good respiratory function reserve, they can tolerate a certain degree of artificial pneumothorax or even unilateral lung ventilation; the trocar with self-activated valve can prevent air from freely entering and leaving the chest during surgery and prevent mediastinal oscillation. So there have been clinical studies to investigate the feasibility of local anesthesia in thoracoscopic sympathectomy. Stefano Elia et al. reportedly completed 15 cases of hand sweats using intercostal nerve block plus local infiltration anesthesia. The patient was placed in a lateral and slightly anterior position, and 0.75% ropivacaine was used to infiltrate a total of three intercostal areas above and below the incision plane, with 4 ml in each intercostal area; the patient was kept on spontaneous respiration and masked with oxygen during the procedure, and blood pressure, ECG, pulse oximetry, and hand temperature changes were monitored. 2 % mabivacaine 10 ml was used to infiltrate the 3rd and 4th intercostal areas in the mid-axillary line, and then a 5-mm incision was made to place the mirror and electrocoagulation hook, respectively. The rest of the procedure was performed in the same way. No sedative or intravenous analgesic was used throughout the operation. After postoperative positive pressure ventilation with a mask, the lungs were observed to reopen under the microscope, one incision was closed with a suture, and a temporary drainage tube was placed in the other incision with continuous low negative pressure suction; the position was changed, and the procedure was completed on the opposite side as well. The operation was observed for 1 hour, and the chest X-ray was reviewed to exclude pneumothorax, and the patient was discharged on the same day. There was no difference in surgical outcome, bleeding and pneumothorax complications compared with the general anesthesia control group, but the operative time was shorter and the cost was significantly lower. Another group, Awad MS et al, completed 14 cases using a similar method of local anesthesia. The difference was that a mixture of 0.5% lidocaine hydrochloride and bupivacaine was used to infiltrate anesthesia in the three intercostal areas above and below the incision plane, respectively, with 10 ml per intercostal area and 5 ml each subcutaneously and deeply, with the total amount controlled at about 30-45 ml based on 7-20 mg/kg. Intraoperative spontaneous breathing and face mask oxygenation were maintained. Three 5-mm holes were opened in the fourth intercostal space in the mid-axillary line, the third intercostal space in the mid-axillary line adjacent to the anterior border of the latissimus dorsi muscle, and the fifth intercostal space in the posterior axillary line, and the pleura was first opened with scissors in the first hole to cause pneumothorax, and then trocar was inserted in the other two points, and thereafter the operation was performed in the same way as other thoracoscopic sympathetic chain severing operations. When changing position to perform contralateral surgery, a 10F temporary chest drainage tube was placed with continuous low negative pressure suction and removed after adequate postoperative lung expansion. Preoperative sedative medozolam was applied, intraoperative intravenous pethidine (pethedine) was used for analgesia, and nine of them still needed supplemental diclofenac for analgesia, and postoperative analgesics were not routinely used. Intraoperative problems may be encountered when the patient coughs and the patient may need intensive analgesia, but in general, thoracoscopic sympathetic chain dissection under local anesthesia is a safe, feasible, inexpensive and patient-friendly method, especially for those patients who are afraid of general anesthesia. In this paper, we summarize the different anesthesia methods currently used for thoracoscopic sympathectomy and conclude that local infiltration anesthesia can successfully perform double-port thoracoscopic sympathectomy with no difference from general anesthesia, while the operation time and hospitalization time are significantly shortened and the cost is significantly reduced, and the operation can even be completed on an outpatient basis.