The treatment of choice for primary hyperhidrosis of the hands and feet, or sweat of the hands, is minimally invasive thoracoscopic sympathectomy. However, there are widespread questions and concerns about the outcome of the surgery, especially postoperative complications such as compensatory hyperhidrosis, which is the most common form of hyperhidrosis. In fact, the core factor determining the outcome of surgery, especially compensatory hyperhidrosis, is the surgical approach, i.e., the segment and extent of the sympathetic chain severance. To talk about results, you need to start with the surgical approach. At present, in the treatment of sweaty hands, the domestic and foreign use of surgical T2 cut off, T3 cut off, T4 cut off, as well as a variety of different combinations of multi-site cut off, etc. T2 cut off the postoperative compensatory hyperhidrosis is very strong, the patient is often very painful, the network of sympathetic surgery to be denied, condemnation, and even denigration of the people are basically this T2 cut off the postoperative ” victims”. This procedure has now been completely abandoned in experienced units (but it seems to be still done in some units, which should not be the case!) T3 cut off to a large extent to reduce the incidence of compensatory hyperhidrosis, but there are still a small number of patients with compensatory hyperhidrosis symptoms are more serious, the patient will therefore feel distressed; individual patients with postoperative palms are too dry, chafed and uncomfortable. 2004, the international doctors began to try to T4 cut off to treat hand sweating, and the results achieved satisfactory results, since then this procedure has been widely adopted in recent years. In recent years, a number of international articles have been published on the comparison of this procedure with other procedures, and the results invariably concluded that T4 cut off is superior to any other single-site or multi-site cut off surgical methods. Now summarized, the advantages of this T4 cut off mainly reflected in two aspects, ① compensatory “sweating” (rather than “excessive sweating”) phenomenon, although it also occurs, but the symptoms are very mild, the patient basically does not have any impact; ② it is completely corrected in the “excessive sweating” at the same time does not completely destroy the palm of the “sweat” this normal function, some patients in the hot weather palm will still be slightly moist, on the surface this does not seem to achieve the “cure”, but in fact it is to let the palm of the “sweat”, but not to achieve the “cure”, but in fact it is to let the palm of the “sweat”. On the surface, this does not seem to be a “radical cure”, but in fact, it allows the patient to return from “patient” to the state of “normal” (neither sweaty, nor too dry), domestic and foreign comparative studies have shown that the patient satisfaction of this procedure is significantly higher than that of other procedures. Comparative studies at home and abroad have shown that patient satisfaction with this procedure is significantly higher than with other procedures. In order to cater to the patient’s desire for a “cure”, some doctors prefer to cut in a higher position, but this may result in more severe compensatory hyperhidrosis after the operation, which will be a lifelong pain for the patient after the operation. In fact, the treatment of sweaty hands is simply to correct the excessive sweating of the palms of the hands, as suggested by Hashmonai M in 2001, “A dry hand is the surgeon’s expectation, not the patient’s wish”, and ChoiBC in 2003, “The ideal treatment outcome for sweaty hands is the same as that of a dry hand”. The ideal treatment outcome for sweaty hands is to correct excessive sweating while avoiding dryness and maintaining the palm in a mildly moist state”. It is hoped that these ideas will be brought to the attention of more surgeons practicing this procedure.