Hyperhidrosis, also known as excessive sweating, is characterized by sweating more than is necessary for physiological thermoregulation18. Although it may arise as a result of psychological factors or a variety of medical conditions, the majority of cases are cryptogenic, or so-called primary, and there is no discernible medical condition underlying it. Video-assisted thoracic surgery is finding an ever-increasing role in the diagnosis and treatment of a wide range of thoracic disorders that previously required sternotomy or open thoracotomy. The potential advantages of video-assisted thoracic surgery include less postoperative pain, fewer operative complications, shortened hospital stay and reduced costs. The VATS approach was initially used for simple diagnostic and therapeutic procedures involving the pleura, lungs, and mediastinum. The thoracoscopic sympathectomy was first described in 1944 . Numerous reports of thoracoscopic sympathectomy were published with the advent of endoscopic surgery. Two fundamental approaches have been described: One involves electrocautery of the sympathetic chain and the other involves electroresection of the appropriate ganglia. Ablation of the ganglia with a CO2 laser has also been reported, but only a few large series have been published up to this point. In a 2018 study identifying the long-term impacts of VATS sympathectomy for PH, the procedure was shown to increase quality of life in 84% of patients, and leading to satisfaction in 97% of the respondents.It is important to note that there are many potential side effects of VATS sympathectomy such as pneumothorax, bradycardia, gustatory sweating, Horner’s syndrome, rhinitis, and compensatory HH, .The specific side effects may be dependent on the rib level at which the procedure is performed, with procedures performed more superiorly generally causing more downstream effects