Objectives: To evaluate the effectiveness of thoracoscopic sympathectomy at level of T2 and T3, for treatment of primary palmar hyperhidrosis and to evaluate the short term results of the procedure regarding the recurrence and complications. Patients & Methods: The study included 24 patients complaining of severe palmar hyperhidrosis, the study conducted at Department of Cardiothoracic Surgery, Benha University Hospital since Jan 2008 till Jan 2010 to allow a minimum follow-up period of 6 months from the last case operated upon. After doing the routine laboratory work and chest x-ray for all patients, they were operated under general anesthesia with single lumen endotracheal tube, using three ports, the patients were operated thoracoscopically by cauterizing and dividing T2 and T3 ganglia. Results: The study included 17 males and 7 females with mean age of 23.9±4.1; ranged from 18 to 33 years. Bilateral sympathectomy done for 79.2% of patients and unilateral right sided done for 20.8%. In 83.3% of patients there were no intraoperative, nor early postoperative complications. 4.2% of patients complicated intraoperatively by injury and bleeding from the 3rd intercostal vein. 8.3% of patients complicated by pneumothorax postoperatively. 4.2% of patients complicated by right sided Horner’s syndrome. Hospital stay ranged from 1 to 7 days with mean of 2.25 ±1.6 days. Follow-up monthly for 6 months showed no recurrence of palmar hyperhidrosis and 37.5% of patients complained of compensatory sweating. Conclusion: Thoracoscopic sympathectomy had excellent results in treating palmar hyperhidrosis with no recurrence on short term follow-up. The only undesirable effect of the procedure is the compensatory sweating which affected more than one third of the patients.