Background: Primary Hyperhidrosis is idiopathic excessive sweating can cause significant professional and social handicaps. Although treatments such as oral medications, Botox, and iontophoresis are available, surgical sympathectomy is being increasingly utilized. Methods: Between December 2009 and January 2012, 125 patients with palmar, axillary, facial, or plantar hyperhidrosis underwent a thoracoscopic sympathectomy in Alhada military hospital. Surgical technique was performed for them included cauterization of the sympathetic ganglia at T2, T3, and/or T4 depending on the location of the sweating, using monopolar cautery. A retrospective study was done to evaluate the results of the VATS sympathectomy for those patients. Results : All patients were males, data were collected after approval of the ethical committee, mortality was 0%, recurrence was 1.6%, dry facial skin was 10.4%, compensatory sweating was 88.8%, sensory loss was 17.6%, breast parathesia was 8%, intercostal neuralgia was 9.6%, hemothorax was 2% and pneumothorax was 2.4%, patients’ satisfaction showed significant difference between the pre and postoperative symptoms on the sweating satisfaction scale. Conclusion: VATS sympathectomy is a very safe maneuver for treatment of primary hyperhidrosis, it gives satisfactory results and accepted controllable complications.