Objective:To evaluate the efficiency of Video-assisted thoracoscopic sympathictomy plus bypass fiber resection for palmar hyperhidrosis and introduce the experience regarding the prevention of related postoperative complication. Methods :The clinical data of 355 cases of primary palmar hyperhidrosis who underwent bilateral Video-assisted thoracoscopic sympathictomy plus bypass fiber resection from May 2005 to November 2008 was analyzed retrospectively. The curative results as well as incidence of postoperative compensatory hyperhidrosis (CH)were compared between T 2~4 group undergoing T 2~4 sympathictomy (n=218)and T 3~4 group undergoing T 3~4 sympathictomy(n=137). Results:Operation was successfully performed on all patients and their palmar hyperhidrosis was completely alleviated after operation. No surgery-related postoperative severe complication occurred. The CH rate of T 3~4 group was 5.1%

significantly lower than that of T 2~4 group (23.9%

P <0.01). Conclusion:Video-assisted thoracoscopic sympathictomy is an effective

safe and minimally invasive procedure for palmar hyperhidrosis.Denervation at lower level (T 3~4 instead of T 2~4 )appears associated with less severe CH in postoperative period.