Endoscopic thoracic sympathetic surgery is a safe and effective method of treating palmar hyperhidrosis. Although hand dryness is the positive outcome of surgery, a residual amount of moisture in the hand is believed to improve the quality of life. Reflex sweating is a well-recognized and annoying complication that surgeons endeavor to avoid. From May 1, 2002 to July 31, 2002, 52 patients suffering from palmar hyperhidrosis were operated on by means of endoscopic clipping of the upper part of the T4-sympathetic ganglion (Upper ESB4). There were 24 males and 28 females with a mean age of 25 years. The mean follow-up period was 8.3 months. The patients answered a detailed questionnaire addressing the following issues: the recurrence rate, the degree of hand dryness, the extent of and areas of reflex sweating, the occurrence of gustatory and facial sweating, and the degree of satisfaction. The surgical outcome was satisfactory. Most patients demonstrated no or only slight hand sweating. Moderate sweating without discomfort was experienced in 9% of patients. Only 25% of patients required the use of lotion for hand dryness. Reflex sweating was observed in 87.5% of the patients but extremely uncomfortable in only 3.2%. Ninety-four percent of patients were satisfied. The remaining 6% were not satisfied but did not regret the operation. Although the duration of the follow-up period in this study was relatively short, we could obtain results comparable to other data in the literature. This is a simpler procedure and less damaging to the sympathetic system.