Background: Every passing day brings new innovations to medical science and Thoracic Surgery is no exception to it. We have witnessed gradual evolution in VATS from multiple ports to single port over the last two decades. Objective: To evaluate whether this evolution is worth in terms of minimizing the postoperative complication. Study Design: Prospective randomized observational trial.

Background: Hyperhidrosis is bilateral, symmetrical and profuse sweating beyond physiological limits of the body. It is an important disease that causes social and emotional disturbances. Conservative treatment has poor results and most of the patients end up in surgical remedy eventually. The choice of operation is Bilateral Sympathectomy which has excellent results. Objective: The aim of this study was to assess the demographic features of patients and to evaluate the outcome of VATS Sympathectomy. Study Design: Prospective Study. Setting: Aseer Central Hospital, Saudi Arabia. Period: September 2017 to March 2020. Material & Methods: Bilateral VATS with resection of sympathetic chain from T2 to T5 was done depending upon the area involved in hyperhidrosis. Results: 28 (58.3%) male and 20(41.6%) female patients with mean age 21 years (range 19 to 53) were documented. 40% of the patients related their condition to be familial. Most common site of involvement was combined Palmer Plant and Axillary in 26(54%) whereas isolated facial hyperhidrosis was the least involved area. Complication rate was 12% with no mortality recorded. Excellent results with 98% patient’s satisfaction was found. Conclusion: Bilateral VATS sympathectomy is the gold standard surgical treatment for Primary Hyperhidrosis with excellent results.