Objective To explore the feasibility of sympathectomy for hyperhidrosis palmaris using mini-endoscopic instruments and two ports approaches.Methods Thirty-one patients underwent sympathectomy using 3 or 5 mm mini-endoscopic through the cannula introduced at the fourth intercostal space and a 2.5 mm Hook-electrode through the cannula introduced at the second intercostal space on the anterior axillary line,without pleural drainage.Results All cases were successful without major intraoperative incident and postoperative complications,such as wound infection and bleeding.No analgesic was used.The average time of operations was(25?8) minutes each side.Hyperhidrosis palmaris was disappeared in 29 cases(93.5%),reduced in 2 cases(6.5%) postoperatively.Conclusions Sympathectomy using mini-endoscopic instruments and two ports approaches is safe,feasible and effective with good cosmetic result.