Thoracic sympthectomy has been proven to the most effective method for the management of palmar hyperhidrosis. Among the many surgical modalities, video endoscopic coagulation of the T2 or T2 and T3 ganglia is one of the simplest and safest methods. Nineteen cases of palmar hyperhidrosis treated by this method are reported. The advantages and disadvantages of various surgical approaches are discussed.