Objective To assess the technical feasibility and safety of treatment of primary palmar hyperhidrosis under thoracoscope in single hole by using the incision protection sleeve． Methods Thirty cases of thoracic sympathectomy was completed under thoracoscope in single hole by using the incision protection sleeve． During the procedure，we accurately positioned the T3 and T4 sympathetic ganglion，and then inserted a thoracoscope and electric coagulation hook via the same pole to cut the sympathetic chain on the surface of the third or fourth rib head，as well as the possibly afferent branchial nerves along the rib，2 to 3 cm away the rib head． The palm temperature was measured before and after exciding the ganglion and the nerves． Ｒesults The procedure was completed successfully in all the 30 patients without leading to postoperative hemorrhage， infection，pneumohemothorax，tachycardia，or Homer’s syndrome． The mean unilateral operative duration was 7 minutes ( range: 5 － 12) ． The mean hospitalization duration was 2． 5 days ( range: 2 － 3 ) ． The mean follow-up period was 3． 5 months ( range: 1 － 10) ． No incision scar was found． During the period，no recurrence or severe compensatory hyperhidrosis occurred， two patients showed mild compensatory hyperhidrosis， accounting for 6． 7% of the 30 cases( 2 /30) ． All patients achieved excellent operative and cosmetic effects． Conclusions The treatment of primary palmar hyperhidrosis under thoracoscope in single hole by using the incision protection sleeve is a minimally invasive，effective，convenient，and safe procedure with accurate positioning of the ganglion and good cosmetic outcomes for patients．

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