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Advances in video-assisted thoracoscopic surgery have allowed endoscopic surgical sympathicotomy to become a viable safe therapy for upper limb hyperhidrosis. We evaluated if and how this procedure improves the quality of life in patients after a mean follow-up of 9.5 years.Between 1995 and 2013, the senior author performed 1440 upper dorsal sympathicotomies in 720 patients. Questionnaires were submitted to randomized patients, both to evaluate the durability of the results and to assess their quality of life after surgery.In 46 patients, anatomical distinctive features obscured the sympathetic chain, precluding partial or total completion of the procedure. The other 674 patients reported complete relief of symptoms. A mean follow-up of 9.5 years (range, 2 to 17 y) was carried out on 450 patients: 6 recurrences have been observed, severe compensatory sweating was reported in 3 patients, and 441 patients were satisfied with nothing to complain. Furthermore, when comparing presurgery and postsurgery results, a statistically significant difference between most of patients answers came out (P=0.001).According to the data obtained, the procedure we described significantly improves the quality of life of treated patients, also proving the durability of this procedure.Minimally invasive endoscopic transthoracic sympathicotomy has proven to be an effective and durable surgical treatment for severe primary hyperhidrosis.