The efficacy of open transaxillary sympathectomy in selected patients with hyperhidrosis, Raynaud's disease and causalgias is well documented. However, postoperative chest pain and dysethesias are common and often severe. We have utilized the new instruments and video cameras used in laparoscopic cholecystectomies to perform thoracoscopic cervicodorsal sympathectomies. The technique is simple, rapid, and provides superior visualization of the sympathetic chain - with almost no postoperative pain.