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Background: The evolving thoracoscopy approach enhanced the thoracoscopic sympathectomy to become the surgical technique of choice for treating primary hyperhidrosis. Objective: To compare the results of 1ry hyperhidrosis patients treated by uniportal and biportal sympathectomy. Methods: In a Randomized control study, 36 cases were included complaining of signs and symptoms of hyperhidrosis, 18 of them underwent uniportal sympathectomy and 18 were managed by biportal sympathectomy in Cardio-thoracic Surgery Department, Faculty of Medicine, Zagazig University Hospitals. Results: There is a significant increase in operative time in the biportal group as compared to the uniportal one with p p-value < 0.0001. There is a significant increase in postoperative pneumothorax with p value = 0.0191 and intercostal chest tube insertion with p value= 0.0455 in the bipotal group. There is a significant increase in pain scores in the biportal group in comparison with the uniportal group. There is no significant difference in pain score between both groups after 3 months of the operation. There are no patients with pain scores of more than 1 after 3 months of the operation. There is a significant increase in patient satisfaction with the scar in the uniportal group compared to the biportal group with p value <0.0001 regarding the mean of both groups. Conclusion: Uniportal Video-Assisted Thoracoscopic Sympathectomy (VATS) sympathectomy may be better than biportal VATS sympathectomy in the management of primary Palmar hyperhidrosis as it takes less operative time with more patient satisfaction and minimal scar with minimal complication compared to biportal VATS sympathectomy. [ABSTRACT FROM AUTHOR]