Objective :Primary hyperhidrosis is a disorder characterized by excessive hand sweeting beyond the thermoregulatory needs , among all the different surgical approaches, video-assisted thoracoscopic sympathectomy has been shown as a safe and minimally invasive procedure for palmar and axillary hyper-hidrosis . our study will discuss the successful bilateral midclavicular single port sympathectomy versus bilateral trans axillary single-port video assisted thoracoscopic sympathectomy METHODS:Patients underwent preoperative, intraoperative, and postoperative follow up . Surgery was performed under general anesthesia and one lung ventilation .In our method all patients of group A through midclavicular approach were placed in the supine position with arms gently abducted underwent endoscopic surgery through 3 cm incision in the areola just below the nipple in male and 3 cm sub mammary incisions infemale in the midclavicular line and the thoracic cavity was approached through the fourth intercostal space. In group B through midaxillary approach the patients were positioned in lateral decubitus position. a single 2-cm long transverse axillary incision was made in the fourth intercostal space. Results:There was highly statistically significant difference between the two studied groups as regard mean operative time it was 48.2± 9.6 in group A and 60.3± 10.4 in group B . There was no statistically significant difference between the two studied groups as regard postoperative follow up data including post operative pain ,compensatory hyperhydrosis ,or worsening of the condition. There was no statistically significant difference between the two studied groups as regard other post-operative complications including residual pneumothrax segmental collapse horners syndrome residual shoulder pain There was significant difference in ,excellent wound healing and better cosmetic apearence. Conclusion:Both bilateral trans-axillary and mid clavicular one-staged video-assisted thoracoscopic sympathectomies are effective and safe.bilateral mid clavicular one-staged video-assisted thoracoscopic sympathectomies had less operative time less post-operative complication in the form of less infection, pneumothorax and collapse.