Thoracic sympathectomy is a widely recognized surgical intervention for treating hyperhidrosis, a condition characterized by excessive sweating that significantly impairs patients' quality of life. Despite its efficacy, this procedure often leads to compensatory sweating (CS), which remains a substantial challenge in patient management. This letter reviews recent studies addressing both the benefits of thoracic sympathectomy and the ongoing efforts to manage CS. Advances such as laser speckle flowgraphy for identifying and targeting sympathetic nerves, comparisons between robotic and video-assisted thoracic sympathectomy, and investigations into different levels of sympathetic chain resection provide new insights into optimizing treatment outcomes. While these developments offer promising strategies for reducing CS and enhancing patient satisfaction, further research is required to establish their long-term effectiveness.