Objective: Thoracoscopic sympathicotomy is effective in treating not only palmar hyperhidrosis, but also axillary hyperhidrosis. But studies for axillary hyperhidrosis accompanying osmidrosis are few. We report the outcome of six axillary hyperhidrosis with osmidrosis with literatures review. Methods: Using a minimally invasive technique, thoracoscopic T3-4 sympathicotomy was performed. The results of sympathicotomy of third and fourth sympathetic chains of six patients from January 1999 to August 2003 for axillary hyperhidrosis with osmidrosis were reviewed. Results: All patients had a successful outcomes, their profuse sweating ceased. Two patients suffered from compensatory hyperhidrosis. Three patients disappeared or diminished foul odor but three patients complained remained osmidrosis. Conclusion: In the treatment of axillary hyperhidrosis, the sympathicotomy of T3 and T4 chain is an effective method but osmidrosis must be treated according to its cause.