The results of endoscopic thoracic sympathectomy performed for 787 patients during a 30-year period are presented. Six hundred seventy three patients were operated on for upper limb arterial occlusion of distal and diffuse type, Raynaud's disease or syndrome, 7 patients - for causalgic pain in upper limbs and Sudeck's syndrome, 85 - for hyperhidrosis. Twelve patients underwent lower thoracic sympathectomy for painful chronic pancreatitis, 4 - total destruction of thoracic sympathetic trunk due to pernicious hypertension of unknown origin, and 6 - endoscopic thoracic sympathectomy for acute thrombosis of upper limb arteries with distal circulation impairment. Immediate positive effect of interventions was detected in all cases except for acute arterial thrombosis. One patient died postoperatively due to arrhythmia-related cardiac arrest. Postoperative complications - lung border damage and intercostal vascular hemorrhage - were detected in 0.2% of cases. Increased air effusion from pleural cavity and intercostal neuralgia were observed postoperatively in some cases but did not require any special management. Long-term outcomes were followed up for period of 5-10 years, 72.7% of monitored patients had stable positive outcomes. Our experience has demonstrated that endoscopic thoracic sympathectomy is a safe, minimally invasive and effective intervention for upper limb chronic arterial insufficiency of distal and diffuse type or for hyperhidrosis.