Vasospastic disorders (acrocyanosis, Raynaud's syndrome, causalgia) can arise from different etiologic factors, but the pathogenesis is always represented by an altered mechanism of vasal motility. Upper dorsal sympathectomy has been demonstrated to be an effective treatment for these disorders by decreasing peripheral resistances. Surgical technique has shown long-lasting results, and it can now be performed by endoscopic approach.Our experience with six cases of sympathectomy is illustrated. The indications, thoracoscopic technique, complications and long-term results are evaluated. Four women with Raynaud's syndrome and two men with causalgia were treated in this series. After an accurate preoperative evaluation, the second, third, fourth and fifth thoracic ganglia of the sympathetic chain were identified and excised.All patients experienced relief of symptoms with very limited pain and discomfort. They did not require further medical therapy and are relapse-free at follow-up.We conclude that thoracoscopic sympathectomy can be considered an effective, safe and simple treatment for selected cases of vasospastic phenomenon.