Undoubtedly, the introduction of microsurgical techniques in the diagnosis and treatment of male infertility has become a revolutionary innovation, with the current focus on the reconstruction and recanalization of obstructed ducts, microscopic resection of varicocele, microscopic sperm extraction, and microscopic single sperm follicle injection. The diagnosis and treatment of male infertility is gradually becoming a rapidly developing urological subspecialty, which is widely concerned by doctors and patients. At present, the microdot multilayer anastomosis method of Cornell University in the United States is more mature, using the techniques of microdot marking, precise positioning, cross wiring and multilayer suturing, which makes this method different from the simple microscopic anastomosis technique and more reasonable and effective. The cumulative rate of conception at 1 year after surgery can be as high as 70%. The main advantages of this method are: the precise marking of the exit points of each layer before suturing, which decomposes the complex anastomosis process into a single orderly suture step and reduces the operational difficulty; the microdot marking before suturing effectively solves the difference of the lumen internal diameter of the proximal and distal ends of the obstruction (usually 2:1 to 3:1, or even higher), which reduces the incidence of postoperative anastomotic stenosis, leakage, and seminal granuloma formation. 2.Vasectomy epididymal duct anastomosis Vasectomy epididymal duct anastomosis is known as the most challenging microscopic anastomosis technique, and the operator must not only be technically proficient, but also have to keep his fist in his hand and bend his mouth. For those who recanalize after vasectomy, the surgery can be performed directly, and depending on the appearance of the proximal fluid of the obstruction and the microscopic performance during the surgery, either vasectomy or vasecto-epidididymal anastomosis can be chosen; for obstructive azoospermia caused by inflammation of the reproductive tract or medical factors, testicular biopsy must be performed before the reconstructive surgery to confirm good spermatogenic function, and scrotal exploration is performed first during the surgery, and if If no spermatozoa are found in the proximal vas deferens, vas deferens epididymal anastomosis is then chosen; for patients with congenital absence of the vas deferens, epididymal sperm extraction is usually used for assisted reproduction. Currently, the classic vas deferens epididymal anastomosis is the two-stitch method with end-lateral overlay, and Cornell recently reported that its recanalization rate can reach over 90%. First, four microdots are marked on the vas deferens surface; two parallel double-stitched sutures are inserted through the dilated epididymal duct at one end, and the epididymal duct is incised longitudinally before exiting the needle. The suturing process follows the general principles: mucosa to mucosa; no tension; ensure blood supply; no damage. Microscopic anatomical testicular sperm extraction Microscopic anatomical testicular sperm extraction is a further refinement of conventional testicular sperm extraction, which can effectively extract sperm cells from the germinal tubules for ICSI. although it is not the least invasive option, this technique ensures maximum sperm acquisition rate and minimal testicular functional side effects, provided that a minimum amount of testicular tissue is taken. This method was introduced by Schlegel as an effective method of testicular sperm harvesting in combination with ICSI for non-obstructive azoospermia. Experienced physicians, under a 25x magnification microscope, can effectively identify sperm-containing germinal tubules, and we usually select full-looking, opaque, large-diameter germinal tubules. If a prior testicular puncture biopsy is performed, we can determine the sperm acquisition rate based on its histopathological manifestations, and we base this on the degree of sperm development of the puncture biopsy specimen, rather than on the cellular composition. 4. varicocelectomy Varicocelectomy is the most common procedure to treat male infertility. Compared with open, laparoscopic, percutaneous puncture and other surgical methods, microsurgery has its obvious advantages: accurate identification and protection of the testicular artery and its branches, the levator artery and its branches, postoperative testicular atrophy, azoospermia incidence is reduced; intraoperative exposure of the testis allows visual observation of all testicular reflux including the internal spermatic vein, external spermatic vein, levator muscle vein, vas deferens vein, and the lead vein, etc. In addition, intraoperative exposure of the testis helps to detect microscopic testicular tumors and epididymal/vas deferens obstruction that are often overlooked; fewer lymphatic vessels are misplaced and the incidence of postoperative syringomyelia is reduced. Advocates of open surgery believe that a misligated testicular artery, along with the vas deferens artery and levator artery, ensures testicular blood supply and is sufficient to prevent testicular atrophy, but anatomic studies have found that the testicular artery at the site of high spermatic vein ligation is larger in diameter than the sum of the latter two and is a true testicular blood supply artery, and the effects of a misligated artery are far greater than those that may occur during microsurgery. Overall, microsurgery is safe, reliable, and has fewer complications, and is gradually being accepted and adopted.