Male infertility has become a global problem plaguing mankind, and varicocele is the most common condition among infertile men. Despite the rapid development of assisted reproductive technologies, the diagnosis and treatment of varicocele is of great importance in male infertility considering economic reasons, reproductive risks, results of comparative cost-benefit studies, and the fact that treatment of varicocele can improve the success rate of assisted reproduction. Current surgical treatments for varicocele include: 1) traditional open transinguinal, retroperitoneal, and infrainguinal varicocele ligation, 2) microtechnical inguinal or infrainguinal (i.e., under the external ring) varicocele ligation, 3) laparoscopic varicocele ligation, and 4) interventional techniques (either collateral or retrograde). Although some studies consider microscopic spermatic vein ligation to be the most ideal treatment, and even some scholars in the United States have labeled it as the “gold standard”, and some related reports suggest that microscopic surgery has certain advantages over traditional surgery in terms of semen quality improvement and natural pregnancy rate. However, in fact, the various methods mentioned above are still parallel in the world, and the reason why our male specialty has favored microscopic technology in recent years is because of its advantages of magnification and fine operation, rather than discussing the advantages and disadvantages of each surgical method. The most important complications of varicocele surgery are edema of the scrotum and its contents, testicular artery damage and testicular atrophy, and persistence or recurrence of varicocele. Safe and effective varicocele repair surgery should comply with the following points: ① Maintain the integrity of the vas deferens and its vasculature system ② Free and ligate all the internal spermatic veins, and ligate the external spermatic vein branches and draining veins, etc., if necessary ③ Maintain the integrity of the lymphatic vessels and arteries. Under the microscope, testicular arteries, lymphatic vessels, and veins with small diameters can be accurately identified, and we believe that microscopic techniques, although challenging, are still of high clinical value. However, it should be clear that any technique has its limitations, and microsurgery is still subject to recurrence, edema, and damage to the testicular artery.