Spermatic cord microscopy is very mature and this surgical procedure is being successfully performed in many tertiary care hospitals. With standardized training and mastery of operating under a microscope, this procedure is easy to do. The biggest advantage of the surgery is that the recurrence rate after the surgery is very low and there are very few complications after the surgery. It is possible to ligate all the draining veins except the vas deferens and preserve the testicular arteries, lymphatic vessels and nerves. Spermatic cord microscopy is recommended as a routine go-to procedure, and if local conditions permit, this procedure is the way to go. If such conditions are not available, laparoscopic high level ligation of varicocele can be considered.