Varicocele is an abnormal dilatation, elongation and tortuosity of the trabecular plexus in the spermatic cord and is the first cause of male infertility, accounting for 35% of patients with primary infertility and 50%-80% of patients with secondary infertility. It is associated with abnormal semen, decreased testicular volume, reduced testicular perfusion and testicular spermatogenic dysfunction. Varicocele can increase testicular temperature, leading to spermatogenesis disorders, resulting in reduced testosterone synthesis by testicular mesenchymal cells, elevated spermatic vein pressure leading to inadequate testicular perfusion, poor venous blood return caused by varicocele can lead to testicular stasis and hypoxia, increasing venous pressure and inducing germ cell apoptosis, the blood returning from the adrenal gland in this patient can flow backwards along the spermatic vein, which can transfer the metabolites secreted by the adrenal gland and kidney such as Steroids, catecholamines, 5-hydroxytryptamine, etc. can affect testicular blood flow and adversely affect testicular metabolism, and may also lead to increased reproductive toxins and increased levels of antioxidants, etc. The significance of varicocele in male infertility, the value of surgical intervention, and the advantages and disadvantages of various intervention modalities are still controversial, but spermatic vein repair techniques remain the most common surgical treatment for male infertility today. It has been suggested that microscopic technique spermatic vein ligation is the most desirable treatment modality, and Diegidio P et al. reviewed the relevant literature in English from PubMed from 1995 to 2011 to compare the pregnancy rates and complication rates of different treatment modalities for varicocele, and the results showed that microscopic subinguinal and transinguinal routes of spermatic vein ligation had the best results. Depending on the indication for the procedure, varicocele repair is aimed at improving semen quality and natural pregnancy and/or reducing scrotal discomfort, and in some patients at increasing testosterone levels, with the most significant complications being edema of the scrotum and its contents, testicular artery damage and testicular atrophy, and persistence or recurrence of varicocele. A safe and effective repair of varicocele is based on the following points: (1) maintaining the integrity of the vas deferens and its vascular system; (2) freeing and ligating all internal spermatic veins and, if a transinguinal incision is used, the branches of the external spermatic veins; and (3) maintaining the integrity of the lymphatic vessels and arteries. The varicocele surgery under microsurgical approach can make the lateral branches of veins, testicular artery, vas deferens artery and lymphatic vessels, and even the levator artery can be clearly displayed under the operating microscope, and the cases of missed ligation of the lateral branches of spermatic vein, mistaken ligation of testicular artery and lymphatic vessels can be significantly reduced, which can improve the surgical results and reduce postoperative complications such as recurrence, testicular atrophy and syringomyelia. Compared with laparoscopic spermatic vein high ligation, retroperitoneal spermatic vein high ligation and transinguinal spermatic vein ligation, spermatic vein microsurgery has the lowest recurrence rate and syringomyelia rate, which is less than 1%. It can reach more than 90% and the pregnancy rate can reach more than 70%. Our department is the first in the region to perform microscopic spermatic vein ligation, which involves freeing and ligating all the internal spermatic veins under a microscope, and ligating the branches of the external spermatic veins if a trans-inguinal incision is used, maintaining the integrity of the vas deferens and its vascular system and the integrity of the lymphatic vessels and arteries, minimizing the risk of surgery, the incidence of postoperative complications and the recurrence rate, and improving the postoperative pregnancy rate.