With the development of minimally invasive technology in recent years, laparoscopic and microsurgical treatment of varicocele has become the main surgical modality. Compared with traditional open surgery, laparoscopic high spermatic vein ligation is less traumatic, faster recovery, better effect, and can be performed bilaterally at the same time, but the anesthesia is complicated and the operation cost is high, and the higher CO2 pneumoperitoneum pressure can make the testicular artery spasm not easy to distinguish and cannot effectively protect the testicular artery and lymphatic vessels, which makes the postoperative testicular atrophy, testicular syringomyelia, recurrence and other complications increase, and some patients have abdominal distension and Some patients have abdominal distension and gastrointestinal discomfort after surgery. In contrast, microsurgical spermatic vein ligation can effectively protect testicular arteries and lymphatic vessels, and can identify small veins and ligate them, which makes the above complications significantly reduced, and also simple anesthesia, less trauma, faster recovery, lower cost and better results. In domestic and international studies, except for the slightly longer operation time, postoperative complications such as abdominal distension and gastrointestinal symptoms, scrotal edema, and recurrence of varicocele were fewer in the microsurgery group than in the laparoscopic group, and both groups were able to significantly improve semen quality, sperm density, sperm survival rate, and percentage of sperm of grade (a + b) compared with the preoperative period, which improved the pregnancy rate of the patients’ spouses. Microsurgery has also been reported to be effective in azoospermia. Compared with laparoscopic spermatic vein ligation, microsurgical spermatic vein ligation has unique advantages, which are mainly reflected in the following aspects: ①Maximum effective protection of testicular arteries and lymphatic vessels. In the past, it was thought that after ligation of the testicular artery, the blood supply to the testis would not be reduced and would not lead to testicular atrophy because of the collateral circulation through the levator artery and vas deferens artery. However, the incidence of testicular atrophy after injury to the testicular artery has been reported to be as high as 14%; even if testicular atrophy does not occur, the spermatogenic process may be affected; the incidence of testicular syringomyelia increases due to the failure to protect the lymphatic vessels during laparoscopic surgery, and the incidence of interstitial testicular edema, damage to the spermatogenic tubules, and decreased testicular endocrine function, etc. The recurrence rate of postoperative varicocele is significantly reduced. The recurrence rate after microsurgical spermatic vein ligation has been reported to be only 0-2%, while the recurrence rate after non-microsurgical procedures is as high as 9%-16%. The present study differs from the literature and needs to be further confirmed by expanding the sample size. ③Anesthesia is simple and has few adverse effects. ④Small incision, low location, can be covered by pubic hair after surgery, and does not affect the aesthetics. ⑤ Low treatment cost, fast recovery, and few complications. At present, it is believed that microsurgical spermatic vein ligation has been gradually recognized by domestic male urologists because of the advantages of less trauma, faster recovery, less complications, lower cost, lower postoperative recurrence rate, significantly improving semen quality and increasing pregnancy rate, etc. Although certain microscopic operation skills are required, it has the potential to become the “gold standard” for the treatment of varicocele. “The advantages of this procedure have been gradually recognized by male urologists in China.