Clinically, varicose veins are classified into 3 degrees according to the degree of varicosity. Mild: not obvious on palpation but palpable by Valsalva test; moderate: varicose veins can be palpated with normal appearance; severe: varicose veins are like clusters of earthworms and are more obvious on palpation and visualization. It can disappear completely when lying down, if not, it is considered as secondary varicose veins of spermatic cord. Color Doppler examination showed that the inner diameter of the vessel was ≥1.8 mm. mild: no reflux during calm breathing in lying and standing position, reflux during Valsalva test; moderate: no reflux during lying position, reflux during calm breathing in standing position; severe: reflux during calm breathing in lying position. All of the patients in this group were moderate and severe, and secondary lesions were excluded. Varicocele with infertility or significant symptoms are all indications for surgical treatment. The main difference is above or below the internal ring, and there is no difference in the recurrence rate between the two. The laparoscopic ligation of the high spermatic vein is performed at the same site as the ligation of the retroperitoneal route, and the surgical results are the same. Laparoscopic high spermatic vein ligation was used in 1990, and it is now accepted that the transabdominal route is the most convenient and least invasive. The transabdominal approach provides a large intraoperative space, clear visualization, and good exposure. In the initial stage, the trachea was intubated with general anesthesia, and two 10 mm and one 5 mm Trocar were established. In the early stage of this group, two cases of titanium clamps were used to close the vessels when the vessels were not tightly ligated and bleeding, and in the later stage, the epidural anesthesia was used to establish two 5 mm and one 10 mm Trocar after the operation was skilled and the operation time was significantly shortened. Compared with titanium clamps, the advantages of filament ligation of vessels and titanium clamps are 1. 2. eliminates the influence of foreign body in the patient’s body during X-ray examination; 3. improves the technical level of intracavitary operation and prepares the technique for difficult intracavitary surgery. The incidence of varicocele is significantly more on the left side than on the right side, which is related to the anatomical direction of the spermatic veins. The incidence of bilateral varicocele can be more than 30% in clinical practice. In a group of 19 patients, 8 cases (43%) were reported as bilateral varicocele; all 8 cases seen for infertility were bilateral varicocele, and by color Doppler examination, the internal diameter of the vessels were >2 mm, and there was blood reflux by Valsalva test, so patients with varicocele should have bilateral color Doppler examination of the spermatic veins, and if there is blood reflux, surgery should be performed bilaterally at the same time. The arteries supplying the human testes and epididymis are 1) the internal spermatic artery, which comes from the abdominal aorta; 2) the vas deferens artery, which comes from the superior cystic artery; 3) the levator ani artery, which comes from the inferior abdominal wall artery. The vas deferens artery and the levator muscle artery all converge into the spermatic vessels below the mouth of the inguinal canal internal ring, which is obviously lower than the position of the ligation of the internal seminiferous artery. Therefore, the blood supply to the testes and epididymis will not be affected by the ligation of the internal seminiferous artery at a high level of concentration. In addition, high ligation that preserves the internal spermatic artery may also lead to postoperative recurrence because the tiny veins surrounding the artery are missed to avoid damaging the artery. We believe that the advantages of set ligation are 1. it can ligate thoroughly and prevent omission; 2. it prevents bleeding during separation, which causes poor visualization; 3. it simplifies the operation, and the results are reliable and easy to promote. Laparoscopic high ligation of the spermatic vein can avoid the larger damage of open surgery and vas deferens misinjury, reduce trauma, and allow bilateral simultaneous surgical treatment; despite the slightly higher cost, it is still a better treatment.