Varicocele (VC) is a collective term for pathological changes such as localized varicose, thickened, and dilated spermatic veins, and is the most common cause of male infertility. Its development may be related to hypoxia, temperature, immune response, and production of nitric oxide in the scrotum, which can affect the quantity and quality of sperm in patients. It is very common in the general male population and is often found during routine physical examinations. VC is also often found incidentally on imaging studies, especially scrotal ultrasound. Surgical treatment can improve semen quality and reduce the use of assisted reproductive technologies in patients with VC infertility. Surgical treatment can significantly reduce the number of spermatozoa with altered sperm ultrastructure and improve improve the genetic material of spermatozoa in VC patients. The main traditional open surgical procedures are retroperitoneal high ligation and transinguinal canal internal spermatic vein high ligation. Theoretically, retroperitoneal surgery is the most likely to completely ligate all the internal spermatic veins, but in practice, it is found that in most cases more than two spermatic veins are found by retroperitoneal surgery, and some tiny veins may not be identified by the naked eye, may be surrounded by lymphatic vessels and not detected intraoperatively, or may be close to the arteries and not easily detected, so there is a possibility of missing the ligation of the veins, and there is still a possibility of recurrence after surgery. The possibility of recurrence remains. The retroperitoneal surgery requires intraoperative separation of the abdominal wall muscles, and postoperative pain is often more pronounced. In addition, in some obese patients, it is often difficult to find and expose the spermatic cord intraoperatively. Laparoscopic surgery is currently the most common surgical procedure used by urologists for the treatment of VC, especially for bilateral VC, but it tends to cause arterial spasm in the testis under high pneumoperitoneal pressure, which is not conducive to the identification of the intra-seminomatous arteries during surgery, and the surgeon often adopts the method of ligating the intra-seminomatous arteries and lymphatics, which increases the risk of postoperative scrotal edema and testicular atrophy. Compared with laparoscopic spermatic vein ligation, microscopic surgery via the external ring-opening route can more accurately identify the microscopic structures of the internal and external spermatic veins, the leading veins, the testicular arteries, the vas deferens veins, and the lymphatic vessels of patients, effectively avoiding ligation errors caused by poor identification of local anatomical structures and achieving better outcomes. Some scholars have found that microscopic spermatic cord ligation with simultaneous ligation of the veins and lateral branches of the testicular ducts can significantly promote the growth of the testis.