When it comes to microscopic spermatic vein ligation surgery, the first thing that clinicians think of is to free the internal vein, external vein and other related veins and then ligate them with fine wire or microscopic titanium clamps and then cut them off, but if you choose to make an incision under the external ring, because the arteriovenous branches are many and slender, the vein network is crisscrossed, and sometimes the small veins next to the testicular artery are close together, so it takes a lot of hours to free the distal and proximal ends without finding a separating interface. When the testicular artery is not separated from the testicular artery, a small operation is done with a lot of pain and suffering, what should we do? Some people say, “Why don’t we just ligate the testicular artery and the collateral vein together? Wait a minute! This is simple but inconsistent with microscopic principles, as many studies have shown that ligation of the testicular artery can lead to testicular atrophy and spermatogenic damage. How about an ostrich policy of leaving the collateral vein intact to avoid accidental arterial injury and leaving the decision of success to God? The literature points out that this can lead to recurrence or persistence of varicosities, clearly defeating the original purpose of the procedure. What can be done about the dilemma? There has to be some way to get off the operating table without regrets! Don’t worry, here is the solution! Since November 2012 to May 2014, I have treated 4 cases of intravesical spermatic veins with difficult separation around the testicular artery using the 9-0 micro single stitch suture technique, with an average 6-month follow-up and no scrotal and content edema on repeat ultrasound, no recurrence, no aneurysm and no arteriovenous fistula, which speaks volumes about the effectiveness and safety of the technique. Sometimes when discussing this topic with colleagues, since it has not been reported in the literature, there may be scholars whose first reaction is to question the low level of microscopic technique of the operator to have difficulty in vein separation. I have been performing microscopic male surgeries since 2004, and I have performed over 1,000 microscopic spermatic cord surgeries and about 200 microscopic vasovaginal epididymal anastomoses, and my microscopic male videos were included in the American Urological Association (AUA) video library in 2013, and I have made oral presentations at the AUA annual meeting for 3 consecutive years from 2012 to 2014. As a result, I consider myself to be a clinically experienced microscopic male surgeon. Although rare, this is by no means an uncommon occurrence. Of course, the possibility of suturing the artery and the possibility of complete closure of the venous lumen are questions that are difficult to avoid, and follow-up ultrasonography not only proves the effectiveness of the technique, but also rules out complications. As for the adequacy of the suturing technique for the closure of the venous lumen, my opinion is that it is partially complete and in some patients only partial closure is possible, but the latter at least prevents or delays the occurrence of reflux. Since this condition is very rare in clinical work, I suggest that the suture ligation should be performed by an experienced surgeon. Of course, a mountain is higher than a mountain, I think that the difficulty of conventional free can only suture ligation to close the case, the possibility that a higher level of doctors can be resolved in the traditional way certainly can not be ruled out!