Microscopic spermatic vein ligation – the gold standard in varicocele surgery Dilatation, tortuosity and elongation of the spermatic vein plexus is called varicocele. Varicocele is most common in young adult men, with a prevalence of 15% in the adult male population, 40% in male infertility patients, and 20% in combined pain and discomfort. It is a known cause of male infertility. The treatment of varicocele is based on surgery, and currently the main surgical methods are transinguinal open surgery, laparoscopic spermatic vein ligation and microscopic spermatic vein ligation. Microscopic spermatic vein ligation can ligate the vein more thoroughly, preserving the arteries and lymphatic vessels, with obvious improvement in semen quality after the operation, fast recovery and fewer complications. It has obvious advantages over traditional surgery and has become the gold standard for varicocele surgery. Varicocele grading standard: Ⅰ degree: not obvious on palpation, the patient can feel the varicose vein when holding breath and increasing the abdominal pressure; Ⅱ degree: the varicose vein can be felt on palpation in non-breath-holding state but the appearance is normal; Ⅲ degree: the varicose vein is like a mass of earthworms, which is extremely obvious on palpation and visualization. Indications for varicocele surgery: Ⅱ～Ⅲ degree or above combined with oligozoospermia; Ⅰ～Ⅱ degree combined with oligozoospermia or oligozoospermia and no significant improvement after 3-6 months of conservative treatment; Ⅰ～Ⅲ degree combined with scrotal distension, pain and discomfort affecting the quality of life.