Researchers aims to estimate MIMV by comparing it to CMSV in operating duration, time to return to normal activity, postoperative complications, achievement of natural pregnancy and improvement of semen quality for patients with infertility, pain score for those with scrotal pain.

In the study, researchers joined 3089 patients who underwent MIMV and 476 who underwent CMSV in our hospital. Varicocele is a common abnormality of the testis, characterized by excessive dilatation of the pampiniform venous plexus of the spermatic cord.

The andrological implications of varicocele include failure of ipsilateral testicular growth and development, symptoms of pain and discomfort, and male infertility. The main goal of all varicocele treatment is to resolve these problems. The aim of treatment in children is to prevent testicular injury and maintain normal testicular function, which can be achieved by surgical ligation of varicoceles.

The surgical complications were reported using the Clavien Classification of Surgical Complications. Postoperative pain was assessed at postoperative hours 3, 24 and 48 using visual analogue scale (VAS) pain scores ranging from 0 (no pain) to 10 (worst pain). Patients were instructed to complete the rest of VAS forms at home and return them 7 days after the surgery.

During microscope-assisted surgery, all testicular venous return routes can be observed directly, and it has been reported that this approach can significantly reduce the recurrence rate of varicocele. Under the microscope allowing for 6 to 25 multiple magnifications of surgical field, the surgeons can perform meticulous hemostasis, identify and protect the testicular arteries and lymphatic vessels, and avoid intraoperative unintentional iatrogenic injury.

The only drawback of microscope-assisted surgery seems to be the longer operation time than that of traditional open inguinal surgery, thus requiring extensive training. Microscope-assisted varicocelectomy can be performed using either the inguinal approach or the subinguinal approach, both of which can improve the surgeon’s identification and accuracy.

From an anatomical perspective, there are more and thinner veins and testicular artery branches in subinguinal region than in inguinal region, making it more challenging for the surgeons to protect the artery and to ligate the veins in subinguinal region. 

In conclusion, MIMV was associated with a lower recurrence rate, shorter operating duration, less time to return to normal activity, higher satisfaction, similar effectiveness (natural pregnancy, semen results, pain scores, NIH-CPSI score) and rate of other complications compared with CMSV.