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A microsurgical varicocelectomy is performed under a high-powered operating microscope to achieve the highest success rates with the lowest side effect risks. There are two approaches to microsurgical varicocelectomy, inguinal or subinguinal. If the procedure is being performed for pain, the inguinal approach is often used to allow access to the ilioinguinal nerve which can be cut to provide permanent pain relief. The incision site for inguinal is a little higher in the groin than the sublingual (anatomy art insert). Once the surgeon incises the skin, he or she dissect down to the spermatic cord where the abnormal veins are encountered. Each vein is meticulously dissected circumferentially and then tied off to disrupt the flow and provide drainage of blood away from the testicle into the inner thigh and pelvis. Keys to a good operation are to interrupt every vein, leave every artery intact, leave the vas deferens intact and leave lymphatic drainage intact. If an artery is cut, damage to the testicle can occur. If the vas deferens is injured, sperm can be blocked. If lymphatics are cut, the scrotum can feel with fluid and require additional surgery to drain the fluid. The microsurgical approach has been statistically shown to reduce all of these risks.