 This meta-analysis and systematic review compares the overall effect and safety of microsurgery versus laparoscopic surgery in treating varicoselle, using 23 studies with 1178 patients. The results show that microsurgery significantly decreases complication rate, hospital stay, and recurrence rate while increasing sperm concentration compared to laparoscopic surgery. However, there is no significant difference in operation time or sperm motility between the two groups. Overall, microsurgery is a better alternative therapy for varicoselle treatment than laparoscopic surgery. This article was authored by Hai Wang and Ji Gang Ji.