We have established a novel method named transumbilical two‑port laparoscopic varicocele ligation (TTLVL) for varicocele, which
is still needed to evaluate. In this study, 90 patients with left idiopathic symptomatic varicoceles of grades II–III according to the
Dubin grading system were randomly assigned to TTLVL (n = 45) and conventional laparoscopic varicocele ligation (CLVL) (n = 45).
The demographic, intraoperative, postoperative, and follow‑up data were recorded and compared between the two groups. All the
procedures in the two groups were completed successfully with no intraoperative complications and no conversions to open surgery.
No significant difference was found in the operative time, resuming ambulation, bowel recovery, postoperative hospital stay, and
postoperative resolution of scrotal pain between the two groups (P > 0.05). However, the postoperative mean visual analog pain
scale scores for TTLVL group were all less at 24 h, 48 h, 72 h, and 7 days postoperatively compared to CLVL (P = 0.001, 0.010,
0.006, and 0.027, respectively). The mean patient scar assessment questionnaire score in postoperative month 3 was 29.7 for
TTLVL group compared with 32.1 for CLVL group (P < 0.001). There was no testicular atrophy observed in both groups during the
follow‑up period. The study shows that TTLVL is a safe, feasible, and effective minimally invasive surgical alternative to CLVL for
the treatment of varicocele. Compared with CLVL, TTLVL may decrease postoperative pain and improve the cosmetic outcomes.

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