Objective To investigate the applicability of laparoscopic ultrasound technology in laparoscopic high ligation of the spermatic vein. Methods The preoperative and postoperative clinical data on 32 patients with bilateral varicoceles treated between October 2018 and October 2020 was analyzed retrospectively. These patients were aged 19 to 36, with an average age of (29.2±2.2) years old. The degree of varicoceles on both sides was Ⅱ～Ⅲ. B-ultrasound showed that the diameter of the varicoceles ranged from 2.2 to 4.6 cm. In twenty-three of these cases, the diameter of at least one varicocele was >3.0 cm. Complications with oligospermia were observed in thirteen of these cases. Preoperative examinations with color Doppler ultrasound ruled out the possibility of secondary varicoceles. Laparoscopic high ligation of both sides of the varicoceles was performed. Combined with laparoscopic ultrasound, a highly selective internal spermatic vein ligation was performed after the artery was preserved. Indicators related to the surgery and sperms, the relief rate of clinical symptoms, and postoperative complications were recorded. Results The surgery was a success for all the 32 patients without any severe bleeding or damage to the surrounding organs. The internal spermatic arteries on both sides were completely preserved in all these cases. In one case, bleeding occurred when one artery was separated, so cluster ligation was performed, leaving the patient with only one spermatic artery. The duration of surgery was (72.53±5.07) minutes while the hospital stay was (4.06±0.68) days. The patients were followed up for 6 months. The scrotal pain was relieved to different extents, and there was no recurrence or testicular atrophy. The preoperative sperm density of 13 patients with oligospermia was (14.38±1.26)×10⁶/ml, and the percentage of (a+b) grade sperms was (21.34±2.12)%, compared with (26.15±2.45)×10⁶/ml and (35.17±3.87)% six months after operation. Conclusions Laparoscopic high ligation of the spermatic vein combined with laparoscopic ultrasound in the treatment of bilateral varicoceles can effectively identify and preserve the internal spermatic arteries. Highly selective internal spermatic vein ligation can improve postoperative symptoms and semen quality.