Minimally invasive varicocelectomy offers improved peri-operative pain and cosmesis as compared to standard microsurgical approaches(1-3).While standard multi-port laparoscopic varicocelectomy yields equivalent outcomes in terms of efficacy(4), an extraperitoneal approach decreases risk of bowel injury or post-operative gastrointestinal symptoms.(5, 6) We herein describe our initial results with an extraperitoneal approach coupled to single port laparoscopy (LESS-ep). We performed an IRB approved retrospective chart review of patients undergoing varicocelectomy (CPT codes 55550, 55530) at our center with a single surgeon between 3/1/2013 to 3/1/2016. Microsurgical and laparoscopic varicocelectomies were performed in standard previously described fashion. LESS-EP was performed as follows; a 2 cm infra umbilical incision was made. The anterior rectus sheath was anchored with 0 Vicryl sutures in parallel then divided. The rectus muscle was dissected laterally thereby exposing the posterior rectus sheath. The extraperitoneal space was developed bluntly using a balloon dissector under direct vision, and then the GelPort Mini Advanced Access (Applied Medical) was affixed. The GelPort was prepared with three trocars positioned in a tripod configuration as well as the Doppler probe. Varicocelectomy was performed under direct vision with a 5mm 30 degree bariatric laparoscope with dissection at the level of the internal inguinal ring. Manual chart review included patient history, lab values, and operative data. Data were analyzed with Student’s T-test. Of the 75 patients in our cohort, 32 underwent microscopic varicocelectomy, 18 had a standard laparoscopic varicocelectomy, and 25 underwent a less-ep repair. The average age was 39. There were no intraoperative complications in any group, nor EBL greater than 25 cc’s. There was no difference in operative times between groups (97 vs 84 vs 101 minutes, respectively; p=0.43). There were no instances of recurrent varicocele. In the LESS-EP cohort, there were no complications within 30 days; 2 patients received treatment for presumed epididymitis within the first 6 months of surgery. No statistically significant difference in change in sperm parameters was identified. Of 27 concomitant surgeries performed, all inguinal hernia repairs were performed with a standard laparoscopic technique and testicular sperm extraction was performed via microsurgical approach. LESS-EP is a novel approach to varicocelectomy. We have found LESS-EP to be comparable to established methods in terms of safety, operative time and efficacy. It may be most appropriate in patients with bilateral disease or prior inguinal surgery. A microsurgical approach may be most apropos in patients with unilateral disease and no prior groin surgery, and as well for whom concomitant surgeries are not required. Further study is ongoing to assess patient outcomes including long term improvement in semen analysis and pregnancy rates.