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Objective: To document a step-by-step guide of crossed transeptal vasoepididymostomy with prioritization of crossover vas deferens measurement. Design: Video presentation. Setting: University of Miami Lennar Surgical Center. Patient(s): The patient undergoing this procedure signed a written, informed consent for video and audio recording. Results: No intraoperative complications were seen during the surgery, and the patient was discharged 6 h after the procedure. Through the steps detailed in the video and manuscript, a proper tubule into vas deferens invagination was formed. Conclusions: Anatomical indications for crossed vasoepididymostomy exists in 6% of azoospermic males and procedural prevalence is increasing. With a standardized step-by-step procedural approach that prioritizes crossover vas deferens measurement, crossed vasoepididymostomy can be considered in couples desiring natural conception, with previous complications of ART or failed ART.