Laparoscopic Inguinal Anatomy Guide
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This document discusses the key anatomical landmarks for laparoscopic inguinal hernia repair. It outlines 9 key landmarks for the trans-abdominal pre-peritoneal (TAPP) approach and 12 landmarks to recognize after the peritoneal reflection for the total extra-peritoneal (TEP) approach. Important structures discussed include the inferior epigastric artery, triangles of Hesselback, Doom and Pain, Cooper's ligament, ilio-pubic tract, and the lateral femoral cutaneous nerve. A thorough understanding of the regional anatomy is essential for accurate surgical treatment of hernias.
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Laparoscopic Inguinal Anatomy Guide
- 2. Laparoscopic Anatomyof Inguinal Region Dr.S.Easwaramoorthy MS FRCS (Eng) FRCS (Glas) Hon FRCS (Edin) Consultant surgeon, Lotus hospital, Erode, TN EC Member, IAGES South Zone
- 3. “ No disease of the human body, belonging to the Province of the surgeon, requires in its treatment, A better combination of accurate anatomical knowledge With surgical skill than hernia in all its variants” Sir Astley Paston Cooper, 1804
- 5. TAPP Vs TEP
- 7. TAPP: 9 Key Landmarks Median Umbilical ligament Medial Umbilical Ligament Lateral Umbilical ligament Vas Gonadal vessels Deep ring Supravesical fossa Medial inguinal fossa Lateral inguinal fossa
- 8. A: Median Umbilical ligament B: Medial Umbilical ligament C: Lateral Umbilical ligament
- 9. Medial Umbilical Ligament •Obliterated Umbilical artery •Medial end of dissection
- 10. Lateral Umbilical Ligament Inferior Epigastric artery •Direct/Indirect hernia •Hesselback’s triangle •Risk of bleeding C
- 12. Triangle of Doom Vas/round ligament Gonadal vessels
- 13. Deep Ring
- 14. Trapezoid of Disaster (Rt Side) Triangle of Doom Triangle of Pain 4. Vas 5. Deep ring 6. Spermatic vessels 7. Triangle of pain 8.Triangle of Doom
- 15. After Peritoneal Reflection 12 Landmarks to Recognize 3 Vessels •Inferior epigastric artery •Iliac vessels •Corona Mortis 3 Nerves •Genitofemoral N •Lateral femoral cutaneous N •Femoral N 3 Triangles Hesselbeck’s Triangle of Doom Triangle of Pain 3 Ligaments Cooper’s Ligament Lacunar ligament Ilio Pubic tract
- 16. Importance of Inferior Epigastric Artery
- 17. Corona Mortis
- 18. Transversalis Fascia • Deep Ring • Iliopubic tract • Bilaminar membrane – Vascular space – Preperitoneal space • Space of Bogros • Space of Retzius
- 19. Iliopubic tract
- 20. Importance of Ilio Pubic tract
- 22. Triangle of Pain •Lateral Femoral Cutaneous N •Femoral Br of GFN •Femoral N We don’t see Ilio hypogastric N Ilio inguinal N
- 23. Lateral Femoral Cutaneous N Meralgia paraesthetica
- 24. Left Femoral ring and Femoral hernia •Black arrow: Femoral ring •Black line: Ilio pubic tract •Straight arrow: In Epi A •Curved arrow: Deep ring •V: External iliac vein •aa: External iliac artery
- 25. Space of Bogros
- 26. TEP
- 27. Anatomy of Rectus sheath
- 28. Space of Retzius Cooper’s Ligament
- 29. Cooper’s Ligament ‘Light House’ during TEP!
- 30. TEP Direct Hernia: Pseudosac Indirect Hernia
- 31. Pseudo sac of Direct Defect
- 32. Myopectineal Orifice of Fruchand Lateral: Ilio Psoas muscle Medial: Rectus muscle Inferior: Bony margin of Pubis Superior: Arching fibres of In.oblique and transversus
- 33. Suffice to say… “I know more than hundred surgeons whom I would cheerfully allow to remove my gallbladder but only one to whom I should like to expose my inguinal canal.” – Sir Heneage Ogilvie British Surgeon 1887-1991
Editor's Notes
- Swedish anatomist