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Laparoscopic anatomy of inguinal canal
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
“ 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
Laparoscopic anatomy of inguinal canal
TAPP Vs TEP
Laparoscopic anatomy of inguinal canal
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
A: Median Umbilical ligament
B: Medial Umbilical ligament
C: Lateral Umbilical ligament
Medial Umbilical Ligament
•Obliterated Umbilical artery
•Medial end of dissection
Lateral Umbilical Ligament
Inferior Epigastric artery
•Direct/Indirect hernia
•Hesselback’s triangle
•Risk of bleeding
C
Hesselback’s Triangle
Triangle of Doom
Vas/round ligament
Gonadal vessels
Deep Ring
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
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
Importance of Inferior Epigastric Artery
Corona Mortis
Transversalis Fascia
• Deep Ring
• Iliopubic tract
• Bilaminar membrane
– Vascular space
– Preperitoneal space
• Space of Bogros
• Space of Retzius
Iliopubic tract
Importance of Ilio Pubic tract
No staples please…
Triangle of Pain
•Lateral Femoral Cutaneous N
•Femoral Br of GFN
•Femoral N
We don’t see
Ilio hypogastric N
Ilio inguinal N
Lateral Femoral Cutaneous N
Meralgia paraesthetica
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
Space of Bogros
TEP
Anatomy of Rectus sheath
Space of Retzius
Cooper’s Ligament
Cooper’s Ligament
‘Light House’ during TEP!
TEP
Direct Hernia: Pseudosac Indirect Hernia
Pseudo sac of Direct Defect
Myopectineal Orifice of
Fruchand
Lateral: Ilio Psoas muscle
Medial: Rectus muscle
Inferior: Bony margin of Pubis
Superior: Arching fibres of
In.oblique and transversus
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
Laparoscopic anatomy of inguinal canal

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Laparoscopic anatomy of inguinal canal

Editor's Notes

  1. Swedish anatomist