UPDATED TOPICS IN MINIMALLY INVASIVE ABDOMINAL SURGERY

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Updated Topics in Minimally Invasive Abdominal Surgery
the cutaneous branch of the femoral nerve and the lateral femoral cutaneous nerve. The
anatomic landmarks and structures of importance are illustrated in the RISE (Rotterdam
Institute of Surgical Endoscopy)-circle, figure 1 (Lange & Kleinrensink, Surgical Anatomy of
the Abdomen, Elsevier gezondheidszorg, 2002).
Ventromedial quadrant (direct hernia):
Base; iliopubic tract (of Thomson)(1)
Conjoint tendon(2)
Transeversalis fascia (caudal part of
Hesselbach’s triangle)(3)
Interfoveolar ligament (of Hesselbach)(4)
Branches of inferior epigastric vessels
Dorsomedial quadrant (femoral hernia at
femoral canal/lacuna vasorum):
Pectineal ligament (of Cooper)(5)
Lacunar ligament (of Gimbernat)(6)
Bladder
Corona mortis
External iliac vein
Prevesical space (of Retzius)
Ventrolateral quadrant (indirect hernia):
Deep inguinal ring
Interfoveolar ligament (of Hesselbach)
Transversus abdominis muscle(7)
Dorsolateral quadrant (Kathouda’s quadrant of
doom):
Nerves of triangle of pain:
Femoral branch of genitofemoral nerve(8)
Femoral nerve(9)
Cutaneous branch of femoral nerve(10)
Lateral femoral cutaneous nerve (11)
Testicular vessels
Iliopectineal arch (ligament)
Vas deferens(12) or round ligament of uterus
Fig. 1. RISE (Rotterdam Institute of Surgical Endoscopy)-circle. Anatomic landmarks and
structures of importance in inguinal hernia repair (Lange & Kleinrensink, Surgical Anatomy
of the Abdomen, Elsevier gezondheidszorg, 2002).