Educational graphic illustrating the surgical planning and anatomy for robotic transabdominal retromuscular umbilical prosthetic hernia repair (r-Rives or r-TARUP) via a left-lateral approach. Figure A shows an infographic detailing patient positioning on the operating table and port placement lateral to the left rectus muscle. Figure B is a clinical photograph of a patient's abdomen under pneumoperitoneum; ink markings delineate the umbilical hernia (central circle) and the anticipated mesh size (outer square). Transparietal needles are inserted at the square's perimeter to guide intra-abdominal preparation. Figure C is a cross-sectional anatomical diagram of the abdominal wall layers (skin, subcutaneous fat, rectus muscles, and posterior rectus sheaths). It maps the surgical dissection path (gray arrow) through the retrorectus space. Key steps are numbered: (1) green dots mark the lateral entry into the left posterior rectus sheath; (2) red dots signify the medial reopening of the sheath near the linea alba; (3) blue dots indicate the entry into the right posterior rectus sheath; (4) identifies lateral nerve preservation zones; (5) shows the mobilized hernia sac and peritoneal bridge. This content serves as a guide for surgical residents and fellows learning complex robotic ventral hernia repair techniques.

A multi-panel educational figure illustrating the key procedural steps of a Transabdominal Preperitoneal (TAPP) inguinal hernia repair. (a) Schematic diagram of the abdomen showing the laparoscopic port arrangement: a 12 mm umbilical port and two 5 mm lateral ports. (b) Intraoperative laparoscopic photograph showing the internal inguinal anatomy and the hernial orifice, classified as EHS-L2 (European Hernia Society classification for a medium indirect lateral hernia). (c) Surgical view demonstrating mesh fixation; a semi-transparent, macroporous polypropylene mesh is positioned in the preperitoneal space to cover the defect and is secured with visible surgical tacks. (d) Final procedural step showing the closure of the peritoneal flap using continuous suturing to exclude the mesh from the peritoneal cavity, preventing contact with abdominal viscera. The series emphasizes proper anatomical orientation, mesh placement, and peritoneal closure in minimally invasive hernia surgery.

This clinical photograph displays a patient's abdomen in the supine position, featuring a large, prominent umbilical hernia. The hernia presents as a rounded, hemispherical protrusion several centimeters in diameter at the midline. The overlying skin appears tense and slightly erythematous, consistent with clinical incarceration. Superimposed on the image are educational annotations for a bilateral rectus sheath block (BRSB). Two horizontal blue boxes indicate the intended footprints for a linear ultrasound transducer, positioned transversely over the rectus abdominis muscles lateral to the umbilicus. Syringe icons illustrate the lateral-to-medial in-plane needle insertion technique. Also visible are vertical tan-colored markings on the skin following the abdominal wall anatomy, and ultrasound transmission gel applied to the right upper quadrant. The image serves as an educational guide for regional anesthesia landmarks and the clinical appearance of a complicated umbilical hernia.

Laparoscopic view and corresponding schematic diagram of the right lower abdominal cavity demonstrating findings related to a de Garengeot hernia. The image shows the median umbilical fold incarcerated within the right femoral ring. A vermiform appendix is visible within the free abdominal cavity; notably, it exhibits a normal appearance with no signs of inflammation, enlargement, or hyperemia. A distinct fibrous band is seen connecting the tip of the appendix to the right femoral ring, indicating a prior or transient incarceration of the appendix. Surrounding anatomical landmarks include the inferior epigastric artery and vein, and loops of the small intestine. This visual illustrates a rare clinical scenario where the appendix is associated with a femoral hernia (de Garengeot hernia) but is found in a reduced state during surgical intervention. The diagram labels these structures to facilitate anatomical identification for educational purposes in general surgery and hernia repair training.