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Abstract Background Robotic TAPP inguinal hernioplasty is increasingly popular as an introductory technique for the robotic platform, but accurate dissection is the key to achieve successful outcomes. Lourié (WebSurg, 2021) highlights the significance of the preperitoneal or intermediate fascia in delineating the visceral and parietal compartments during TAPP. The objective of the video is to demonstrate this dissection in the performance of a robotic left inguinal hernia TAPP. Case presentation We present the left side of a robotic bilateral TAPP hernioplasty in a male patient. After placing the robotic trocars, the peritoneum was opened from the median umbilical ligament to the iliac spine. Medial access involved dissecting the parietal compartment and safeguarding the bladder while reducing the medial hernia. Continuing to the lateral area, the dissection proceeded in the visceral compartment, preserving the intermediate fascia to protect the inguinal nerves. Both compartments were then separated by the intermediate fascia, which was sectioned to access the central area, identifying the spermatic vessels and the vas deferens. Closure involved barbed suture for the direct hernia defect and placement of a 12 × 15 cm polypropylene mesh, secured to the pectineal ligament. The left side procedure concluded with peritoneal suturing. Conclusion The awareness of the presence of the intermediate fascia provides us with a better anatomical approach to the myopectineal space. The dissection of the parietal and visceral compartments minimizes the risk of bladder or inguinal nerve injury in robotic TAPP hernioplasty.
Barranquero et al. (Wed,) studied this question.