Ten golden rules for a safe MIS inguinal hernia repair using a new anatomical concept as a guide

Christiano Claus, Marcelo Furtado, Flavio Malcher, Leandro Totti Cavazzola, Edward Felix

Research output: Contribution to journalEditorialpeer-review

35 Scopus citations


Background: Although laparoscopic inguinal hernia repair was described about 30 years ago and advantages of the technique have been demonstrated, the utilization of this approach has not been what we would expect. Some reasons may be the need for surgeons to understand the posterior anatomy of the groin from a new vantage point, as well as to acquire advanced laparoscopic skills. Recently, however, the introduction of a robotic approach has dramatically increased the adoption of minimally invasive techniques for inguinal hernia repair. Methods: Important recent contributions to this evolution have been the establishment of a new concept known as the critical view of the Myopectineal Orifice (MPO) and the description of a new way of understanding the posterior view of the antomy of the groin (inverted Y and the five triangles). In this paper, we describe 10 rules for a safe MIS inguinal hernia repair (TAPP, TEP, ETEP, RTAPP) that combines these two new concepts in a unique way. Conclusions: As the critical view of safety has made laparoscopic cholecystectomy safer, we feel that following our ten rules based on understanding the anatomy of the posterior groin as defined by zones and essential triangles and the technical steps to achieve the critical view of the MPO will foster the goal of safe MIS hernia repair, no matter which minimally invasive technique is employed.

Original languageEnglish (US)
Pages (from-to)1458-1464
Number of pages7
JournalSurgical endoscopy
Issue number4
StatePublished - Apr 1 2020


  • Critical view
  • Golden rules
  • Inguinal hernia
  • Laparoscopy
  • Minimally invasive surgery
  • Robotic

ASJC Scopus subject areas

  • Surgery


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