Dr. R. Padmakumar
Laparoscopic & Obesity Surgeon

Inguinal Anatomy with Peritoneum Intact

With the introduction of the laparoscope into the abdomen, five important landmarks can be identified in the infra-umbilical region.

  1. Inferior epigastric vessels
  2. Medial umbilical ligament
  3. Spermatic vessels
  4. Vas deferens
  5. Trapezoid of disaster
Inguinal Anatomy with Peritoneum Intact
Inguinal Anatomy with Peritoneum Intact

Inferior epigastric vessels

The inferior epigastric artery is prominently visualized during laparoscopic preperitoneal dissection of groin hernia.

  1. It forms the lateral border of the Hesselbach’s triangle.
  2. It demarcates between direct and indirect inguinal hernia.
  3. It leads us to iliac vessels and apex of triangle of doom.
  4. Bleeding due to its injury can occur during dissection.

Medial umbilical ligament

Urinary bladder lies medial to the medial umbilical ligament.

Spermatic vessels

It forms the lateral border of the ‘triangle of doom’ and the medial
border of the ‘triangle of pain’.

Vas deferens

Forms the medial border of the ‘triangle of doom’ and ‘quadrangle
of disaster’

‘Trapezoid of Disaster’ (Labeled by Seid)

Lying beneath the peritoneum and transversalis fascia are the external iliac artery and vein and nerves- triangle of pain + triangle of doom

Dissection should be done with care in this area. No tacks should be placed in this area.

Dr. R. Padmakumar is one of the Best Hernia Surgeon in India. He has been changing lives through Keyhole Surgery. He has got more than 30 years of hands-on experience in laparoscopic Surgery in major hospitals across India and has completed more than 7000 cases of Laparoscopic Hernia Surgeries. Dr. Padmakumar has trained more than 300 surgeons from all over the world the art of laparoscopic surgery especially Laparoscopic Hernia Surgery. Dr. Padmakumar is also hailed as one of the Best Bariatric Surgeon in India & UAE. He is renowned for new and improved treatment techniques and the first in the World to perform Scarless Bariatric Surgery with Tummy Tuck / Abdominoplasty. He is also one of the very few thyroid surgeons in India doing Endoscopic Thyroidectomy (scarless thyroid surgery).

Hernia Surgeon India
Laparoscopic Hernia Surgeon
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The Wizard Laparoscopic Surgeon
The Wizard Laparoscopic Surgeon – Indian Express
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Contact Details

Dr. R. Padmakumar
Senior Consultant Laparoscopic and Metabolic Surgeon &
Director - Verwandeln Institute (Transforming Lives)
CMD - Keyhole Clinic, Metro Pillar no. 448, Edappally, Kochi, Kerala, India
HOD - VPS Lakeshore Hospital, Maradu, Kochi, Kerala, India
(Specialist in Laparoscopy, Hernia, Cancer, Obesity Surgery or Bariatric Surgery, Diabetes Surgery, Endoscopic Thyroid Surgery, Thoracoscopy, Intragastric Balloon)

Website Dr. R. Padmakumar - www.drrpadmakumar.com

Mobile: +919447230370, +919846320370
Email: drrpadmakumar@gmail.com

Past Chairman, Association of Surgeons of India - Kerala Chapter, 2019 - 2020
National President - Indian Hernia Society (2016)
GC Member, Association of Surgeons of India (2013 - 2018)
Vice President- Society of Endoscopic and Laparoscopic Surgeons of India
Jt. Secretary - Indian Association of Endocrine Surgeons (2016)
Founder Member, Obesity and Metabolic Surgery Society Of India
Founder Member, Association of Minimal Access Surgeons of India
International Faculty of IASGO on Hernia and Diabetic Surgery
International Faculty of IFSO on Diabetic Surgery
Associate Editor : Diabetes and Obesity International Journal

Keyhole Clinic - Center for Obesity and Laparoscopy
Keyhole Clinic - Center for Obesity and Laparoscopy

Metro Pillar No. 448, Edappally, Kochi
Tel: 9847296357 / +919645222401