A 42-year-old woman presented with a symptomatic epigastric hernia measuring 5 cm in diameter. She had had a prior caesarian delivery thorough a lower midline incision. She was taken to the operating room for laparoscopic ventral hernia repair.
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Local anesthesia was injected prior to the insertion of each port. A 12-mm incision was made 2 cm below the left costal margin in the anterior axillary line. The flank muscles were bluntly split with a large hemostat down to transversalis fascia. A finger was used to penetrate transversalis and peritoneum, using the costal margin as a fixed anchor.
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