<p>This study describes an innovative robotic extended totally extraperitoneal (eTEP) technique for ventral hernia repair via a medial bottom–up approach using the new HUGO^™ system. The surgical steps and a novel setup guide for this approach are detailed. A 78-year-old male with an incisional umbilical hernia and concomitant rectus diastasis was treated using the HUGO™ system. The system’s modular design enabled a customized surgical approach. Robotic eTEP repair was performed via a medial bottom–up approach, and robotic trocars were placed in the hypogastric region. Single docking was sufficient. The procedure lasted 180&#xa0;min, with no intraoperative complications. The patient’s postoperative recovery was uneventful, and a normal diet was resumed on the first postoperative day. The postoperative hospital stay was 7&#xa0;days. Satisfactory outcomes without complications were observed during follow-up. This study introduced a novel robotic eTEP approach for abdominal wall hernia repair using the HUGO^™ system, highlighting the medial bottom–up technique and an innovative docking configuration. The medial bottom–up robotic eTEP approach using the HUGO^™ system is a feasible and promising technique for abdominal wall hernia repair. To evaluate long-term outcomes and broader applicability among surgeons experienced in robotic and retromuscular hernia repair, further studies are warranted.</p>