Abstract: Surface marking of the Arcuate line of Douglas has attained surgical importance not only in the open surgery including rectus abdominis flap harvest and stoma formation but also the laparoscopic surgery such as the total extraperitoneal preperitoneal (TEPP) inguinal hernioplasty. Present study used four surface landmarks (Umbilicus, pubic symphysis, xiphisternum and the line joining the two anterior superior iliac spines) during TEPP hernioplasty to assess the location of the arcuate line. Mean distances of the arcuate line from the umbilicus, pubic symphysis, xiphisternum and interspinous line were 5.376 ± SD 1.62 cm (Range 2.5-11.5 cm), 10.67 ± SD 2.44 (Range 1.5-14.5 cm), 20.11 ± SD 1.88 (Range 15.5-26.5 cm), and 3.71 ± SD 2.32 (Range, -1.5 to 9.5 cm). Arcuate line was found located at 2/3rd of the pubis-to-umbilicus distance and at 1/3rd of the pubis-to-xiphisternum distance, confirming the recent reports. Upper border of the pubic symphysis is recommended as the optimal reference point as compared to other three surface landmarks for surface marking and localization of the Arcuate line of Douglas, albeit with a little caution in the overweight /obese patients.