Background and Aims With the development of minimally invasive concepts and techniques, laparoscopic incisional hernia surgery has become a major trend. However, due to the varied size and location of the abdominal incisional hernia, there are no established trocar arrangement criteria to apply for surgeons, which makes the learning process of this procedure more difficult, and the inappropriate trocar arrangement will also likely lead to increased surgical difficulty. Here, the authors introduce a modelized trocar arrangement method based on data analysis and calculation, and show its advantages and clinical efficacy by comparison with the conventional trocar arrangement method based on experience.Methods A total of 44 eligible patients with abdominal wall incisional hernia scheduled to undergo laparoscopic intraperitoneal onlay mesh repair (IPOM) in the Sixth Affiliated Hospital of Sun Yat-sen University from January 2017 to May 2018 were enrolled, and randomly designated to control group (21 cases) and study group (23 cases) by computer generated randomization. During operation, the arrangement of the operating trocars after the observation trocar placement was performed according to the surgical experience in control group, while the layout of the trocar ports was directed by calculation of the reasonable distance according to the operation instruments size after preoperative abdominal contour analysis and stepwise determination of the restrictive parameters. The main intra- and postoperative clinical variables between the two groups were compared.Results There were no significant differences in the general characteristics between the two groups of patients (all P>0.05). In study group compared with control group, the average trocar placement time (7.28 min vs. 9.93 min), the average operative time (67.62 min vs. 79.10 min), and the intraoperative trocar addition rate (17% vs. 48%) were all significantly reduced (all P<0.05). There were no significant differences between study group and control group in terms of the incidence of postoperative complications (4.3% vs. 19.0%), the length of postoperative hospital stay (5.13 d vs. 5.76 d) and postoperative recurrence rate (4.3% vs. 4.8%) between the two groups (all P>0.05).Conclusion In laparoscopic IPOM repair of abdominal wall incisional hernia, using the modelized trocar arrangement method can shorten the trocar placement time after operation initiation, and its rational placement of the operating trocars can reduce the difficulty of adhesion separation, defect suturing and mesh fixation, reduce the total operative time and the probability of additional operating trocar requirement during the operation, and meanwhile, it will not increase the incidence of postoperative complications, hospitalization time and the probability of hernia recurrence. The modelized trocar arrangement method that uses the objective data plus quantitative assessment to replace the experience-oriented decision-making of the conventional port arrangement, is more explicit in the using process, and also can be continuously updated and improved in practice. So, it is helpful for the standardization and promotion of laparoscopic abdominal wall incisional hernia surgery.