The intraperitoneal underlay mesh ventral hernia repair technique, once the predominant approach, has encountered less frequent use with the advent of a variety of new minimally invasive hernia repair techniques that allow for mesh placement within the abdominal wall. However, the robotic intraperitoneal underlay mesh ventral hernia repair has re-invigorated the technique by allowing for reliable closure of the underlying fascia (rIPUM+) and precise suture fixation. It remains an efficient, safe, and effective minimally invasive approach to hernia repairs that is able to be performed successfully by surgeons with varied previous laparoscopic experience. It is an excellent minimally invasive option for several challenging patient subsets. Most common complications include seroma and recurrence, though primary fascial closure and wide mesh overlap help to minimize these occurrences.