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Laparoscopic techniques have revolutionized the field of surgery with benefits that include decreased postoperative pain, earlier go back to normal activities following surgery, and fewer postoperative complications (eg, adhesion, wound infection, hernia). However, unique complications are related to gaining access to the abdomen for laparoscopic surgery. Inadvertent bowel injury or major vascular injury is uncommon, but both of them are potentially life-threatening complications which are probably to happen during initial access..

The strategy for use of the peritoneum, choice of access, multiple port placement, and complications of access is going to be reviewed here. Laparoscopic issues and complications not related to abdominal access are discussed in separate topic reviews.

Knowledge of the anatomy of the abdominal wall is important for the safe insertion of laparoscopic access devices. The unit traverse your skin, subcutaneous fat, variable fascial layers, preperitoneal fat, and parietal peritoneum.

Access locations - The fascial and muscular layers of the abdominal wall are variable depending upon specific location. Anatomy at typical laparoscopic access sites and related intraabdominal anatomy are discussed below. Detailed anatomy of the abdominal wall is discussed elsewhere.