The position of the first trocar should be guided by previous abdominal surgeries and the location of the hernia, in an attempt to anticipate and maximally avoid intra­abdominal adhesions. The location should be at least several centimeters from all previous scars and as fa r from the hernia as possible, but still providing suitable instrument reach. Often, for midabdominal and lower abdominal hernias, the first trocar is optimally pla ced in the left (or right) upper quadrant subcostally in the miclavicular line. At such a location, the peritoneum is suspended from the costal margin, facilitating Veress needle insertion; In addition, adhesions are sparse, espe­cially in the left subcostal area. For up per abdominal hernias, it may be necessary to access the abdomen in the lower quadrants. Regardless of the location or technique used, great care must be exercised to minimize the risk of complications such as vascular or visceral injuries. Specific to ventral hernia repair, if a visceral injury occurs, the placement of a permanent mesh prosthetic may not be possible, as discussed later.