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Vascular injury can occur regardless of the method of access, and most vascular injuries (up to 80%) occur at the initial access. Recent studies have suggested that the incidence of major vascular injury is slightly higher with the closed technique (Veress and direct trocar insertion) as opposed to the open (Hasson) technique. Molloy et al. [4] suggest that the open technique decreased the rate of vascular injury to 0.01% compared with a rate of 0.04% associated with closed techniques using a Veress needle. Although the incidence of major vascular injuries is low, the mortality rate arising from these lesions reportedly ranges between 8 and 17%. Vessel injuries attributable to trocars are usually more obvious and catastrophic than injuries related to Veress needle insertion. An expanding retroperitoneal hematoma, hemodynamic instability in the face of active bleeding, and active intraabdominal hemorrhage that cannot be managed laparoscopically are all indications for conversion to laparotomy and exploration or vascular repair.