Laparoscopic techniques have revolutionized the field of surgery with benefits that include decreased postoperative pain, earlier return to normal activities following surgery, and fewer postoperative complications like wound infection, and hernia. However, unique complications are associated with gaining access to the abdomen for laparoscopic surgery. Inadvertent bowel injury or major vascular injury is uncommon, but both are potentially life-threatening complications that are most likely to occur during initial access. The techniques for access to the peritoneum, choice of access, multiple port placement, and complications of access will be reviewed here. Laparoscopic issues and complications not related to abdominal access are discussed in separate topic reviews.