The causes of complications from laparoscopic trocar puncture are varied and include the patient’s own factors, the surgeon’s experience, and factors related to trocar design, in addition to the different methods of trocar insertion that have a significant impact on the incidence of complications. There are currently three methods of trocar placement for laparoscopic surgery: direct incision, closed method (pneumoperitoneal needle puncture) and direct visualization with a visual trocar. The choice of the method of trocar placement is determined by the surgeon’s practice and personal experience, with the most commonly used methods being the closed method and the direct incision method. Since 1971, when Hasson first reported the use of direct dissection for laparoscopic trocar placement, there has been an ongoing debate about the safety of the direct dissection method over the closed method. The greatest concern with the closed approach is the potential for injury to large vessels and vital organs, and although the exact incidence is not known, FDA surveys have shown that the actual incidence is much higher than that reported in the medical literature. In the event of injury to large blood vessels and vital organs, it may increase the patient’s pain in mild cases or even cause death in severe cases. Therefore, some authors advocate the use of direct incision to eliminate large vessel and vital organ injuries, but there are also different opinions that there is insufficient evidence that direct incision is safer than the closed approach and that serious complications are rare after all. However, reports of death during the establishment of the pneumoperitoneum during laparoscopic surgery make it essential to determine which method of placement is appropriate. There have been reports of patient deaths due to injury to the abdominal aorta and iliac artery during closed method placement, involving procedures such as diagnostic laparoscopy, laparoscopic cholecystectomy, laparoscopic sterilization, and laparoscopic appendectomy. Some authors used the direct incision method to place a total of 5904 tubes, with only one serious complication related to trocar placement (small bowel perforation), while a literature search was performed, 22 articles used the closed method to place a total of 760890 laparoscopic procedures, resulting in 336 cases of large vessel injury, with an average of 1 large vessel injury occurring in 2272 cases; 11 articles used the direct incision method to place a total of 22465 laparoscopic The statistical analysis showed that the difference between the two groups was very significant. A total of 515 cases of visceral injury occurred with the closed method, with a mean incidence of 0.07%, and 11 cases of visceral injury occurred with the direct incision method, with a mean incidence of 0.05%, with no significant difference between the two groups in statistical analysis. The American College of Physicians Insurance (1980-1999) and the FDA (1995-1997) reported a total of 594 complications related to cannula placement in 506 patients, including 239 cases of large vessel injury and 278 cases of significant organ injury, resulting in a total of 65 deaths (13% mortality). Of these, 556 complications (94%) were caused by pneumoperitoneum or first trocar placement, and 20 complications were caused by second trocar placement. Only 18 complications were caused by direct incisional placement. Only two cases of large vessel injury due to incisional placement have been reported, one case occurred when the scalpel punctured the abdominal aorta during skin incision, before the trocar was placed, and a similar situation occurred with closed method placement, when the abdominal aorta was accidentally punctured by the scalpel before the pneumoperitoneum needle was used. In another case, the abdominal aorta was punctured by a damaged trocar tip, which is actually the only reported case of major vascular injury due to incisional trocar placement available in the literature. This shows that direct incisional placement significantly reduces the incidence of complications during placement, especially the risk of major vascular injury. In our group of 802 urologic laparoscopic procedures, all of them were placed by the direct incisional method, and all of them were successful, without any complication of trocar puncture and intermediate open surgery, and there was not a single case of serious complications (large vessel injury and important organ injury) related to trocar puncture, which is consistent with the reports in the literature. Only five patients had bleeding from the abdominal wall or lumbar dorsal puncture sites during the remaining trocar punctures, which was stopped by electrocautery and did not interfere with the surgical operation. The following measures helped prevent serious complications during incisional placement by removing the tapered core of the cannula and placing the first cannula directly through the incision, with the remaining cannulae placed under direct vision. The disadvantage of direct incisional placement is that the incision is slightly larger than the closed method, and the muscle and fascia should be carefully sutured closed at the end of the procedure to prevent postoperative incisional hernia. In addition, care should be taken to prevent gas leakage during surgery to avoid subcutaneous emphysema. Immediately after trocar placement, the muscles, fascia and skin should be sutured in full so that the trocar leaves as little space as possible with the surrounding tissues and is fixed. In addition, when the peritoneum is cut, only a very small incision is made in the peritoneum so that the trocar enters the peritoneal cavity by extrusion and the gap between the two is reduced to prevent gas leakage. No serious subcutaneous emphysema or incisional hernia was found by applying the above measures.