Minimally invasive surgery carries the inherent risk of trocar injury during placement. Initial trocar placement can be performed open, blind, or with Veress needle insufflation. There is no consensus regarding the safest option. The majority of trocar injuries are to the small bowel, many of which are identified immediately. However, a high index of suspicion for missed enterotomy should be maintained when working up patients who present with fevers and abdominal pain after recent laparoscopy. Trocar injuries to vascular structures are less common but carry higher mortality risk, often requiring multidisciplinary care of the patient with close coordination between anesthesia and the surgical team. Minimally invasive surgery continues to rise in popularity and is considered to be safe and effective; however it is critical to understand some of the consequences of entry injuries and how to address them.