We retrospectively reviewed all 2201 laparoscopic procedures performed at our community teaching hospital in the 3-year period between 1992 and 1995. There were three major vascular injuries, for an incidence of 0.14 per cent. Vessels injured were the left common iliac vein, the right common iliac artery, and the left internal iliac artery. Two of the injuries were believed to involve the 10 mm trocar, whereas the third involved the Veress needle. Two of the injuries were All injuries were successfully repaired primarily. We believe such major vascular injuries can be avoided by strict use of proper techniques of needle and trocar insertion, and by using the open technique to create a pneumoperitoneum in patients with previous abdominal operations. Laparoscopic surgeons should be aware of the potential for injury to major vascular structures and constantly be prepared to identify and treat this potentially life-threatening complication.