Objective To review the advances in instruments designed for safer entry into the abdominal cavity. Design A systematic review of the literature, including a Medline search of the period from 1966 to February 1999, using the words: laparoscopic, mini, micro, entry, Veress needle, optical, safety and methods. Results There are approximately 0.4 Veress needle‐related injuries per 1000 procedures. The modified ‘optical’ Veress instruments are designed to further decrease this rate. Despite extensive studies demonstrating the use of the latter, there are no large‐scale, well‐designed trials to confirm their superiority over the conventional Veress. Conclusion Veress needle‐related injuries are rare, but their sequelae can be fatal. Many of the alternative instruments have potential advantages over the Veress needle, but lack of quality research means that they are not yet validated. This must be done by well‐planned trials as soon as possible.