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Normally an incision is made in the umbilicus, and CO2 is insufflated in order to make a  safe entrance of the first trocar possible.  We use an 11 mm trocar with a large side opening (Storz) , in order to permit the use of a high flow insufflator (Storz) , which procures additional safety  in case of bleeding and aspiration or during gaz loss during hysterectomy. 

Secondary incisions and trocars  

2 trocars of  5mm   (= laser surgery )    

We mostly use 2 secondary incisions very low in the abdomen within bikini limits. When the use of dissection and electrosurgery for a short period of time is anticipated (eg A hydronefrosis) the incisions are put slightly more lateralbut still low. This permits the use of a third secondary trocar in the middle if necessary.

3 trocars of 5 mm  (electrosurgery)    
When the entire surgery is will be done by electrosurgery, 3 secondary punctures are used higher on the abdomen . Thereason for this is the angle of access to the pelvis

2 trocars of 5 mm + 1 trocar of 10 mm          
When morcellation is needed, 1 of the 5 mm trocars has to be replaced by a 10 mm

Enlargement of incisions
When larger pieces of tissue have to be removed, the first incision ha to be enlarged to some 2 cm.

Discussion
The first incision is always vertical deep in the umbilicus since the wall is thinnest at that level and in order to prevent a scar ( an horizontal incision produces a ‘smile’ scar).

If adhesions could be present insufflation can be done though a 5 mm incision, under the ribs on the left side.

With a laser most surgery can be done with 2 secondary ports put very low.

Using electrosurgery  3 ports are necessary to work properly. These are placed higher in the abdomen. If suturing outside the pelvis, eg sigmoid endometriosis, is necessary 3 secondary ports placed higher in the abdomen are mandatory.

To remove larger blocks of tissue, either a morcellator of 1 cm or a small enlargement of an incision is necessary.

Besides technical and esthetic considerations, it is important to know that in general a more experienced surgeon with perfect assistance is needed to do surgery with 2 secondary trocars only, inserted low in the abdomen. On the other hand, safety si the most important issue.