A. Patients Factors

1. Patient can not tolerate general anesthesia
It is essential that a patient is under general anesthesia for laparoscopic operations.

2. Patient body habitus
In many cases, patients that is has morbid obesity, laparoscopic operation is quite technically challenging to perform. Except when the laparoscopic operation is performed for weight lost. For example: Laparoscopic insertion of adjustable gastric banding system, laparoscopic sleeve Gastrectomy and laparoscopic RNY gastric by pass)

3. Patient had many previous abdominal operations
Many previous operations may have generated significant amount of scarring or so called adhesions. These increase the challenge of creating a “working space” within the abdominal cavity. These certainly will make the operation longer and perhaps increase the risk of iatrogenic injury to the internal organ. Some experience laparoscopic training surgeons are still willing to offer the minimally invasive approach to the patient knowing that should he/she encounter difficulty, the conduct of the operation will be changed to a traditional open approach.