Background- In the present era Laparoscopic cholecystectomy has established as the gold standard to open cholecystectomy. It is proved that one of the commonest causes among stressful minimal access surgery is wrong port position, even if one port is at wrong place or not following laws of ergonomics. In this study, we have study of ergonomics in laparoscopic cholecystectomy by changing epigastric port site in relation to falciform ligament A total of 40 patients, 20 in each conventional and 20 Methodusing our modied epigastric port site laparoscopic cholecystectomy was performed and ergonomics was measured in terms of azimuth angle, manipulation angles and baseball eld concept. The angle of manipulation in our Result- cases was 60 degree (vs 105 degree in control). Azimuth angle was 30 degree (vs 80 degree). Distance between optical and epigastric port is on average 5.7.5 cm (vs 14-16 cm) and distance between target and epigastric port is on average 12-15 cm (vs 6-7 cm). Above ndings are following principles of ergonomics In LC, epigastric port Summarywhen inserted to the left of falciform ligament gives better ergonomics integration in terms of manipulation angle, azimuth angle than from right of ligament. providing better freedom of movement, precision and also reduce physical strains on the surgeon plus increases productivity intraoperatively following baseball eld concept.

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Primary hyperparathyroidism is not so uncommon a disease. In high-income countries, with the introduction of routine biochemical testing in 1980s, it is diagnosed early, and the majority are seen as asymptomatic disease. However, in India, a severe symptomatic form is still seen, and many times patients are undiagnosed, thus continuing to suffer debilitating disease. Here, we report such a patient who was being treated as having bony metastases from an unknown primary source, when in fact he had osteitis fibrosa cystica due to primary hyperparathyroidism and was cured after surgery.

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