Intermittent bupivacaine infusion into the rectus sheath space after midline laparotomy does not reduce postoperative opioid requirement nor does it affect postoperative pain score or peak expiratory flow rate.

As per baseball diamond concept of port position, experimentally it is well known that putting camera port in the line of target organ and working port equidistant from camera port such that they form a 30º angle each gives optimum ergonomic advantage. However while performing laparoscopic surgeries in humans it is seldom possible to achieve such port position. No such study  has ever been attempted to find out value of angle of manipulation and angle of azimuth while performing laparoscopic procedure. Purpose of our study was to measure such angles in our patients during laparoscopic splenectomy (LS) and to verify the concept of baseball position of ports in the procedure. This was a prospective observational study where angle of manipulation between right and left working port of surgeon and angle of azimuth of both working instruments with the camera were measured intraoperatively. In our series of 12 patients who underwent LS in lateral position, we found angle of manipulation ranging from 41-85°. The azimuth angle between first working port (epigastric) and camera port was in the range of 22-45° and the azimuth angle between camera port and second working port was in the range of 19-40°. This was a first study that gave valuable insight into the application of theoretical concept of triangulation in port placement in LS. This study may guide the surgeons to measure and to modify the port position to gain advantage of better ergonomics and better long term health.

Background: Majority of laparoscopic procedures can be performed on day-care surgery basis, unexpected conversion to open surgery requires overnight or longer admission in these patients and can have additional financial and psychological impact on the patient. The aim of our study is to study the risk factors associated with conversion and the surgical outcomes in patients who underwent conversion of minimally invasive surgery to open procedure.Methods: It was a prospective observational study. All the patients who were planned for minimally invasive surgery but had intraoperative conversion to open surgeries were included.Results: A total of 41 patients were recruited in the study. Mean age of the patients was 44.7 years. Male patients had more frequent conversion (24 patients, 58.5%). 11 patients (26.8%) had history of previous surgery. Most common cause of conversion to open procedure was dense intra operative adhesions (24 patients, 58.5%); followed by iatrogenic injury to surrounding visceral organs or uncontrolled bleeding (11 patients, 26.8%). The average recovery time (duration till return to work) was 12 days. As per Clavien-Dindo classification, 28 patients (68.29%) had grade I, 9 patients (21.95%) had grade II, 3 (7.31%) had grade III, and one patient (2.43%) had grade IV complication.Conclusions: History of previous surgery and presence of intraoperative adhesions were frequently present in patients who underwent conversion of minimally invasive procedure. These patients required long period for recovery from the surgery and had frequent minor surgical complications.

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