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The number of robotic surgical procedures for thoracic disease is increasing. The automatic linear stapler has become a necessary device in endoscopic surgery. A 67-year-old man with a history of smoking was referred to our hospital for an abnormal finding on chest x-ray. Computer tomography of the chest revealed a ground glass nodule in the right middle lobe. We performed right middle wedge resection through the assistant port using a long-shaft stapler (LSS). Because the nodule was diagnosed as an adenocarcinoma on the intraoperative frozen section, the patient underwent robotic-assisted thoracoscopic surgery (RATS) right middle lobectomy using the da Vinci® Xi system. The pulmonary arteries, veins, right middle bronchus and minor fissure were divided using the LSS through the utility thoracotomy or assistant port. The postoperative course was uncomplicated. This case suggests that the LSS can be used in RATS lung resection for cancer.

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We report two cases of pyogenic spondylodiscitis caused by bacteremia following gastric surgery. [Case 1] An 85-year-old male patient underwent total gastrectomy for gastric cancer. After the surgery, leukocytosis and elevated C reactive protein (CRP) were sustained; however, there was no surgical site infection (SSI). His lumbar pain was present; therefore, we performed magnetic resonance imaging (MRI). Thereafter, he was diagnosed with L3 spondylitis, L2/3 discitis, and bilateral iliopsoas abscess on postoperative day (POD) 33. He has been treated with daptomycin (DAP). [Case 2] A 72-year-old male patient was admitted to our department for post-distal gastrectomy reflux esophagitis. After admission, conservative therapy was continued; however, severe symptoms appeared many times. Then, surgical treatment was scheduled to reduce reflux. When his body temperature (BT) was elevated to 39.1°C before the surgery, vancomycin (VCM) was administered because of suspected catheter infection. Once his BT normalized, fundoplication was performed. On POD 19, his BT elevated again, and the central vein (CV) catheter was removed. On POD 27, he complained of back pain. He was diagnosed with pyogenic spodylodiscitis using MRI. He was treated conservatively with VCM followed by sulbactam/ampicillin (SBT/ABP) based on the result of the culture. Physicians should be alert regarding possible occurrence of pyogenic spondylitis in patients with back pain or lumbago who have undergone gastric surgery.

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