Clinical Implementation of Carina™ Modular Robotic Platform in Thoracic Surgery for Stage IIIA Squamous Cell Lung Carcinoma after Neoadjuvant Chemoimmunotherapy: A Case Report

Background Neoadjuvant chemoimmunotherapy has become a standard approach for locally advanced non-small cell lung cancer (NSCLC), enhancing resectability. However, it also increases surgical complexity because of treatment-induced fibrosis—a challenge well addressed by robotic-assisted thoracic surgery (RATS). This report demonstrates the successful application of a modular robotic platform for post-neoadjuvant left lower lobectomy in a patient with stage IIIA squamous NSCLC, highlighting its precision and feasibility in complex oncologic resections. Case presentation: A 51-year-old man was diagnosed with squamous cell carcinoma of the left lower lobe (cT2aN2M0) and achieved a partial response following pembrolizumab plus chemotherapy. After completing neoadjuvant chemoimmunotherapy, robot-assisted left lower lobectomy with systematic lymph node dissection was performed using the Carina™ Modular Robotic System (Ronovo Surgical, Shanghai, China) because of anticipated pleural adhesions and the complex anatomical location of enlarged lymph nodes. The robotic platform demonstrated excellent outcomes: 20 mL blood loss, 5-minute docking time, and 141-minute console time. Intraoperatively, severe pleural adhesions were encountered but successfully managed with robotic assistance, enabling complete dissection and safe tumor resection. The patient recovered rapidly, with chest tube removal by postoperative day 5 and discharge on day 7. Pathology revealed a major pathological response with negative bronchial margins. Conclusions Neoadjuvant chemoimmunotherapy is an effective strategy for treating locally advanced, resectable NSCLC. Although it introduces surgical challenges such as pleural adhesions, RATS offers a technically optimized approach to overcome these obstacles. This case highlights the precision and feasibility of the Carina™ system in complex post-neoadjuvant surgery, along with potential advantages in space efficiency and ergonomics. While the results are promising, larger studies are needed to validate these findings.