# On the Design and Implementation of a Mixed-Platform Collaborative Virtual RAS Planner
###### Abstract  
Robotic Assisted Surgery (RAS) represents an important step forward in the field of minimally invasive surgery. However, the learning curve of RAS is steep, and a systematic planning of surgical robot setups should be performed to leverage the features of RAS. For this reason, in this paper we show the design and implementation of a mixed-platform collaborative system, creating an interactive virtual shared environment that simulates RAS during the surgery planning phase. The proposed system allows one or more experts to plan together the different phases of an RAS-based surgical procedure, while integrating different levels of immersion to enhance computer-assisted training. We have tested our system with a total of four domain experts. Our results show that experts found the system excellent in terms of usability and useful to prepare and discuss surgical planning with RAS. RAS; planning; collaborative environment; virtual reality; extended reality +
Footnote †: journal: Applied Sciences  
**Citation:** [PERSON]; [PERSON]; [PERSON]; [PERSON]; [PERSON] On the Design and Implementation of a Mixed-Platform  
**Combartive Virtual RAS Planner**  
**Appl. Sci. 2024, 14, 3349. [[https://doi.org/10.3390/app14083349](https://doi.org/10.3390/app14083349)]([https://doi.org/10.3390/app14083349](https://doi.org/10.3390/app14083349))**  
**1. Introduction**  
In recent years, the number of health-related computer applications has increased due to the improved technological capabilities of smart devices and the integration of highly interactive paradigms, such as virtual and extended realities (VR, XR). While VR allows user immersion in a pure virtual environment, XR is an umbrella term that covers different interaction paradigms that combine the real and virtual worlds [1]. In collaborative virtual shared spaces, the XR paradigm has the advantage that it allows direct vision of other people, as well as of other elements that can be of interest while collaborating, such as printed documents. However, the misalignment of the real and virtual worlds in XR might cause discomfort and/or distract focus from the virtual objects, which is not the case in VR. Other related interaction paradigms are Augmented Reality (AR), which combine the real and virtual worlds taking into consideration the spatial alignment between the two worlds, and Mixed Reality (MR), which is a continuum between a purely virtual and a purely real environment [2]. In this research, we focus on integrating a collaborative virtual environment in a mixed-platform fashion [3], to help surgeons perform the planning phase of Robotic Assisted Surgery (RAS). The learning curve of RAS is steep [4], and some phases, including the surgery planning, require specific training to leverage the features of these expensive devices [5]. Thus, it is of the utmost importance to help surgeons overcome these difficulties. Such mixed-platform architecture, which includes VR and XR interaction paradigms, can offer new points of view to observe virtual information representing the surgery process, so that instead of seeing it on a monitor, it can be displayed in the space around the user. In our system, the volumetric information (which can be derived, for instance, from a Computed Tomography scan) can be observed as if the patients themselves were lying on the surgery table, being able to hide irrelevant elements, highlighting those that are important, or taking measurements. In this sense, we aim to improve the planning process of RAS, providing tools that allow overcoming the most difficult aspects of this type of surgery. Three key aspects have been identified: the positioning of the surgical robot (the trocars that are introduced into the patient and the robot arms), access to the first-person perspective of the surgeon, and the possibility of performing collaborative, even remote, planning with other specialists. The placement of the robot and the incisions through which the robot arms are inserted are key to the correct performance of the surgical process.