# On the Design and Implementation of a Mixed-Platform Collaborative Virtual RAS Planner
## 6 Conclusions and Future Work  
The role of RAS in surgical practice is becoming increasingly important. This type of surgical technology has peculiarities that make RAS planning different from other types of surgery. In addition, the use of new technologies can help facilitate the surgical planning process for this type of procedure. Therefore, it is necessary to provide tools customised for this type of procedure to facilitate surgical planning. For this reason, this article presents a collaborative MR-based tool that allows one or more experts to plan together the different phases of an RAS-based surgical procedure. The proposed system is a mixed-platform collaborative virtual recreation of a surgery room and allows multiple users to work together, both locally and remotely, using different interaction tools and computing devices. To the best of our knowledge, this is the first mixed-platform asymmetrical collaborative virtual RAS planner published in the academic literature. An experimental test with four RAS domain experts was performed with good results. None of the users had problems using the application, and the researchers observed that all of them were pleasantly surprised by the proposed tools. The results obtained from the evaluation support this initial impression, since the mean usability score is 83.75 and the answers obtained from the satisfaction questionnaires were also positive. Nevertheless, we acknowledge that our research is still in TRL5 [33] and a validation process with a larger number of participants would be required to deploy our system for surgical planning experiences in hospitals. After this initial success, we plan to deploy the system in an operational environment and perform a more extensive validation to reach TRL7 and begin to introduce it in real environments. Thus, future work includes the evaluation of the tool with a larger group of domain experts. This is, of course, difficult because this surgical technology is not widely available and it is not easy to find surgeons that have expertise in RAS. As the domain experts suggested, future work will also include incorporating medical imaging into the application, in order to tailor the surgical planning process to each patient. We \begin{table}
\begin{tabular}{c c c c c c} \hline \hline
**Question** & **Expert \#1** & **Expert \#2** & **Expert \# 3** & **Expert \#4** & **Mean** \\ \hline Q1 & 7 & 7 & 7 & 6 & 6.75 \\ Q2 & 7 & 7 & 6 & 7 & 6.75 \\ Q3 & 6 & 6 & 6 & 6 & 6.00 \\ Q4 & 6 & 7 & 7 & 6 & 6.50 \\ Q5 & 7 & 6 & 7 & 7 & 6.75 \\ Q6 & 6 & 6 & 7 & 5 & 6.00 \\ Q7 & 6 & 6 & 7 & 6 & 6.25 \\ Q8 & 5 & 5 & 7 & 4 & 5.25 \\ Mean & 6.25 & 6.25 & 6.75 & 5.88 & 6.28 \\ \hline \hline \end{tabular}
\end{table} 
Table 3: Results of the satisfaction questionnaire. will also introduce annotations in order for the surgeons to introduce textual and audio information into the system, so that all the comments and steps agreed upon by the surgical team can be properly recorded and subsequently consulted by any surgeon. It is also important to emphasize that our system could be used for laparoscopic surgery too, although this technique presents differences in the approach, and there are also different types of laparoscopy, so it would be necessary to adapt the system for each type. Conceptualization, J.G. and S.C.-Y. ; methodology, C.P. ; software, B.P. ; validation, B.P., J.G. and I.C. ; formal analysis, S.C.-Y. ; investigation, B.P. and S.C.-Y. ; resources, I.C. ; data curation, C.P. ; writing--original draft preparation, B.P., C.P. and S.C.-Y. ; writing--review and editing, J.G. and S.C.-Y. ; visualisation, B.P. ; supervision, J.G. ; project administration, S.C.-Y. ; funding acquisition, S.C.-Y. and J.G. All authors have read and agreed to the published version of the manuscript.