## 7 Discussion  
Analysis of the simulation data showed that the mean time for the virtual surgery planning process was 2.86 working days (standard deviation 1.35 days). This suggests that in most cases the planning can be completed within 3 days. Of note, only 2 of the 7 simulations required redesign iterations, which is an indicator of the accuracy and efficiency of the initial plan. In addition, a trend of increasing efficiency was observed over time. Later simulations generally required fewer working days, which seems to reflect the learning curve of the team and the gradual improvement of the protocol. This trend demonstrates the potential for the surgeon-bioengineer collaboration protocol to become more efficient over time. The results of this analysis suggest that the proposed collaboration protocol is efficient and can be operated within a time frame applicable to real-world clinical settings. It also demonstrates the potential for the process to become more efficient as the team gains experience. This case report demonstrates the successful implementation of a proposed collaborative protocol between surgeons and bioengineers in virtual surgical planning for mandibular reconstruction. The results highlight several key benefits of this interdisciplinary approach while also identifying areas for potential improvement and further research. One of the primary benefits observed in this case was the high level of precision achieved in the reconstruction. Postoperative panoramic radiographs and cone-beam CT scans showed that the actual reconstruction closely matched the virtual surgical plan (Figure 12A,C). When comparing the overall preoperative and postoperative results, the average discrepancy was 0.90 mm. This level of accuracy is consistent with findings in the literature, where studies have reported average differences between virtual plans and postoperative results ranging from 0.9 mm to 3.0 mm [9; 19; 20; 21; 22; 23; 24; 25; 26; 27]. While virtual surgical planning and guided surgery improve accuracy and reduce operative time, especially flap ischemic time [13; 28], they require greater expertise and preoperative planning. The proposed collaborative protocol demonstrated significant time savings in preoperative planning. The clear division of tasks between surgeons and bioengineers allowed parallel workflows, optimizing the overall process. Surgeons focused on critical clinical decisions, while bioengineers handled the technical aspects of 3D modeling and guide fabrication. This efficient use of expertise not only reduced operative time but also potentially reduced the risk of surgical complications associated with prolonged procedures. The synergy between surgical expertise and bioengineering skills was particularly evident in the flap design phase. The surgeon's understanding of the anatomical and functional requirements guided the bioengineer's optimization of the virtual flap design. This collaboration resulted in a flap that minimized the need for intraoperative adjustments by maximizing the natural contour of the iliac crest. The implementation of this collaborative protocol demonstrated the importance of clear communication and mutual understanding between surgeons and bioengineers. While there was an initial learning curve in adopting these techniques, team efficiency improved over time as each discipline became more familiar with the capabilities and limitations of the other. This underscores the need for ongoing interdisciplinary training and education to maximize the benefits of computer-assisted surgery. The advantage of the protocol presented in this article is that it can be performed without a large adaptation period even when working with other bioengineers. In fact, we worked with a bioengineering team rather than with a single bioengineer, and we were able to complete the work without a large change in time. This is thought to be because the surgeon directly performs important decisions in the VSP process.