1 Department of Computer Science and Software Engineering Concordia University Quebec Canada.
2 Maisonneuve Rosemont Hospital University of Montreal Quebec Canada.
3 School of Health Concordia University Quebec Canada.

Video-assisted thoracic surgery (VATS) is a minimally invasive approach for treating early-stage non-small-cell lung cancer. Optimal trocar placement during VATS ensures comprehensive access to the thoracic cavity, provides a panoramic endoscopic view, and prevents instrument crowding. While established principles such as the Baseball Diamond Principle (BDP) and Triangle Target Principle (TTP) exist, surgeons mainly rely on experience and patient-specific anatomy for trocar placement, potentially leading to sub-optimal surgical plans that increase operative time and fatigue. To address this, the authors present the first virtual reality (VR)-based pre-operative planning tool with tailored data visualization and interaction designs for efficient and optimal VATS trocar placement, following the established surgical principles and consultation with an experienced surgeon. In the preliminary study, the system's application in right upper lung lobectomy is demonstrated, a common thoracic procedure typically using three trocars. A preliminary user study of the system indicates it is efficient, robust, and user-friendly for planning optimal trocar placement, with a great promise for clinical application while offering potentially valuable insights for the development of other surgical VR systems.