Video: Robotic Hair Transplant: Tensioner Placement
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February 16th, 2017

Dr. Bernstein demonstrates how he places the tensioner on the patient in a robotic hair transplant procedure. The tensioner is a plastic picture frame-like device that adds tension to the patient's scalp allowing for improved harvesting. It also has little dots, called fiducials, on its outer border which the ARTAS® robot "reads" for proper orientation. The robot scans the edges of the tensioner, reads the dots, and uses them to orient the robotic arm and punch tool. Transcript of the video:
I'm just going to go over how I use the tensioner. I'm a leftie, so I grab the tensioner with my dominant hand, which is my left hand. Then with my free hand, I use the thumb and middle finger to apply additional tension. What this does is it allows me to squeeze the tensioner using two hands so it takes the pressure off my left hand and also allows us to be more accurate. When we do the placing, I'm going to first grab the upper edge of the box, the area that I'm going to be harvesting from. Pull it towards me and I'm going to lay the tensioner down and then put my three fingers from the free hand in it. Ok so let's take a look. I have assistants stretch the scalp. This can be done either with one assistant putting their right hand here and left hand here, or four corner traction. So if you have the staff it's usually better to have two people. And so, again, middle finger and thumb. I'm grabbing the upper edge and pulling it towards me, laying the tensioner down, taking my three fingers, ok here. Ok now this is important, you want to make the straps as vertical as possible. We used to have the straps coming diagonally from the corners. Now we use the lower-most notches almost all the time and have the upper part going vertically upward rather than out. We find that you get better tension and more stability that way. I use tumescent most of the time. Not that much. In his case the scalp is relatively tight so we're not going to use that much. But I still do it, especially in the corners to even out the field and also in the center because the center has actually the least tension because it is the furthest away from the needles. And we're ready to go.
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