Robotic FUE - Bernstein Medical - Center for Hair Restoration
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FIGURE 1. Yellow fiducials and white light guide incision.

Innovations In Robotic Hair Restoration

Synopsis: With the latest version of the ARTAS platform, 9x, Restoration Robotics has designed a faster and more accurate system for hair transplantation. The improved accuracy of harvesting and shortened procedure time increases graft viability, while smaller needles reduce scarring and allow patients to wear shorter hairstyles. Many of the changes in this upgrade have been made as a response to specific physician feedback.

Advances in Robotic FUE

Synopsis: Since the publication of “What’s New in Robotic Hair Transplantation” (Hair Transplant Forum Int’l. 2017; 27(3):100-101), there have been important improvements to the robotic system in both its incision and recipient site creation capabilities. These advances fall into four overlapping categories:increased speed, increased accuracy, increased functionality, and improved artificial intelligence (AI). The overlap occurs since improvements in functionality, accuracy, and AI can also increase the overall speed of the procedure. A faster procedure decreases the time grafts are outside the body and allows the physician to perform larger cases without placing additional oxidative stress on the follicles.

Commentary on Redefining the “E” in FUE: Excision = Incision + Extraction

Synopsis:There has been a change in the nomenclature of the FUE procedure. It will not be called Follicular Unit Excision, describing the two main components of an FUE procedure, incision (separatioin of the follicle from the tissue) and extraction (the removal of the follicular unit from the scalp once it is separated). Drs. Robert M. Bernstein and William R. Rassman’s commentary explains the importance of this change in terminology.

Fig 1. Touchscreen user interface - What's New in Robotic Hair Transplantation

What’s New in Robotic Hair Transplantation

Synopsis: Since the introduction of robotic FUE technology over five years ago, there have been numerous upgrades to the system. The current paper describes the most recent advances. These include a more user-friendly interface, the ability to select for larger follicular units, greater range-of-motion of the robotic arm, improved methods for stabilizing the scalp and newly designed needles for more accurate harvesting.

Robotic Follicular Unit Graft Selection

Synopsis: The current robotic system harvests follicular unit grafts in a random manner. A new capability of the ARTAS robot is to select follicular units based on the number of hairs they contain, in order to increase the hair/wound yield. This bilateral controlled study of 24 patients was designed to evaluate this functionality. Results showed that, compared to random follicular unit harvesting, robotic follicular unit graft selection produced more hairs per harvest attempt (2.60 vs. 2.22) and more hairs per graft (2.72 vs. 2.44). The clinical benefit was statistically significant at p<.01.

Long-Hair Robotic FUE

Synopsis: A limitation of FUE procedures is the short-term cosmetic problem of clipping the entire donor area in the back and sides of the scalp. The long-hair robotic technique avoids this problem by harvesting through a broad band of clipped hair that is covered with longer hair combed down over the harvested area. This technique enables the physician to harvest relatively large amounts of donor hair without shaving the patient’s entire scalp.

Robotic FUE Transection Rate Compares Favorably with Manual FUE Transection Rates

A 2014 study in the journal Dermatologic Surgery measured follicular unit transection (follicle damage) during the extraction step of a robotic follicular unit extraction (R-FUE) procedure. The study found that robotic transection rates, using the ARTAS Robotic System, compared favorably with non-robotic (manual) FUE transection rates.

Commentary on Robotic FUE in Hair Transplantation

Synopsis: In their excellent article, “Robotic Follicular Unit Extraction in Hair Transplantation,” Avram and Watkin give a review of the salient aspects of the newly evolving field of robotic hair transplantation. As the authors state, the appeal of robotic FUE is part of the “inexorable trend” toward minimally invasive surgical procedures. As with any new technology, it is up to the practicing physician to make sure that it is used appropriately and to the maximum benefit of our patients.

ARTAS Robotic System Provides Minimized Donor Area Scarring

Synopsis: The ARTAS® Robotic System provides a unique, comprehensive suite of tools that physicians can use to minimize donor area scarring and offer the patient greater styling options post-surgery. Factors that influence scarring in the donor area include: dissection punch size, density of harvest sites, distribution of the harvest sites, total number of sites, and the ‘blending in’ of harvest zones with un-harvested areas.

Robotic Recipient Site Creation in Hair Transplantation

Synopsis: The initial application of the ARTAS® robotic system (robot), released in the fall of 2011, was the separation of follicular units from the surrounding scalp tissue, the first step in a follicular unit extraction procedure. Subsequent steps in FUE include removal of the follicular unit grafts from the donor scalp, site creation, and graft placement. With its new hardware and software capabilities, the robot can now perform one more step in this process, making recipient sites. Preliminary observations suggest that it can accomplish this function with greater precision and consistency than when performed manually.

Robotic Hair Transplants

Synopsis: A major advance in Follicular Unit Extraction is the introduction of a robotically controlled, image guided system to remove intact follicular units directly from the scalp. The robotic device increases the accuracy of graft harvesting, which in turn minimizes damage to hair follicles and reduces harvesting time. Each of these factors potentially contributes to increased graft survival. The technology also enables FUE to be performed on a wider variety of patients. This paper discusses this new robotic technology.

Integrating Robotic FUE into a Hair Transplant Practice

Synopsis: In addition to acquiring a robotic device, performing FUE hair transplant procedures using a robotic image-guided system requires special surgical facilities, staff training, and modification of the FUE procedure itself. This paper reviews some of the key elements that go into successful implementation of R-FUE into a physician’s practice.

Pre-Making Recipient Sites in FUE and R-FUE Procedures

Synopsis: In FUT procedures, once the donor strip is removed, follicular unit dissection and graft insertion can be performed simultaneously. In FUE procedures, graft extraction must be completed before placement can begin, increasing the time grafts are out of the body and subjecting them to hypoxic injury. Waiting for recipient sites to be made adds to this time. These authors suggest creating recipient sites prior to extraction to decrease the time the grafts are outside the body. Other potential advantages of pre-making recipient sites are discussed.

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