Robotic FUE

Synopsis: The traditional order for the steps of a hair transplant sur­ gery has been to first perform donor harvesting then make sites and place grafts. Hair transplant surgery can often be a long procedure, and one goal of many teams is to find ways to decrease the length of the procedure to improve the patient experience, decrease the physical strain on the team, and specifically decrease the out-of-body time of the grafts to improve graft survival.

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.

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.

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.

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.

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.

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.

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.

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.