Restoration Robotics, a company founded by Dr. Frederick H. Moll, developed the ARTAS System. This completely automated machine is the first robot designed to carry out the scoring aspect of the FUE hair transplant procedure. Once the machine is turned on and initial parameters are set by the physician, and set to start, the machine decides which follicles to score around. It then proceeds from one follicle to the other at preset speeds.
HOW ARTAS WORKS: THE MECHANICS
Cameras, color identification sensors, and 3-D imaging software guide the robotic arm of ARTAS in selecting which follicles to score. To carry out the rest of the FUE process, ARTAS employs:
- A needle punch mechanism
- Disposable dermal punches
- Disposable cartridges
- A video imaging system
- A user interface
This double-punch extraction technique requires an outer 16g (1.65mm) punch with cutting capabilities, along with an inner 18g (1.2 mm) punch with a blunt edge.
ARTAS is only approved for use on patients with straight hair that is dark brown or black in color.
The patient is positioned for the robot to punch out the grafts on a donor area of roughly 5 to 10cm at a time. During this time, the patient must remain absolutely still as the head is restrained by straps. After this, the surgeon removes each graft by hand with a pair of forceps. The patient is then repositioned for ARTAS to work on a new section of donor hair. This process continues until the extraction portion of surgery is complete. The implantation of grafts to the bald area is done using a traditional transplant approach.
ABOUT RESTORATION ROBOTICS
On April 14, 2011 the FDA granted a 510K dollar clearance to the ARTAS System for follicular unit extraction of the scalp on androgenic alopecia patients.
In 2007, the International Society of Hair Restoration Surgery (ISHRS) meeting was presented with the initial test results of ARTAS. At that point, the prototype had an unacceptably high transection rate of 30%. After more research and testing, at the ISHRS meeting of the following year the company reported that the device had decreased transection rates to 6-15%. At the ISHRS meeting in September 2011 the company reported further improvement in the transection rates of 2-7%, but this is subject to verification.
POTENTIAL PROS OF ARTAS
The prospect of a machine delivering FUE grafts is an attractive one if the machines can replicate the touch of an expert human practitioner.Also, the ARTAS System intends to boost the speed of the extraction process.
It is the opinion of Dr. Umar that these machines may suffice for clinics who wish to provide Follicular Unit Extraction, but whose physicians are still in the process of fine tuning their surgical skills in FUE.
Ultimately, he believes that robotic technology is still in its early stages of development and limited in their ability to replicate the nuanced and finer touch of a highly experienced FUE surgeon. For instance, the robot is currently restricted to scoring follicles in the middle areas of the back and sides of the head and not for lower laying hairs of the nape or even beard and body. It obviously has restrictions with regards to the color of hair and curliness of the hair.
CONS OF ARTAS
Regardless of how sophisticated a 3-D imaging system or color identification sensor may be, an automated device will still have limitations in discerning the best follicle for extraction. For example, it is important to select donor hairs with a specific hairline or eyebrow design in mind. An algorithmic approach is very technical. Therefore, a robot cannot make decisions to fulfill an artistic vision.
Many experienced FUE practitioners may find no reason for using robotics at this stage. However, it is conceivable that novice FUE practitioners lacking a firm grasp of FUE might find robots as a more viable option; a short-cut to the necessary time and learning curve required of advanced FUE.
Nonetheless, the inherent limitations of a machine may result in outcomes that fall short of a patient’s expectations.
Therefore, the need for training in the FUE procedure cannot be over-emphasized.
Other issues Dr. Umar considers to be possible areas for improvement in robotic FUE include the following:
1. While the use of a larger bore punch of 1.65mm in the robotic technique may improve on the transection rate, it also raises the prospect of certain complications or undesirable effects such as:
- The use of larger bore punches in robots, for example 16g (1.65mm in diameter) would create larger wounds. Larger wounds equal larger scars and more healing complication potential. Regular hand directed FUE tools utilize a 0.8-1.2mm punch on average. At these punch sizes, wound size is smaller, thus wounds have less healing complications and less scarring.
- The use of larger bore punches of 1.65mm in any FUE procedure also increases the chance of damaging the adjacent hair follicles. This raises the prospect of the complication that can sometimes accompany FUE hair transplants, called the “halo” effect. Each halo consists of a large circular area of loss from the removed grafts and surrounding hair that is damaged by the reach of a large punch. Many of these in a donor area could create a moth-eaten look.
2. It has long been known that a technique involving the use of a sharp punch that is followed by a deeper-reaching blunt punch may increase the risk of buried grafts, which may lead to cyst formations, in addition to damaging the selected follicle.
3. If a robotic device set to “automatic” punches out hundreds of grafts in that 5-10cm section before the surgeon checks for transections, then it would mean the potential loss of several of those grafts before the physician realizes what is going on. A surgeon is thus best advised to constantly check on transection rates in order to help ensure the health and integrity of the follicles.
4. As mentioned before, the Artas robotic system’s approval is thus far limited to those with black or brown and straight hair only.
5. After the extraction process comes the insertion phase of surgery. This is where slits are prepared for receiving the grafts. The highest level of skill is required for creating natural looking angles and orientations.
A novice FUE practitioner using ARTAS must understand that extraction is only the first step to any kind of hair transplant. The provider must be skilled in the art of recipient area designs and principles. This is something no machine can execute on behalf of a surgeon. Replicating nature requires the natural touch of a doctor and an artist.
We at DermHair Clinic believe that no robotic device can replicate the fine touch of a skilled FUE physician using a hand-held extraction device.
To learn about the pros and cons of the Artas Robot system, click here to read more.