ARTAS® Robot, Manual FUE, Neograft and Long Haired FUE

What you need to know about NHI, FUE, Long Haired FUE, Neograft and The ARTAS® Robotic System

 

Artas robot close up

 

  1. We have been doing FUE longer than any medical group in the world, as we invented it
  2. We invented the two most significant components of the Artas® Robot long before the Artas® came to market and it was incorporated into the Artas® Robot
  3. The Keys to a successful FUE are:
    1. Accurate coring of the grafts.  This is well performed by the Artas® Robot or an experienced surgeon with the manual FUE process who has lots of experience
    2. The team working with the surgeon on the grafts is as important as the FUE instruments as they must be experienced in the process of handling the graft to be sure that they are kept healthy once they have been removed from the donor area
    3. The team must be skilled at placing the grafts. Ask the team how many years of experience they each have with the surgeon doing the FUE and/or graft handling. More years reflect more experience and this counts. We have a transplant team with more than 50 years of combined experience so we have consistency in the quality of grafts we create.
    4. Ask the doctor if he uses preserving solutions for storing the grafts while awaiting placement. These are expensive but work well to insure high graft survival.
    5. Ask how many years the medical group has been doing FUE. The New Hair Institute (NHI) has been doing FUE since 1996, some 6 years before we published the first article on FUE in 2002, and we published it in a prestigious peer reviewed medical journal and presented it at the largest medical hair transplant meeting in the world.
    6. Ask about the doctors results from FUE. We have performed FUE on hundreds of patients with successful outcomes.
    7. Ask to see an FUE/Artas® in process while it is being done.  Bring your family and friends with you to meet our patients and see why NHI’s reputation stands out as the leading FUE referral source for physicians themselves. We have monthly Open House events to facilitate the opportunity for you to see us in action.

    See here for more details: http://baldingblog.com/2014/12/24/new-hair-institute-will-offering-robotic-hair-transplant-artas-fue-robot/ – Also below

    The Robotic Artas® System For FUE

    The New Hair Institute has the Artas® Hair Restoration Robot for Automated Follicular Unit Extraction (FUE).  In addition to the traditional Follicular Unit Transplantation with strip harvesting, our Follicular Unit Extraction Surgeries (FUE) will include: (1) The Artas® Hair Restoration Robot, (2) the Manual FUE performed by Dr. Pak (we joke by calling him the Pak Robot using techniques we have perfected since 1996), and (3) the Long Hair FUE (LH-FUE), done with our own specialized instruments (we have generally limited LH-FUE to about 400 grafts and now offer lunch-time FUE where between 200-400 FUE grafts can be done in 3 hours over your lunch period without shaving your head).

    A little bit of FUE technology history.

    Before he became a doctor, Dr. Pak was an engineer who help me evolve FUE instrumentation in 1996. Shortly after that, he and I invented the concept of a robot (2003) which would use a special optical sighting system to align the hairs exiting the scalp for an automated and efficient Follicular Unit Extraction System. At the time we came up with this technology, I was using Follicular Unit Extraction (FUE) for a few years commercially. With his help, I submitted the patents for two appropriate technologies, one would address the siting system U.S. Patent # 6,572,625 critical for aligning the extraction instrument with a hair graft so as not to damage it during the coring process, and the second would facilitate stabilization of the scalp with a tension apparatus Patent #US 10/235,563 to facilitate quality graft extraction. Both of these inventions are now used in Restoration Robotics’ Artas® System. We also submitted patents for some future steps in automation which included graft implantation techniques (US Patent #5,817,120) which had cartridge storage for holding a large number of grafts and used in a graft placement apparatus which we built and tried to commercialize without success. Although Restoration Robotics’ Artas® robot only performs FUE today, the company will eventually incorporate the full hair transplantation process into the robot. The additional steps needed will: (a) move the grafts from the scalp into a storage mechanism while out of the body and (b) provide graft placement which will most likely use some form of our patented technology. This makes the Artas®, a very appealing technology for our practice both now and in the future. Below are figures taken from the two patents incorporated into today’s Artas® Robot.

    robot-artas-patient-300x209
    Figure taken from U.S. Patent # 6,572,625

    tension-300x180

    Figure taken from: U.S. Patent #US 10/235,563

    We are problem solvers and we recognized that although we performed the FUE well, after pioneering it in the mid-1990s and writing the first scientific FUE article in 2002, doctors in the hair transplant field initially failed to perform the FUE procedure with consistency, efficiency and with minimal transection damage to the grafts, so results were generally poor despite proclamations by many doctors to the contrary. The market demand for FUE started to rise and more and more doctors wanted to offer the technique, but failures plagued the field. What was needed was the robotic technology we envisioned (like the Artas®), but that would be a very expensive engineering project, so most doctors tried to master the manual techniques with a wide variety of instruments developed, at times, by the doctors themselves. Some instruments were good like Dr. Jim Harris’s ‘Safe System’ and doctors produced terrible instruments that failed to create quality grafts. Many patients became victims of the failures which were all too common. Some of these patients found their way to our office so we became significantly aware of the FUE problems that our invention created. In 2006, Restoration Robotics, Inc. was formed with a mission to build a robot for hair transplantation and financed the effort properly. Finally, in 2011 (just 9 years after we published our breakthrough article on FUE and five years after the engineering project was started), Restoration Robotics introduced the Artas® robot which fully addressed the frequent failures seen with the manual FUE process.

    The following are important facts about us, the FUE and the Robot

    (1) We are very efficient at doing FUE (without the robot) as we have been doing the FUE surgery longer than any medical group in the world (since the mid-1990s) with a focus on perfecting the procedure and developing instrument iterations which we pioneered along the way (16 issued patent to-date), (2) We are fast in doing FUE, even faster than the robot, and faster than most doctors world-wide because we have been doing FUE, in some form, for 19 years. Only a small handful of doctors can match our overall speed, quality, and efficiency with manual instruments. (3)  The Robot delivers unquestionable quality and consistency. As the Robot’s capabilities extends into placing grafts, the robot becomes even more efficient. (4) It solved two of the most prominent problems associated with manual FUE, (a) by eliminating the eye strain and the physical fatigue for the surgeon when performing the repetitive motions for FUE. Eye fatigue, a real known problem previously identified by me in lectures and publications, is worse for any surgeon approaching the age or over the age of 50 (e.g. Dr. Rassman) as their ability to focus and coordinate eye movement becomes a problem of aging in almost all people (fortunately for NHI, Dr. Pak is 42 years old and has none of these changes yet, so he does all of NHIs Manual FUEs) and (b) repetitive hand motions with manual FUE stress the surgeon’s hand and wrist and can produce health problems like carpel-tunnel syndrome. Dr. Pak who does all of our Manual FUE procedures, tells me that on some days, he feels wrist pain, a precursor of this syndrome, and (5) There were some initial concerns that there may be a legal problem in using a robot for hair transplantation. The Medical Boards of the Various States, like California, had not ruled on the legality of a robot performing this type of hair transplant surgery but they seem to have ignored limiting its use so our initial concern that the Medical Board of California would ‘ding us’ with regard to our license for improper conduct for using the robot, seemed to fall by the wayside. Although the State of California still has not made such a ruling, its silence on this, we believe, has become a quasi-approval on the legality of using a robot for hair transplantation. The Artas® is not ‘legally’ different from other robotic surgeries in medicine such as the da Vinci® Robotic Surgical System for Prostate Cancer Surgery and other similar robots which are routinely used in surgical procedures elsewhere in the body.

    Are there other hair transplant robots?

    Other hair transplant instrument companies have, unfortunately, may have falsely implied that their system is a robot, when in-fact it is not. Robots like the Artas®, uses real robotic technology with mechanical and optical systems that controls quality and obviates the errors associated with human FUE surgery (just like the robots used in the automotive industry to improve automotive quality manufacturing). The goal of a robot is to maintain human judgments while minimizing humans from performing the tedious components of the surgery and maximizing the robotic technology to obtain predictable quality products or services.

    The Neograft System

    We have used the Neograft on loan from the company in our office and it worked very well in our hands. Like any tool, the tool is only as good as the operator (just like the ARTAS). The Neograft has a long history to it. It was one of the first instruments ever developed (previously called the Calvitron) in the early 1990s by a Dr. Pascal Boudjema, one of the true geniuses in the hair transplant field and a man who became a good friend to us. He envisioned FUE type instruments (with a slightly larger punch scale) ten years before my first pioneering paper was written on FUE and the Neograft today is the modern generation of this original invention which Dr. Boudjema received world-wide patents on. The Neograft system uses a hollow drill to core the grafts (similar to many FUE instruments) but has a special, unique suction system that allows the surgeon to actually remove the grafts in the same motion immediately after coring each individual graft. It also has a graft implanter which is unique in the hair transplant instrumentation field particularly when associated with the FUE extraction capability that substitutes for the manual placement of grafts that could otherwise damaged the grafts by the use of the traditional forceps. No other commercial instrument that I know of does these additional two steps. In the hands of a good operator, this is an excellent instrument, but like most manually operated instruments the experience of the operator and the surgical team is what makes hair transplant surgery work. The ARTAS robotic system, a competitive system, only cores the grafts and does not presently remove them from the donor area nor does it presently implant the graft, and again, like the Neograft system, requires an excellent surgical team to get good results with good tight quality control systems in place. 

    The image in the market is that robotic FUE is superior to the manual FUE process. This is probably true in most cases when the system is Restoration Robotic’s artas® system; however, when other system are used like the Neograft system or our own individually developed technology that we have been using for years, quality again is in the hands of the surgical team. Both the doctors offering FUE services and the patients receiving them should fully understand what is happening and that there is no misrepresentation made with regard to the robotic or non-robotic technology being used. The results from any manual system is heavily dependent upon the skill of the person performing the surgery (eye and hand control), just like it has been in our hands since 1996 in providing FUE services. Many doctors can use manual systems, of many designs, competently including the Neograft system.

    …and who does the surgery?

    If you buy into a surgeon who facilitates a hair transplant procedure and you think that you are getting an experienced doctor performing the surgery on you, it might be a fraudulent misrepresentation. One death that I know of (in the hands of a doctor unskilled in the field, not a technician) occurred California probably from an anesthetic overdose of a simple, usually safe and commonly used anesthetic. Not that simple if it kills someone (the doctor lost his license and the patient’s two children lost their father). Criminal charges (i.e. manslaughter or murder) can be brought against anyone who administers anesthesia and by mistake, kills someone. In other words, an incision through the skin with any instrument, the administration of an anesthetic or the general management of the hair transplant process must be performed directly and administered by a licensed physician.

    The quality of anything we do, is what motivates us and sharing it with the medical profession is critical to our philosophies and our Hippocratic Oath which requires us to teach our colleagues any and all advances in medicine that we originate. When I first introduced the FUE to over 500 doctors at an ISHRS meeting in 2002, to teach FUE, I produced over 500 DVDs which I gave out to the doctors in the audience who never heard of FUE prior to that meeting. The DVD was, in effect, a limited tutorial for FUE. Unfortunately, some doctors used it as a marketing tool to instantly proclaim their expertise in FUE, harming far too many patients.

    People always ask us: “What Motivates Our Inventions?”

    My standard answer reflects the cliché that ‘necessity is the mother of invention’ and we personally believe that ‘there is always a better way to do something, always’. All you have to do is to “think out of the box” when confronting any problem. That is why the Artas® was invented, built and commercialized. The company Restoration Robotics created a masterful, technologically sophisticated robot that leveled the playing field for all those who use one. The training time is relatively short for the coring of the grafts, but all of the surrounding technology still remains manual and good quality control systems must be in place to guarantee good results. The Artas® FUE creates a very high standard of care for FUE graft extraction. Although today’s Artas® does not offer all of the features and functions (e.g. implantation) it will eventually offer the other elements of the hair transplant process. Again, masterful control of the quality control systems leads to great results. Only with a good team behind the surgeon, will the Artas® produce great FUE results. We will write more on the Artas®, robotics and the FUE procedure in a future post shortly that will shed more light on the actual surgery that is very pertinent to the decision on how to pick an FUE doctor. Those doctors who own an Artas®, should be in that consideration.