New ARTAS Robot iX Performs Implantation Step of Hair Transplant

On October 12, 2018 Robert M. Bernstein, MD, FAAD, introduced Robotic Implantation of Follicular Unit Grafts at the 26th World Congress of the International Society of Hair Restoration Surgeons (ISHRS).

To the audience of over 550 hair restoration surgeons, Dr. Bernstein explained how this new robotic capability can help the physician make the hair transplant procedure even more accurate and precise, while further reducing the variabilities brought on by human error and physician fatigue. In addition, the new robotic device (called ARTAS iX) speeds up the procedure and a newly designed operating chair is significantly more comfortable for the patient.

After years of development, this innovation of the ARTAS Robotic System, the ARTAS iX, has recently been cleared by the FDA for implantation. It builds upon the technology of the first nine iterations of the ARTAS System and adds implantation as a significant functionality. With this system, the physician inputs the surgical plan into the computer and the robot automatically carries out the incision and mechanical graft insertion. The instrument is designed for the “stick and place” technique where an incision is made with a needle-shaped cutting instrument and a graft is immediately inserted into the recipient site.

With this new capability, three of the four mechanical steps of a hair transplant procedure have now been automated. The latest advance allows the physician to use a robot to perform graft incision, site creation and now implantation with only graft excision the remaining step to automate.

With the new robot, harvested grafts are loaded, 25 at a time, into rectangular cartridges. The cartridges are then inserted into the arm of the robot. A main advantage of using cartridges with robotic implantation over manual techniques is more accurate handling of the grafts with less risk of crush injury. During manual implantation, the grafts are generally grasped by the bulb, or just below the sebaceous glands, and then dragged into the incision risking considerable damage in the process. In contrast, with the ARTAS system, a cartridge is loaded by grasping the graft at the epidermal end and then gently placing it into the cartridge channel. By avoiding the lower and mid-portions of the follicles, this system eliminates unnecessary injury to the growth centers of the transplanted hair.

Robotic Implantation Technique

With robotic implantation, the physician creates a digital recipient site plan that is communicated directly into the robot’s computer. This includes the size, distribution, density, direction and angle of the sites to accept the 1-, 2-, 3- and 4-hair follicular unit grafts. The robot’s stereoscopic vision system identifies the areas where the grafts are programed to be inserted. The fiducials on the scalp guide the robotic arm to its proper position. The physician adjusts for density, direction, and depth of the incision, as well as depth of graft implantation.

Once the system is positioned over the patient’s recipient area, an individual cartridge is loaded into the arm mechanism and implantation begins. The system currently can implant up to 500 grafts per hour.

Both follicular unit excision and recipient site creation can now be performed robotically, making the ARTAS iX Robotic System an even more powerful tool for the hair transplant surgeon. The physician’s skill and judgement are still the critical aspects of the procedure, but the more labor-intensive parts and those subject to human error are further reduced.