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  1. #1
    Senior Member PayDay's Avatar
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    Default Robot-assisted hair restoration LA Times Article

    http://www.latimes.com/health/la-he-...,5660320.story
    Hair-transplant surgery could become cheaper and more accessible with a new robot that plucks hair follicles from the back and sides of the head so they can be moved to the top and front of a balding pate.

    It normally takes eight to nine hours to individually harvest, by hand, the 1,000 follicle clusters needed to build a full mane of hair, according to Dr. James Harris, director of the Hair Sciences Center of Colorado in Denver. Since the surgery is tricky and time-consuming, fewer than 10% of hair-restoration surgeons do it. Most simply remove a whole strip of scalp and separate out the follicles under a microscope. Strip surgery is painful and takes weeks or months to heal versus just a couple of days' healing time and less scarring with individual follicular-unit extraction, Harris says.

    The new ARTAS robot decides which follicles to collect and plucks them out as the doctor stands by to check its work. The surgeon can watch from the same room or via a remote monitor.

    Harris says the time passes quickly as he watches the robot do its thing: "It's certainly less tedious than doing it by hand. It allows me to think more about the other things I'm going to do with the patient."

    The robot halves the surgery time, Harris says, and surgeons can be trained in its use in a couple of days, rather than the two to three years it took him to perfect the by-hand operation.

    Harris developed a blade for the drill tip that the machine uses to punch out follicles without damaging them and licensed it to Restoration Robotics Inc. of Mountain View, Calif., the company that makes ARTAS. His office is one of two that tested a prototype of the machine.

    Harris was so impressed he became the first hair-restoration specialist to install the ARTAS robot, which was approved by the U.S. Food and Drug Administration last year. He and his fellow testers have already put more than 350 heads under the machine's care, with no complications, he says.

    Since collecting follicles one by one directly from the scalp is so time-consuming and difficult, physicians that do it charge $5,000 to $10,000, Harris says. The robot cost $200,000, but because it saves him time, Harris offers patients a discount if they let ARTAS do the follicle extraction.

    —Amber Dance

  2. #2
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    I really don't understand why the data on follicle extraction is so inaccurate in these reports regarding robotic extractions.

    Extraction rates vary by physician and technique. There are many physicians who can extract over 1000 grafts in one hour by a variety of techniques.

    it does not take years to become proficient in manual FUE. It takes no more than one week for a physician with good hands. Many physicians are able to extract grafts well by the second day when done manually. With some mechanical devices including mine, which is not available at this time, you can become proficient in 2 or 3 minutes.

    Transection rates vary by physician and technique, as well. The robot is better than some physicians and worse than others.

    The robot has trouble differentiating grafts containing more than one hair so it tends to select grafts containing fewer hairs per graft even though it uses a larger 1.2 mm punch.

    In Alaska, over 40% of the physicians in the audience offered FUE. i have no idea where the 10% of all physicians came from. In 2008 over 10% of all hair restoration surgery procedures were done by FUE (mostly manual techniques).

    i think the robot has a place in hair transplant surgery. It offers a better transection rate than many physicians can achieve. It is also going to be faster than many physicians. Still, it is much slower than many physicians and much slower than some.

    i think we should see accurate data when a physician promotes a tool they have an financial interest in. Otherwise, i think it really damages their credibility.

  3. #3
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    Default ARTAS Article in LA Times

    The data in the article are estimates as we have no survey data to provide the accuracy that we would like. The recent 2011 practice survey of the ISHRS did not inquire about the percentage of physicians performing FUE and certainly did not ask about rates of extraction. I am basing the estimate on discussions I have had with several hundred physicians. More importantly the point I was trying to make is that very few physicians offer FUE as a primary treatment in their practice even when their websites promote them as FUE experts; the fact is that they use FUE as a marketing tool rather than a treatment modality for a multitude of reasons.

    In my discussions with them I have found out that in they are not extracting at acceptable rates because they do not have the opportunity or the desire to train and practice. In spite of your imagination there are not many physicians producing 1000 grafts an hour and it certainly isn’t happening after a week of experience and your assertion of proficiency in 2-3 minutes is a stretch.

    Your claim that the robot may be faster than some surgeons and slower than others is absolutely true. But so what? Your tone is one of incrimination and the point and you are trying to make is meaningless as some physicians are faster than others in any procedure. What does your comment have to do with the application of any technique and specifically what does it have to do with the introduction of new technology that will benefit many doctors and the patients that decide to go to them?

    In addressing your inaccuracies, there is absolutely no “tendency” for the robot to select grafts with fewer hairs, in fact the opposite is true. The size of the punch creating the incision around the target graft is 1 mm, not 1.2 mm. I do not receive royalties or payments of any sort based robot sales, my lectures or discussions with physicians.

    The article was intended to let the potential patient know of a new technology that may enhance their clinical results in the hands of the right surgeon.

  4. #4
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    I have my consultation with Dr. Harris Nov 16th.

    I plan on getting James Harris with the ARTAS robot transplant next year. Assuming I am a good candidate for the process. The numbers he quoted me were right within my budget.

    Hopefully his time schedule for a transplant is better than his consultation time schedule 2ish months +

  5. #5
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    There has been a plethora of knowledge available regarding extraction rates and transection rates for years. Rather than accept this data or mention it in any of your marketing message, you have chosen to simply ignore it, while perpetuating the claims that you have the fastest equipment on the market. You have done this for many years in marketing your safe system.

    Yes there are some very good physicians who can produce well over 1000 graft extractions in an hour. Some may be based on burst rates, but many can cut this many in one hour. Others may average 400 to 500 per hour, but that's still much better if you produce a lower transection rate and more hair per graft because the patient gets more hair and a better value to what really bothers them, their hair loss. The fact that you ignore these physicians is completely understood. You seem to ignore other physicians as a rule of thumb.

    You are cutting with a 1.2 mm punch. You are not communicating with an idiot or someone who does not perform FUE. You are communicating with someone who understands it far better than you do and to someone who has done far more FUE procedures than you will probably ever perform. A 1.2 mm punch would average more hair per graft, if the Robot did not select grafts with fewer hairs per graft. The Robot cannot discern grafts containing more hair in many instances due to limitations in the equipment. The reason you are cutting with a larger punch is to reduce the transection rate of the grafts.

    Frankly, I really don’t care if you receive royalties or just a boost to your ego. What I do care about is your failure to recognize the limitations of some equipment, the advantages of other equipment, and the abilities of many physicians using a variety of different techniques. I can still recall when you felt that you did not need depth control or a variation in punch sizes. Even the depth of your safe system has decreased significantly from your original 5 mm depth. Over time even the most stubborn people catch on through a variety of means.
    I’m not incriminating the Robot. It’s going to offer FUE options to many patients in the hands of physicians, who would otherwise not be able to offer FUE for a variety of reasons. I’m very much pro FUE and very much anti-strip.
    What I’m doing is lecturing you. I’m lecturing because your message is meant to market the Robot while failing to inform patients that there are also some very good alternatives with proven results and documented safety records that exceed the capacity of the Robot in it’s present form. Rather, you are quoted that typically takes 8 to 9 hours to harvest 1000 follicle clusters by hand. That is simply ridiculous. Also, over 10% of hair restoration surgery procedures in the 2008 ISHRS practice census were FUE cases. This number did not go down during the time the Robot was not commercially available.
    It is my opinion that someone who does not accurately quote the literature does place his or her credibility into question.

    There are very good hair transplant surgeons, who are quite quick and pick things up quickly. There are others, who cannot pick things up as quickly and may never be good at FUE. Furthermore, if you are not committed to FUE, you may never be as good at it as those who practice it every day. With proper instrumentation, you can pick it up quickly, and if you have good hand eye coordination with outstanding instrumentation, along with proper teaching you can be very good in a short period of time. Perhaps over time, the Robot can make significant strides, but for now, the Robot cannot match the potential available from other modalities to perform FUE.

    I do think that it is great that we have an alternative option for FUE that fits the budget of many people. That’s one potential clear advantage in favor of the Robot for many patients. The difference is that you will average fewer hairs per graft and risk a higher transection rate. It really does not matter if it takes you longer to get the Robot transplant performed than other methods available. Eventually, I’m sure they will figure out how to improve that, as well.

  6. #6
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    Thumbs up

    I love this forum! Where else can you see two of the best FUE surgeons in the world having an open debate? I’m very interested in learning more about this robot and personally think that it looks like a positive step for HT surgery. Cool stuff! I wonder what Spencer Kobren thinks about it?

  7. #7
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    How very thankful we all can be for the many improved strides in HT surgery methodology espcially now that we have so many options for patients today that let's face it, we did not have even 5 years ago. You both have your place in your own methodologies and instrumentation whether they be by robotic or not. It really comes down to each individual patient and his/her needs as defined by their goals.

    I am also seeing more and more repair patients regain some level of social independence freeing some of them of the psychological barriers from past HT surgery procedures. Let's not lose sight of that.

    That is what this is all about and let's rather be encouraged by the obvious improvements in robotic technology from Dr. Harris and others. I am seeing more and more IAHRS and ISHRS physicians adoting this robotic tooling in their own practices and even the more as we speak. I am especially encouraged by the range and total control over the robotic device as the seperate FU extractions are made. It's very similiar to the potential control in the robotic devices an urologist uses when various sized kidney stones are extracted. Stones as small as .5 mm with very precise movements. Obviously they also employ the use of a monitor so they can make any needed adjustments as they guide their instrument at and through the point of extraction.

    With time, and as Dr. Cole pointed out, more and more improvements will be made in the industry and hopefully the transection rate can be reduced to nearly zero! We are sincerely behind you Dr. Harris!

    Thank you again gentlemen for your passion.
    "Gillenator"
    Independent Patient Advocate
    more.hair@verizon.net

    NOTE: I am not a physician and not employed by any doctor/clinic. My opinions are not medical advice nor are they the opinions of the following endorsing physicians: Dr. Bob True & Dr. Bob Dorin

  8. #8
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    can the ARTAS do body hair FUE's?

  9. #9
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    Most clinics don’t offer FUE because they simply do not have the necessary skill to offer it without damaging the patient. They also realize that they simple cannot make much profit spending their whole day working on one patient even if they had the skill. Of course not being able to offer FUE leaves them at a distinct disadvantage so I’m sure they are chomping at the bit.

    To suggest this robot is for the benefit of the patient is nonsense in my opinion. If my figures are correct more than $63M+ has been raised in attempt to bring this robot to market. These investors have one goal in mind at that is to realize a hefty return.

    Most patients that have had a FUE procedure or are familiar with it know that a 1mm punch is too large and usually ends up in visible scarring. How exactly does this benefit the patient? Are patients made aware that skilled doctors are using punches that are .75-.85 in size? Are patients made aware that a 1mm punch covers a square area that is 80% larger? Does that matter in the clinics opinion? This industry always seems to think it’s quite ethical to leave out information if the patient doesn’t ask.

    With the limited extraction area will overharvesting become of concern for clinics concerned only with numbers? The suggestion that FUE can be learned in 2-3 minutes I find to be absurd.

  10. #10
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    I’m all for technology and advancements but I’m also for providing the patient with as much information as possible and letting them make an educated decision. I hope everyone associated with this business regardless of their capacity becomes a billionaire but that do it honestly.

    Let the patients that sign up for this robot know that the punch is bigger than what most highly skilled doctors are using and are getting a comparable or lower transaction rate. The result of using a bigger punch obviously is a greater chance for white dot scarring. Some of the pictures I have seen of clinics using a 1mm punch can only be described as shot gun blast to the back of the head.

    This machine in its current state also limits the harvesting area so what exactly is the limit on how many fue’s can be extracted over time. My guess is that it would be a fairly low number so what is the point? As I stated in my previous post the odds of over harvesting is going to be very high.

    I would like to know the thoughts of all the consumer advocates out there. Why is important information always conveniently left out by many clinics and people in this industry?

    I understand that we don't want to step on anyone's toes but you are either a consumer advocate or you're not. There is no in between.

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