The popularity of robotics in hair transplant will remain till they make the Surgeon feel like an “Iron Man”!
The “Da Vinci” surgical system (for various surgeries, but not hair transplant) is the most popular robotic system in the world, whose insect-like arms are operated by a Surgeon sitting at a control booth. When this system was introduced, most Surgeons felt threatened that robots will replace them. Of course, this never happened. And as they worked together, surgeons valued the precision and efficiency of robotics coupled with their own knowledge . There was another benefit. As physicians grew older and lost some dexterity, robots allowed them to operate with precision.
Taking inspiration from this, “ARTAS” was developed as the first physician-assisted robotic system in hair transplant by the same team behind Da Vinci system. However, the team realised that hair transplant surgeries were very different as it is a unique combination of not only precision surgery but also artistic vision and therefore needs higher physician supervision.
The earlier generations of ARTAS (Generations 3X to 9X) focused on extraction with every new model improving on speed. ARTAS iX, released in July 2018, is next generation model which does implantation also.
ARTAS stands for ‘ART’ and ‘SCIENCE’ of robotic hair restoration. As per Ryan Rhodes, CEO of US-based company “Restoration Robotics” that owns ARTAS, “ARTAS is a support technology, not a replacement technology. It is an important tool, but its success depends on the user of tool i.e. hair transplant Surgeon.”
Reflecting back, ARTAS was devised keeping in mind that 80% Surgeons frequently use Assistants to place grafts. Due to this, many questions were raised. Do these Assistants have skill and training? Do they get tired during procedure? Do they care? How can we make this process more efficient?
Thus, a key role for ARTAS became to eliminate human fatigue for repetitive tasks subject to high Surgeon supervision. ARTAS iX system claims to have a high extraction speed of 1,600 grafts per hour.
ARTAS comes with a “Hair Studio” tool, which a consultant uses to walk around the patient with an iPad to render a 3D model in 40 seconds. A drawing is made on digital image to show how patient would look with a prescribed treatment plan. Using Hair Studio, company claims to have a 60% conversion rate. So ARTAS works very well as a marketing tool! But does it give the desired result to patients with precise angle, depth, density and natural look? That depends entirely on the surgeon’s skill.
ARTAS has many inherent constraints.
1. ARTAS is unable to make judgement calls on various aspects, where surgeon’s inputs are needed, including right diagnosis, creative vision on treatment plan, punch size selection, hairline designing, correct depth, angle and direction for implant, and setting realistic patient expectations, to name a few.
2. Compromised graft handling: In ARTAS, manual work is required to be done by Assistants. For example, Assistants pull out grafts from scalp, store them securely and load them into cartridges using forceps. The machine then pulls each graft from cartridge and implants it one at a time. This two-step process compromises graft handling and survival ratio.
3. High Transection rates: Tests show a very high 30% transection rate, reduced to 10% only when a highly skilled Surgeon operates machine.
4. In hair transplant, speed is not the ultimate goal of the patient, it is the most natural looking result with right density. But ARTAS practitioners do generate a social media buzz around speed.
5. No impact on results: The results admittedly depend on the surgeon’s skill and ARTAS has no impact on it. Even from the ARTAS brochures, results look unnatural and of poor density.
6. Extremely expensive: ARTAS iX is priced at US$400-500,000. They also charge $2,200 per procedure, which is prohibitively expensive. Obviously the other costs remain – Surgeon, Assistants, clinic costs etc. Then there is cost of future upgrades. Should the patients pay for such an expensive hair transplant treatment, and what benefits are they getting?
7. Highly uncertain future – ARTAS has lost $29Mn in 2018 alone with revenue of only $22Mn, which grew by only 3%! Market cap is only $26Mn, which means it lost more than its market cap in 2018 alone. Will this company be able to survive, even after its recent merger with Venus Concepts (Neograft)? Will this company be able to support its 286(only!) ARTAS users worldwide?
Conclusion: ARTAS is a marketing tool to attract patients in the name of technology, but there is no true benefit to them.
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