The findings were presented at the Military Health System Research Symposium (MHSRS) 2025, the DoD's premier scientific meeting on military medicine. The study, "Comparison of Self-Retaining Retractor Systems for Use in Forward-Deployed Surgical Teams," evaluated multiple commercially available systems — including the TITAN CSR® retractor, Bookwalter®, Alexis™, and Balfour — based on exposure quality, ease of use, portability, and suitability for damage control surgery in austere environments.
Statistically significant results from the study demonstrated that the TITAN CSR® retractor:
- Provided the greatest surgical exposure of any retractor tested, measured by the visualized surface area of the abdominal cavity. Surgeons rated the TITAN CSR® retractor's exposure performance 4.9 out of 5.0 — nearly a perfect score and a critical advantage for life-saving operations where every centimeter of visibility matters.
- Assembled and deployed faster than the Bookwalter®, a complex system requiring a table attachment and multiple components. Combat hospitals often lack the standard operating room beds with side rails needed to mount the Bookwalter®, meaning it is frequently not even an option for military surgeons. The TITAN CSR® retractor eliminates this limitation, and in high-acuity trauma cases, reducing setup time can help achieve control of hemorrhage faster and save valuable minutes in the operating room.
- Received the highest overall perception of use among all systems tested, based on surgeon and surgical team ratings of setup simplicity, adaptability to different procedures, stability during use, and overall effectiveness in achieving optimal exposure.
The study was led by Dr. Mylea Echazarreta Cristner, who received the Young Investigator Award at MHSRS 2025 for this work.
"The TITAN CSR® retractor has been rigorously evaluated by the Department of Defense, with the study's significant findings showing it delivers the greatest surgical exposure, fastest setup, and highest overall surgeon satisfaction among systems tested," said Dr. Ramon Cestero, trauma surgeon, military veteran, and inventor of the TITAN CSR® retractor. "It is in active use at military facilities as well as Level 1 trauma centers across the U.S. and Canada, where civilian surgeons have reported the same benefits in their own high-acuity cases — speed, exposure, and simplicity that directly impact patient outcomes."
About the TITAN CSR® Retractor
Designed for austere, damage control, and trauma surgery, the TITAN CSR® retractor is a lightweight, post-free, self-retaining retractor that allows rapid setup and exceptional exposure without requiring a surgical table. It is actively used at multiple Military Treatment Facilities (MTFs), by special operations surgical teams, and at deployed Role 2 military hospitals around the world, including:
- Brooke Army Medical Center
- Walter Reed National Military Medical Center
- Naval Medical Center San Diego (Balboa)
- Naval Hospital Camp Lejeune
- Naval Medical Center Portsmouth
- Michaud Expeditionary Medical Facility, Camp Lemonnier, Djibouti (CLDJ)
- Air Force Special Operations Command (AFSOC) surgical teams
Importantly, the same design and performance advantages that make the TITAN CSR® retractor ideal for military use translate directly to civilian trauma centers and operating rooms. Many of the most significant advancements in civilian trauma surgery — from tourniquets to damage control laparotomy — originated in the military before becoming standard of care in civilian practice. The TITAN CSR® retractor follows that tradition, providing rapid setup, superior exposure, and unmatched versatility for multiple surgical specialties performing abdominal surgery in hospitals worldwide.
Key Features of the TITAN CSR® Retractor:
- Post-Free™ Design – No table attachment required
- Rapid Setup – Assembles in under 2 minutes
- Portability – Compact and rugged for field or hospital use
- Versatility – Used in trauma, general, and multiple other surgical specialties performing abdominal surgery
- Reusable – Fully autoclavable, reducing long-term costs
For more information, clinical videos, and training opportunities, visit: www.titanretractor.com
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About ASR Systems®
Advanced Surgical Retractor Systems, Inc. develops innovative retraction platforms that improve surgical exposure, reduce operative time, and deliver performance in both hospital and austere environments. The TITAN CSR® retractor is trusted by civilian trauma centers, military surgical teams, and deployed hospitals throughout the U.S., Canada, and worldwide.
Media Contact:
Mike Girouard
CEO & President
[email protected]
855-415-7471
SOURCE ASR Systems
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