Designed by a Military Trauma Surgeon. Built for the Operational Mission.

The TITAN CSR® retractor is a lightweight, self-retaining, Post-Free™ surgical retractor designed to provide rapid, hospital-quality abdominal exposure without requiring attachment to an operating table. It combines the portability and rapid deployment needed for operational surgery with the ability to add Bookwalter®-compatible blades for deep, upper abdominal, pelvic, and retroperitoneal exposure.Importantly, the TITAN CSR® retractor was designed by a military trauma surgeon with combat surgery experience. Its design reflects the realities of operational surgery, where equipment must be portable, adaptable, simple to deploy, and capable of performing when personnel, space, and conventional operating-room infrastructure are limited.Military surgeons have traditionally faced a tradeoff between portability and exposure. The Balfour is commonly used for deployed surgery because it is portable and does not require an operating-table attachment, but its ability to expose deep and retroperitoneal structures is limited. Bookwalter® and other table-mounted systems provide advanced exposure but require a standard OR table with compatible rails and mounting architecture, generally limiting their use to fixed Military Treatment Facilities.The TITAN CSR® retractor was designed to eliminate that tradeoff. It provides the portability and rapid Post-Free™ deployment needed in forward environments while adding the advanced exposure capabilities associated with hospital-based table-mounted systems.Despite its compact design, the TITAN CSR® retractor does not sacrifice exposure. Published clinical experience demonstrated exposure comparable to table-mounted systems, while independent DoD-sponsored comparative testing presented at MHSRS 2025 demonstrated that the TITAN CSR® retractor with accessory blades provided greater measured surface-area exposure than the Bookwalter®.The TITAN CSR® retractor also serves as a surgical force multiplier. Because it is self-retaining and does not require a table-mounted post, it reduces personnel requirements for setup and manual retraction, allowing limited surgical teams to direct personnel toward other critical tasks.At 2.2 pounds with only 10 reusable components, the TITAN CSR® retractor is highly portable and adaptable. When combined with Bookwalter®-compatible accessory blades, the reusable TITAN CSR® Lighted Retractor Blade, and sterile battery-powered TITAN CSR® Blade Lights, it becomes a comprehensive operational retraction and illumination system that does not depend on a table-mounted post, fiber-optic light source, or external power connection.Together, these capabilities allow military surgical teams to bring hospital-quality exposure and illumination across the spectrum of military environments rather than limiting advanced surgical retraction to fixed hospital operating rooms.

A Department of Defense-sponsored study presented at the 2025 Military Health System Research Symposium (MHSRS) directly compared the TITAN CSR® retractor with the Bookwalter®, Balfour, and Alexis™ retractors using cadaveric and simulated laparotomy models.The TITAN CSR® retractor with accessory blades provided the greatest measured abdominal surface-area exposure across the incision lengths tested—including greater exposure than the Bookwalter®—despite requiring no table-mounted post or operating-table attachment. It also received the highest surgeon-rated exposure score (4.9/5), the highest overall perception-of-use score (4.4/5), and the highest rating for providing exposure without an assistant (4.4/5). Read the 2025 Military Study Press Release. For military surgeons, the significance extends beyond the comparison itself. The TITAN CSR® retractor demonstrated that hospital-quality exposure does not have to depend on the infrastructure required by a conventional table-mounted system.These findings support the TITAN CSR® retractor as a portable, adaptable surgical force multiplier for both fixed and deployed military environments.

The Balfour has traditionally been a standard abdominal retractor for deployed surgery because it is portable, rapidly deployed, and does not require attachment to an operating table. However, its major limitation is exposure. Traditional Balfour-type retractors provide abdominal wall retraction but are limited in their ability to expose deep abdominal and retroperitoneal structures—areas that can be critically important during damage-control surgery.The TITAN CSR® retractor preserves the operational advantages that make the Balfour useful forward while overcoming those exposure limitations. Like the Balfour, the TITAN CSR® retractor is portable, self-retaining, rapidly deployed, and requires no table attachment. Unlike the Balfour, its overlying frame accepts Bookwalter®-compatible accessory blades, allowing surgeons to obtain targeted upper abdominal, pelvic, deep, and retroperitoneal exposure without changing retractors or requiring a table-mounted system.Independent military testing reinforces this distinction. In the MHSRS comparative study, the TITAN CSR® retractor with accessory blades provided substantially greater measured abdominal exposure than the Balfour and received markedly higher surgeon ratings for exposure and overall usability.For deployed surgical teams, the TITAN CSR® retractor addresses the traditional tradeoff between portability and exposure: it provides the portability and speed needed forward while adding advanced exposure capabilities normally associated with hospital-based table-mounted systems.

Yes. This is one of the most important advantages of the TITAN CSR® retractor for military surgery.Bookwalter® and other table-mounted retractors depend on a standard OR table with compatible rails and mounting architecture. In the military, this generally restricts their use to fixed Military Treatment Facilities. Role 2 and Role 3 surgical facilities, buildings of opportunity, and other deployed or austere environments typically do not have the infrastructure necessary to use a table-mounted retractor.The TITAN CSR® retractor is completely Post-Free™ and requires neither a table rail nor an operating-table attachment. It can therefore provide advanced abdominal retraction across Role 2 and Role 3 facilities, deployed land- and sea-based surgical teams, aircraft, vehicles, ships, buildings of opportunity, and other nontraditional surgical environments.Its ability to accept Bookwalter®-compatible accessory blades means military surgeons can obtain deep and retroperitoneal exposure similar to what they expect from hospital-based table-mounted systems without requiring the table-mounted infrastructure.For operational surgical teams, the same retraction platform can move with the mission instead of requiring the surgical environment to accommodate the retractor.

The TITAN CSR® retractor is self-retaining and allows a single surgeon to obtain and maintain complex abdominal and retroperitoneal exposure without requiring additional personnel to manually retract tissue.This is particularly important during damage-control surgery. With traditional deployable retractors such as the Balfour, obtaining adequate exposure of deep or retroperitoneal structures may require additional hands to hold retractors. With the TITAN CSR® retractor, Bookwalter®-compatible blades can be positioned to provide hands-free exposure of difficult structures, allowing other scrubbed personnel to assist directly with hemorrhage control, vascular repair, bowel surgery, resuscitation, or other critical portions of the operation rather than simply holding retraction.The TITAN CSR® retractor may therefore reduce the number of personnel required to create and maintain surgical exposure—an important advantage for small military surgical teams where every team member has multiple responsibilities.Its Post-Free™ design further reduces manpower requirements by eliminating the setup associated with a table-mounted post, horizontal bar, couplings, and related equipment. Independent military testing also gave the TITAN CSR® retractor high ratings for its ability to provide exposure without requiring an assistant.Military surgeons have specifically recognized this operational advantage, with one describing it simply:“The TITAN CSR® retractor is a clear force multiplier.”For deployed surgical teams, that is the practical benefit: fewer personnel dedicated to retraction means more hands available to actively care for the casualty when they are needed most.

The TITAN CSR® retractor is designed for rapid deployment and can establish abdominal wall exposure in seconds without first assembling a table-mounted post and its associated components.This can be particularly important during damage-control surgery and other time-critical operations where rapid access to hemorrhage or contamination may be essential.Its modular construction also allows the TITAN CSR® retractor to be assembled around the surgeon's hands while manual control of life-threatening hemorrhage is maintained—a capability that can be particularly valuable when exposure must be established without relinquishing hemorrhage control.Once initial exposure is established, additional Bookwalter®-compatible blades can be added to obtain deeper, upper abdominal, pelvic, or retroperitoneal exposure without changing to another retractor system.

The TITAN CSR® retractor weighs 2.2 pounds and consists of only 10 reusable components, making it substantially smaller and lighter than traditional table-mounted retractor systems.Its compact design is backpack-compatible and reduces both the weight and cube that must be transported with a surgical team. This is particularly important because a conventional table-mounted system requires not only the retractor components themselves, but also a compatible operating table and mounting architecture that generally are not available in forward and austere environments.Additional Richardson and malleable accessory blades are available in either stainless-steel or lighter titanium configurations. Selecting the titanium accessory set further reduces the weight of the complete system while preserving the ability to add deep, targeted, and retroperitoneal retraction when needed.The TITAN CSR® retractor is currently used by Special Operations surgical teams, where weight, portability, ease of use, and rapid deployment of essential equipment are particularly important. It is also used by other deployed military surgical teams across multiple Areas of Responsibility.Its smaller size also supports operational reprocessing. The TITAN CSR® retractor can fit in both standard and dental sterilizers, increasing its adaptability when conventional hospital infrastructure is limited.For deployed teams, the result is hospital-quality abdominal retraction with a substantially smaller logistical footprint and without dependence on a standard OR table.

Yes. One of the major operational advantages of the TITAN CSR® retractor is that the same retraction platform can be used across the continuum of military surgical care—from fixed Military Treatment Facilities to Role 3 and Role 2 surgical teams, deployed land- and sea-based units, Special Operations teams, and other austere or nontraditional surgical environments.Traditional military retraction capability can change depending on where the surgeon is operating. A fixed MTF may have access to a Bookwalter® or other table-mounted system, while forward environments traditionally rely on simpler retractors such as the Balfour because standard OR tables and mounting infrastructure are unavailable.The Post-Free™ TITAN CSR® retractor removes that distinction. The same system can provide rapid basic abdominal retraction or be expanded with accessory blades for deep abdominal and retroperitoneal exposure regardless of the level of care or physical environment.Using the same TITAN CSR® retractor across multiple levels of care allows military organizations to standardize equipment, training, setup, accessories, and reprocessing. Surgeons and surgical teams can develop familiarity with one retraction platform and continue using it as the mission, location, and level of care change.The system can also be configured to meet different mission requirements. Accessory Richardson and malleable blades are available in stainless steel or lighter titanium, while the TITAN CSR® Lighted Retractor Blade and battery-powered TITAN CSR® Blade Lights provide targeted illumination without dependence on a fiber-optic light source or external power connection.For military surgical systems, the advantage is significant: one portable, adaptable retraction platform can support surgical teams across the continuum of care.

Yes. The TITAN CSR® retractor is regularly incorporated into military surgical readiness training designed to prepare surgeons and deploying surgical teams for damage-control surgery in operational environments.The TITAN CSR® retractor is used in ASSET+ courses and Joint Expeditionary Trauma Training (JETT), both of which include cadaver-based training focused on obtaining rapid and effective surgical exposure during the management of military casualties. The TITAN CSR® retractor is also incorporated into U.S. Air Force Ground Surgical Team (GST) training, providing surgeons assigned to small, mobile Role 2 teams an opportunity to become familiar with the system during readiness training.ASR Systems® has supported more than 100 military surgical training courses with TITAN CSR® retractors, including ASSET+, JETT, and related military readiness training. This repeated hands-on exposure allows military surgeons and surgical teams to train with a portable, Post-Free™ retraction platform in realistic damage-control scenarios before those skills are required in an operational setting.The broader benefit is familiarity and standardization: military surgeons can train with the same type of portable, adaptable retraction platform that is already being used across fixed and deployed military surgical environments.

Yes. The TITAN CSR® retractor provides rapid initial abdominal wall retraction while creating a stable overlying frame that accepts Bookwalter®-compatible accessory blades.This addresses an important limitation of traditional deployable retractors such as the Balfour, which can provide rapid abdominal wall retraction but are limited in their ability to expose deep and retroperitoneal structures.In a published series of 89 trauma and emergency surgery laparotomies, the TITAN CSR® retractor provided effective abdominal and retroperitoneal exposure without requiring a table attachment. Documented exposures included the inferior vena cava, femoral and iliac vessels, duodenum, stomach, proximal jejunum, pelvis, and other deep structures.These structures can be critically important during damage-control surgery, where rapid exposure may be required for hemorrhage control, vascular access, contamination control, or evaluation of penetrating and blunt abdominal injuries.Accessory Richardson and malleable blades can be selected in stainless steel or lightweight titanium, allowing military surgical teams to balance capability and transport weight based on mission requirements.

The complete TITAN CSR® retractor system can include the reusable TITAN CSR® Lighted Retractor Blade and sterile, disposable, battery-powered TITAN CSR® Blade Lights.The TITAN CSR® Blade Light attaches directly to the Lighted Retractor Blade and provides up to approximately 90 minutes of targeted illumination without requiring a fiber-optic light source, light cable, or external power connection.This is particularly useful in operational environments because surgical illumination does not depend on the availability of conventional hospital lighting infrastructure. The cordless design also eliminates fiber-optic cables and associated trip hazards around the surgical team.Combined with the Post-Free™ TITAN CSR® retractor and accessory blades, the lighting system provides an integrated solution for both exposure and visualization without requiring many of the infrastructure components associated with a conventional hospital operating room.

Yes. The TITAN CSR® retractor is reusable and has validated cleaning and steam-sterilization processes.The TITAN CSR® retractor has been validated for steam sterilization fully assembled, completely disassembled into its 10 individual components, or at an intermediate stage of assembly after proper cleaning and inspection. The validated cycle uses pre-vacuum/vacuum-pulse steam sterilization at a minimum temperature of 132°C/270°F.Its compact size further supports operational use because the TITAN CSR® retractor can fit in both standard and dental sterilizers, increasing adaptability where full hospital sterilization infrastructure may not be available.The TITAN CSR® Blade Light is provided sterile, battery powered, and single use, so it does not require reprocessing.

The TITAN CSR® retractor has achieved broad adoption across the military surgical community, spanning fixed Military Treatment Facilities, deployed Role 2 surgical teams, sea-based surgical platforms, Special Operations units, military medical education, and allied military forces.Within the United States, the TITAN CSR® retractor is in use at several of the military's major referral and teaching hospitals, including Brooke Army Medical Center, Walter Reed National Military Medical Center, Naval Medical Center Portsmouth, Naval Medical Center San Diego, and Naval Medical Center Camp Lejeune.Its use extends well beyond fixed hospitals. The TITAN CSR® retractor is being used by multiple deployed Role 2 surgical teams across military Areas of Responsibility worldwide, by Air Force Special Operations Command and other Special Operations surgical units, and in sea-based operational environments, including aboard the USS George H.W. Bush.The TITAN CSR® retractor is also used within military medical education and readiness programs, including at the Uniformed Services University and in ASSET+, Joint Expeditionary Trauma Training (JETT), and Air Force Ground Surgical Team training. ASR Systems® has supported more than 100 military surgical training courses with TITAN CSR® retractors, giving military surgeons repeated hands-on exposure to the system in cadaver-based damage-control surgery training.Internationally, the TITAN CSR® retractor is also used by the Canadian military.This breadth of adoption reflects the ability of one portable, Post-Free™ platform to support military surgeons across the continuum of care—from major fixed MTFs to deployed Role 2 teams, Special Operations units, shipboard surgery, and other austere environments where a standard OR table and table-mounted retractor may not be available.

Military surgeons who have evaluated or used the TITAN CSR® retractor have highlighted its clinical performance, portability, familiarity, ease of use, and value in forward and austere surgical environments.Dr. Brian Eastridge, an internationally renowned civilian and military trauma surgeon, has stated:“I expect the TITAN CSR® surgical retractor will significantly change the future of trauma and emergency operations, ultimately improving patient outcomes.”Additional comments from military surgeons include:“The TITAN CSR® retractor is a clear force multiplier.”“Significant benefit of portability in military environment.”“Has high potential for forward/austere surgery.”“Need in Forward Surgical Teams.”“Awesome — used successfully for shipboard emergency surgery.”“Great device. I only have a few must-have tools. This is my new one.”“This retractor should be in every deployed team’s ‘kit.’”“Ease of familiarity is great.”“Great device.” These comments reinforce the characteristics military surgical teams value: effective exposure, rapid deployment, portability, adaptability, reduced manpower requirements, and the ability to operate without dependence on a standard OR table or other fixed operating-room infrastructure.

Yes. The TITAN CSR® retractor is designed to accept Bookwalter®-compatible blades and attachments.This allows military surgical teams to use familiar Richardson/Kelly, malleable, and other compatible blades to customize exposure while maintaining the advantages of a Post-Free™ system.ASR Systems® also offers dedicated accessory blade sets in both stainless-steel and lighter titanium configurations. The titanium option provides additional weight savings for units where minimizing transport weight and cube is a priority.This compatibility is particularly useful because it provides Bookwalter®-type blade functionality without requiring the Bookwalter® post, ring, or compatible OR table.

The TITAN CSR® retractor itself is the 10-piece titanium frame and abdominal wall retraction system. For a complete operational capability, military surgical teams should also consider the accessory blade set, TITAN CSR® Lighted Retractor Blade, TITAN CSR® Blade Lights, and an appropriate sterile container.The accessory blade set adds Richardson/Kelly and malleable blades with tilt ratchets for deep, upper abdominal, pelvic, and retroperitoneal exposure. Accessory blades are available in stainless-steel or lighter titanium configurations, allowing units to further reduce system weight when portability and cube are critical mission considerations.The reusable TITAN CSR® Lighted Retractor Blade and sterile battery-powered TITAN CSR® Blade Lights provide targeted surgical illumination without dependence on a fiber-optic light source, cable, or external power connection. The sterile container keeps the reusable system organized for transport, sterilization, storage, and deployment.Together, these components provide a comprehensive operational retraction and illumination capability that does not depend on a standard OR table, a table-mounted retractor post, or a fiber-optic lighting system.

Yes. The TITAN CSR® retractor and several major system components have assigned National Stock Numbers (NSNs), simplifying identification and procurement within the military supply system.NSNs are available for the TITAN CSR® retractor, stainless-steel and titanium accessory blade sets, TITAN CSR® Lighted Retractor Blade, TITAN CSR® Blade Lights, and sterile container systems.The TITAN CSR® retractor is also available through established federal and military purchasing channels, including E-CAT Med Surg, DAPA, and GSA/FSS pathways through authorized vendors and SDVOSB partners.ASR Systems® can assist military customers in identifying the appropriate components and procurement pathway for their unit's operational requirements.

The independent MHSRS comparative study is complemented by published real-world clinical experience.A peer-reviewed study by Brigmon and Eastridge in Trauma Surgery & Acute Care Open reported use of the TITAN CSR® retractor in 89 adult and pediatric trauma and emergency surgery laparotomies at an academic Level I trauma center. All reported laparotomies were completed without setting up a table-mounted post, including cases requiring challenging abdominal, pelvic, vascular, and retroperitoneal exposure.The authors found that the TITAN CSR® retractor provided exposure comparable to table-mounted systems in a faster time period. They also specifically identified its smaller size, lower weight, and independence from table-mounting architecture as potentially valuable for deployed military and humanitarian operations, noting that many operating beds in these environments do not have the mounting architecture required for bed-mounted retractor systems.Together, the MHSRS comparative research and published clinical experience demonstrate the central operational advantage of the TITAN CSR® retractor: it can provide advanced abdominal exposure comparable to hospital-based systems without requiring the infrastructure that limits those systems outside the conventional operating room.