TITAN CSR™ Featured in August Issue of General Surgery News
AUG. 7, 2021
By Bora Kahramangil, MD (PGY-4) and Lisandro Montorfano, MD (chief resident), Cleveland Clinic Florida, Weston
Trauma surgery is uniquely positioned among general surgical specialties, as surgeons routinely have to operate on patients in extremis. This is further compounded by the limited resources in combat trauma surgery. When performing a damage control laparotomy, there are only 2 goals – to achieve hemostasis and control contamination. The time in the operating room must be limited to the absolute minimum necessary to achieve these goals. Following damage control, the patient must be expeditiously transferred to the intensive care unit for continued resuscitation, or to a trauma center in combat settings. Due to the time-sensitive nature of trauma surgery, table-mounted retractors with long setup times are rarely appropriate for use in trauma patient population.
An ideal trauma retractor would be a multi-arm self-retaining retractor, which does not require any table mounting. The TITAN CSR™ (ASR Systems, Inc., San Antonio, TX; asrsystemsinc.com) was designed by Dr. Ramon Cestero with this principle in mind. This retractor has 4 intraabdominal blades with 2 blades retracting on each side of the midline abdominal incision. Modular arms expand laterally on this 4-blade frame with the resulting retraction, both establishing the lateral separation of the abdominal wall and stabilizing the retractor in place. The 4-blade configuration forms a stable base to prevent unintended rotations. Additional blades can be attached onto the modular arms to expose deep abdominal structures. The ring attachments are compatible with the Bookwalter® (Symmetry Surgical, Nashville, TN) blades, facilitating adoption of the TITAN CSR in hospitals already using the Bookwalter® retractor with minimal added cost. Furthermore, the TITAN CSR ring height is adjustable, and the 4-blade frame can be adapted to different incision lengths ranging from 13 to 37 cm, allowing the use of this retractor in patients with different body habitus.
In cadaveric studies, TITAN CSR was found to achieve excellent exposure of the abdominal structures comparable to the table-mounted systems. Furthermore, it was noted to have a faster set-up time due to its non-table-mounted design. TITAN CSR has been U.S. FDA approved as a class I, 510(k)-exempt medical device and is in clinical use at University Hospital in San Antonio, TX. Although this new retractor is especially promising for trauma surgeons in both civilian and military practices, there is also potential benefit for other surgical specialties that routinely perform laparotomies such as general surgery, colorectal surgery, surgical oncology, vascular surgery, transplant surgery and hepatobiliary Surgery.