Beyond Trauma. Built for Complex Open Surgery.

The TITAN CSR® retractor is a versatile Post-Free™ surgical retraction platform that has been used across a broad range of open surgical specialties and procedures—not just trauma and emergency surgery.Specialty applications include:Spine and vascular access procedures, including anterior lumbar interbody fusion (ALIF)Kidney transplantationSurgical oncology, including Whipple procedures and other complex open abdominal operationsColorectal surgeryVascular surgery, including aortobifemoral bypass and aortic and iliac exposureAortic surgery, including congenital aortic procedures performed through a thoracotomyOpen urologic proceduresGynecologic and pelvic surgery, including hysterectomyRib fixation and selected thoracic proceduresICU bedside laparotomiesHybrid operating room proceduresRapid conversion from laparoscopic or robotic surgery to open surgeryEmergency abdominal or pelvic exposure during procedures performed on specialty operating tablesPublished clinical experience has demonstrated effective abdominal, pelvic, vascular, and retroperitoneal exposure with the TITAN CSR® retractor. In addition, independent comparative testing demonstrated that the TITAN CSR® retractor with accessory blades provided greater measured abdominal surface-area exposure than the Bookwalter®.The TITAN CSR® retractor is particularly adaptable because its Post-Free™ frame can be combined with any Bookwalter®-compatible blade or attachment, allowing surgeons to customize exposure according to the procedure, anatomy, and their individual preferences.For specialty surgeons, the key advantage is flexibility: one retraction platform can be configured for very different procedures and operating room environments while providing rapid setup, hands-free exposure, and access to deep structures.

The TITAN CSR® retractor provides a Post-Free™ approach to anterior lumbar interbody fusion (ALIF) exposure, allowing the access surgeon to obtain and maintain self-retaining anterior spinal exposure without attaching a retractor post to the operating table.This can be particularly valuable during ALIF procedures because frequent C-arm imaging is often required. Traditional table-mounted retractors place a post and mounting hardware alongside the operating table, which can interfere with C-arm positioning and require additional coordination during imaging. The TITAN CSR® retractor eliminates the table-mounted post, leaving the area around the table more accessible for imaging equipment.For ALIF exposure, the TITAN CSR® retractor can be configured with tilt-ratchet accessory blades rather than the traditional four abdominal-wall blade configuration. Compatible Richardson, malleable, and other blade designs can be positioned where needed to maintain vascular and soft-tissue retraction.The self-retaining configuration can also reduce dependence on personnel for manual retraction, allowing other scrubbed team members to assist directly with the exposure, vascular mobilization, instrumentation, and other portions of the procedure.The TITAN CSR® retractor has also been used successfully for ALIF exposure in challenging patients, including patients with obesity, where maintaining deep anterior exposure can be particularly demanding.For spine and vascular access teams, the practical advantages include a smaller operative footprint, improved C-arm access, rapid setup, hands-free retraction, and customizable deep exposure without a table-mounted post.

The Post-Free™ design of the TITAN CSR® retractor can simplify intraoperative imaging during ALIF procedures because there is no table-mounted post, horizontal bar, or mounting hardware alongside the operating table.ALIF procedures often require repeated C-arm imaging. With traditional table-mounted retractors, the post and associated hardware can interfere with positioning or require the imaging team to work around the retractor. The TITAN CSR® retractor removes that obstruction, providing greater freedom to move and position the C-arm around the patient.The titanium components of the TITAN CSR® retractor are visible on X-ray but typically produce a relatively faint radiographic shadow, and lightweight titanium accessory blades are available when minimizing the amount of stainless-steel instrumentation in the imaging field is desirable.For spine and vascular access teams, the benefit is a cleaner operative environment with fewer physical constraints around the table while maintaining stable, self-retaining anterior exposure.

The TITAN CSR® retractor can provide the broad upper abdominal and deep exposure required for complex surgical oncology procedures, including Whipple procedures, without requiring a table-mounted post.The expandable Post-Free™ frame provides initial abdominal wall retraction, while Bookwalter®-compatible blades can be added around the frame to customize upper abdominal and deep exposure. Importantly, surgeons are not limited to a small proprietary blade selection. Any Bookwalter®-compatible blade or attachment can be connected to the TITAN CSR® retractor, allowing surgeons to maintain the specific blade configurations and exposure techniques they already prefer.This flexibility can be particularly valuable during complex oncologic procedures, where the optimal blade type and position may change as the operation progresses.Independent comparative testing demonstrated that the TITAN CSR® retractor with accessory blades provided greater measured abdominal surface-area exposure than the Bookwalter®. Its ability to provide complex upper abdominal exposure has also been demonstrated repeatedly in more than 300 American College of Surgeons ASSET and ASSET+ cadaver-based courses requiring exposure of the liver, spleen, stomach, distal esophagus, major vessels, and other abdominal structures.The Post-Free™ design also removes the vertical post and horizontal mounting hardware from around the operating table, giving the surgeon and assistants greater freedom of movement.When additional visualization is required, the TITAN CSR® Lighted Retractor Blade can deliver targeted illumination directly into deep operative spaces without requiring a fiber-optic cable or external light source.

The TITAN CSR® retractor has been used clinically for kidney transplantation and is well suited to procedures requiring stable, hands-free pelvic and retroperitoneal exposure.Its Post-Free™ frame provides a stable platform without requiring attachment to the operating table. Bookwalter®-compatible blades can then be positioned around the frame to retract the abdominal wall and surrounding tissues as needed to expose the iliac vessels and operative field.Surgeons can use the specific Bookwalter®-compatible blade styles and configurations they prefer rather than being limited to a proprietary blade selection.The ability of the TITAN CSR® retractor to provide this type of exposure has also been demonstrated repeatedly in more than 300 American College of Surgeons ASSET and ASSET+ cadaver-based courses requiring exposure of the kidneys, iliac vessels, aorta, and inferior vena cava. Independent comparative testing also demonstrated greater measured abdominal surface-area exposure with the TITAN CSR® retractor and accessory blades than with the Bookwalter®.Eliminating the table-mounted post reduces equipment around the patient and gives the surgeon and assistants greater freedom of movement during vascular anastomosis and other critical portions of the transplant procedure.

The TITAN CSR® retractor can provide customizable, hands-free exposure for vascular procedures requiring access to the aorta, iliac vessels, pelvis, and retroperitoneum without requiring a table-mounted post.The TITAN CSR® retractor has been used clinically for aortobifemoral bypass and for aortic and iliac vessel exposure. Any Bookwalter®-compatible blade or attachment can be connected to its Post-Free™ frame, allowing vascular surgeons to configure retraction according to the anatomy and their preferred technique.Published clinical experience has demonstrated effective exposure of deep vascular and retroperitoneal structures, including the inferior vena cava and iliac and femoral vessels, without requiring attachment to the operating table.The ability to expose major vascular structures has also been demonstrated extensively in more than 300 American College of Surgeons ASSET and ASSET+ cadaver-based courses requiring exposure of the aorta, iliac vessels, and inferior vena cava. Independent comparative testing demonstrated that the TITAN CSR® retractor with accessory blades provided greater measured abdominal surface-area exposure than the Bookwalter®.The TITAN CSR® retractor has also been used at Boston Children’s Hospital for congenital aortic surgery performed through a thoracotomy, demonstrating adaptability beyond abdominal vascular procedures in selected complex aortic cases.

The TITAN CSR® retractor can provide broad, stable abdominal and pelvic exposure for open colorectal procedures without requiring a table-mounted post.Its expandable Post-Free™ frame provides rapid initial abdominal wall retraction, while any Bookwalter®-compatible blade or attachment can be added around the frame as the operation progresses. This allows colorectal surgeons to use their preferred blades for upper abdominal, pelvic, paracolic gutter, and deep tissue retraction.The TITAN CSR® retractor has been used clinically for colectomy, hemicolectomy, sigmoidectomy, bowel resection, and other open colorectal procedures. Published clinical experience has also demonstrated effective pelvic exposure and the ability to reposition accessory blades as different areas of the abdomen need to be accessed.The Post-Free™ design removes the vertical post and horizontal mounting hardware from around the operating table, providing greater freedom of movement while reducing setup complexity.The TITAN CSR® retractor can also be particularly useful if a laparoscopic or robotic colorectal procedure unexpectedly requires conversion to open surgery because it can be rapidly deployed without first assembling a table-mounted retractor.

The TITAN CSR® retractor can provide broad, stable, hands-free pelvic and abdominal exposure for open gynecologic procedures without requiring a table-mounted post.The TITAN CSR® retractor has been used clinically for hysterectomy, including a published emergency case requiring extensive pelvic exposure. Its expandable Post-Free™ frame retracts the abdominal wall while creating an overlying platform for additional Bookwalter®-compatible blades when more targeted pelvic or deep retraction is required.Any Bookwalter®-compatible blade or attachment can be connected to the TITAN CSR® retractor, allowing gynecologic surgeons to use the blade configurations they already prefer for bowel retraction, pelvic sidewall exposure, and access to deeper structures.Pelvic exposure is also routinely performed with the TITAN CSR® retractor in American College of Surgeons ASSET and ASSET+ cadaver training, providing extensive additional experience with deep pelvic visualization and access.When additional visualization is required, the TITAN CSR® Lighted Retractor Blade can deliver targeted illumination directly into the pelvis without requiring a fiber-optic cable or external light source.

The TITAN CSR® retractor can provide stable, hands-free abdominal, pelvic, and retroperitoneal exposure for open urologic procedures without requiring a table-mounted post.Its Post-Free™ frame provides initial exposure while allowing any Bookwalter®-compatible blade or attachment to be positioned around the frame as needed. This gives urologic surgeons the flexibility to use their preferred blade types and configurations for exposure of the kidney, retroperitoneum, pelvis, bladder, and major vascular structures.The ability of the TITAN CSR® retractor to create these exposures has been demonstrated extensively in more than 300 American College of Surgeons ASSET and ASSET+ cadaver-based courses requiring exposure of the kidneys, aorta, iliac vessels, inferior vena cava, bowel, and pelvis.The Post-Free™ design also removes the vertical post and horizontal mounting hardware from around the operative field, providing more freedom of movement while maintaining self-retaining exposure.When additional visualization is needed, the TITAN CSR® Lighted Retractor Blade can provide targeted illumination into deep pelvic or retroperitoneal operative spaces without requiring a fiber-optic cable or external light source.

Yes. Although the TITAN CSR® retractor was originally developed for abdominal exposure, it has also been used successfully in selected thoracic and chest procedures where stable, adaptable, hands-free retraction is required.Clinical use has included rib fixation procedures as well as congenital aortic surgery at Boston Children’s Hospital performed through a thoracotomy.The Post-Free™ design can be particularly useful in chest procedures because it reduces equipment around the patient and does not depend on a standard operating room table or mounting rails. Bookwalter®-compatible blades and attachments can be added according to the surgeon’s preferred exposure strategy and the anatomy being addressed.For selected thoracic applications, the TITAN CSR® retractor demonstrates the adaptability of the same portable retraction platform used for abdominal, pelvic, vascular, and retroperitoneal exposure.

Bedside laparotomy in the ICU is often more challenging than performing the same operation in a conventional operating room. The patient is typically on an ICU bed rather than a standard operating room table, lighting may be suboptimal, equipment has to be brought from the operating room, and the surgeon and assistants frequently have less room to position themselves around the patient.Traditional table-mounted retractors such as the Bookwalter® generally cannot be used because the ICU bed does not have the compatible rails and mounting architecture required for a table-mounted post.The TITAN CSR® retractor helps bring operating room-level exposure to the bedside. Its portable, Post-Free™ design can be brought directly to the ICU and rapidly deployed without changing beds or attaching anything to the patient-support surface. Bookwalter®-compatible blades can then be added for upper abdominal, pelvic, vascular, or retroperitoneal retraction when needed.Lighting can also be a significant challenge during bedside surgery. The reusable TITAN CSR® Lighted Retractor Blade and sterile, battery-powered TITAN CSR® Blade Light provide targeted illumination directly into the operative field without requiring a fiber-optic light source, cable, or external power connection.Together, the TITAN CSR® retractor and cordless lighting system can make the bedside operative environment function more like a conventional operating room by providing excellent self-retaining exposure and targeted illumination with a compact, portable equipment footprint.For surgeons performing ICU bedside laparotomy, this can make a difficult procedure more manageable and efficient while supporting better visualization, access, and control in an environment that is inherently less optimized for major surgery.

Hybrid operating rooms combine open surgery with advanced imaging and endovascular or interventional capabilities, making equipment positioning and access around the patient more complex than in a conventional operating room.Traditional table-mounted retractors such as the Bookwalter® require a compatible table rail and mounting system. Hybrid operating room tables often require a separate rail extender or adapter before the Bookwalter® post can be attached. These extenders may not always be readily available when needed, can add setup time, and may provide a less stable mounting configuration than a standard operating room table.The Post-Free™ TITAN CSR® retractor eliminates the need for the table rail, extender, post, horizontal bar, and associated mounting hardware entirely. It can be rapidly deployed within the sterile field without modifying the hybrid table or depending on additional mounting components.This keeps the area around the patient more open for C-arms, imaging systems, endovascular equipment, anesthesia, and the surgical team. If deeper exposure is required, any Bookwalter®-compatible blade or attachment can be connected directly to the TITAN CSR® retractor frame.The TITAN CSR® Lighted Retractor Blade and battery-powered TITAN CSR® Blade Light can also provide targeted illumination without adding fiber-optic cables or an external light source to an already equipment-dense room.

The TITAN CSR® retractor is particularly useful when a minimally invasive or robotic procedure unexpectedly requires conversion to an open operation.In an unplanned conversion, a table-mounted retractor may not already be assembled or immediately available. Traditional systems may require multiple trays to be brought into the room, a post attached to the operating table, and mounting hardware assembled before advanced exposure can be established.The Post-Free™ TITAN CSR® retractor can instead be brought into the sterile field and rapidly deployed without modifying the operating table or assembling a table-mounted post.If more complex exposure is required, any Bookwalter®-compatible blade or attachment can be added directly to the frame for upper abdominal, pelvic, vascular, or retroperitoneal retraction.This versatility can be valuable across colorectal, gynecologic, urologic, general surgical, vascular, and other minimally invasive procedures where conversion to open surgery remains a possibility.For surgeons, the practical advantage is rapid access to an advanced open retraction platform during a case in which circumstances have already changed unexpectedly.

Yes. The Post-Free™ design of the TITAN CSR® retractor can be particularly valuable when unexpected abdominal or pelvic exposure is required during a procedure being performed on a specialty operating table. Orthopedic, spine, vascular, and other specialty procedures may use tables that do not have standard rails or mounting architecture for a Bookwalter® or other table-mounted retractor. If an intraoperative complication requires urgent abdominal, pelvic, vascular, or retroperitoneal exposure, changing operating tables or attempting to add incompatible mounting hardware can create significant workflow challenges and delay.The TITAN CSR® retractor requires no table attachment. It can be brought directly into the sterile field and rapidly deployed on the patient’s existing table. If deeper exposure is required, Bookwalter®-compatible blades and attachments can then be added directly to the TITAN CSR® retractor frame.For specialty operating rooms, this adds an important level of surgical readiness: advanced abdominal and pelvic exposure can remain available regardless of the operating table being used.

The exposure capabilities of the TITAN CSR® retractor are supported by independent comparative data, published clinical experience, and extensive cadaver-based surgical training use.In a Department of Defense-sponsored study presented at the 2025 Military Health System Research Symposium, the TITAN CSR® retractor with accessory blades was directly compared with the Bookwalter®, Balfour, and Alexis™ retractors. It 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 rating for exposure (4.9/5).Published clinical experience further demonstrated effective abdominal, pelvic, vascular, and retroperitoneal exposure with the TITAN CSR® retractor, including exposure of the inferior vena cava, iliac and femoral vessels, duodenum, stomach, and pelvis without a table attachment. In addition, the TITAN CSR® retractor has been used in more than 300 American College of Surgeons ASSET and ASSET+ cadaver-based training courses requiring surgeons to obtain exposure of structures throughout the abdomen, pelvis, and retroperitoneum, including:Iliac vesselsInferior vena cavaKidneysSpleenLiverStomachDistal esophagusSmall bowelLarge bowelPelvisTogether, these experiences demonstrate the breadth of exposure that can be achieved with one adaptable Post-Free™ platform and complement the growing specialty-specific clinical use of the TITAN CSR® retractor.

The TITAN CSR® retractor is well suited to challenging exposure in obese patients because its adjustable frame can accommodate different incision lengths and abdominal wall thicknesses, while additional Bookwalter®-compatible blades can be positioned wherever deeper or more targeted retraction is required.This allows the surgeon to establish initial abdominal wall exposure quickly and then customize retraction for the anatomy and procedure. Richardson/Kelly, malleable, and other compatible blades can be added for upper abdominal, pelvic, vascular, or retroperitoneal exposure without requiring a table-mounted post.The Post-Free™ design can also be advantageous in larger patients because it reduces equipment around an already crowded operative field and gives the surgeon and assistants greater freedom to position themselves around the patient.For specialty procedures such as ALIF, colorectal surgery, surgical oncology, vascular surgery, and other complex open operations, this ability to progressively customize exposure makes the TITAN CSR® retractor particularly adaptable when body habitus makes visualization and access more challenging.

Yes. Any Bookwalter®-compatible blade or attachment can be connected to the TITAN CSR® retractor, allowing surgeons to customize exposure using the blade types and configurations they already know and prefer.This is particularly important in specialty surgery because exposure strategies vary significantly by procedure and surgeon. A vascular surgeon, surgical oncologist, colorectal surgeon, kidney transplant surgeon, urologist, or spine access surgeon may each prefer different Richardson/Kelly, malleable, or other blade configurations depending on the anatomy and phase of the operation.Rather than requiring surgeons to adopt a limited proprietary blade system, the TITAN CSR® retractor provides a Post-Free™ frame that accommodates familiar Bookwalter®-compatible accessories while eliminating the traditional table-mounted post.ASR Systems® also offers dedicated accessory blades in stainless steel or lighter titanium configurations, as well as the TITAN CSR® Lighted Retractor Blade when targeted illumination is desired.For specialty surgeons, the goal is not to change how they create exposure. The TITAN CSR® retractor gives them a more adaptable platform for achieving the exposure they already want using familiar blades and techniques.

Complex open procedures often require both deep surgical exposure and adequate illumination. The TITAN CSR® Lighted Retractor Blade combines retraction and targeted lighting by placing illumination directly at the point where tissue is being retracted.The reusable Lighted Retractor Blade uses a sterile, single-use, battery-powered TITAN CSR® Blade Light that provides up to approximately 90 minutes of illumination. Because the light source is self-contained, it does not require a fiber-optic cable, external light source, or power connection.This can be particularly useful during procedures involving deep abdominal, pelvic, vascular, retroperitoneal, or anterior spine exposure, where overhead lighting alone may not adequately illuminate the operative field. The cordless design also eliminates fiber-optic cables and their associated setup requirements and trip hazards.The TITAN CSR® Lighted Retractor Blade can be used with the TITAN CSR® retractor and with standard Bookwalter® frames, allowing surgeons to add targeted illumination regardless of which of those two retraction platforms is being used.For specialty surgeons, the benefit is straightforward: the same blade that creates exposure can deliver light directly into the operative field, improving visualization without adding another cable or external lighting system.