Trauma surgeon’s invention redesigns antiquated technology aimed to save lives

Ramon Cestero, MD, MBA, FACS, FCCM, holding the TITAN CSR™, a surgical retractor that combines speed and superior exposure.

Frustrated with the outdated technology he found throughout his medical and military surgical career, Ramon Cestero, MD, MBA, FACS, FCCM, trauma surgeon and clinical professor in the Department of Surgery, invented a new design for an abdominal surgical retractor, helping to advance surgical procedures and improve patient outcomes.

Dr. Cestero served as an active-duty U.S. Navy trauma surgeon for 10 years. During those years, he was deployed a total of seven times, with three deployments to combat zones. In his experience, both in the field and in civilian hospitals, he found many challenges and short-falls with the very old technology used to perform laparotomies, or abdominal surgery.

“The equipment we use is very antiquated, and some of that technology is over 100 years old,” Dr. Cestero said.

He explained that the Balfour retractor, a surgical instrument commonly used in trauma surgery to hold back the edges of an incision so that the body cavity can be quickly accessed for a surgical procedure, has had few developments over the last 100 years since it was invented, presenting significant limitations for trauma surgeons taking care of severely injured patients.

“Surgeons are typically forced to choose between traditional self-retaining retractors like the Balfour, which is really fast and provides rapid access but is limited by poor abdominal exposure, or more complicated table-mounted retractors, which take a long time to set up but provide superior exposure for a surgeon to see deep into the abdominal cavity. There are no retractors that combine both those features.” he said. “I thought there could be something better.”

Dr. Cestero’s retractor, called the TITAN CSR™, is unique in that it combines both speed and ample exposure. It does not need to be mounted to a table, and can be set up in about six seconds—50 times faster than a table-mounted design—without losing any functionality.

“Surgeons are finding that very valuable. Those two things, speed and exposure, make a surgeon more efficient, more effective and just better. And ultimately this is something that we hope will save lives.”

As he developed the idea for a better retractor, he received support from UT Health San Antonio’s Office of Technology Commercialization (OTC), helping to provide a pathway from concept to reality.

“Most faculty have never done this before, so to provide us assistance with entrepreneurial processes including evaluating the market opportunity, filing patent submissions, obtaining funding for prototype design and testing, licensing and forming a company—that guidance and expertise was very helpful.”

He was also supported with internal funding from UT Health San Antonio, winning a President’s Translational and Entrepreneurial Research Fund (PTEF) award in 2015. The PTEF is a competitive award intended to provide early-stage seed funds to projects that demonstrate a high probability of being commercialized but lack the resources to develop to the next pivotal stage.

After receiving the award, he was able to develop a prototype and move forward with his new device. He filed two patents through the UT system, one of which has been issued in three countries. He also went on to found the company Advanced Surgical Retractor Systems, Inc. in 2019, serving as the chief medical officer. And while he doesn’t plan on becoming a CEO, stating that he will always be “a physician first,” he did obtain a Master of Business Administration (MBA) degree during the development of his invention and company.

“I found that learning about advertising, branding, marketing and company financials, all of those things helped me understand how the process works,” he said. “And it allowed me to know what to look for when I started looking for a CEO to form a company. It helps me to speak the same language as the business side.”

This interest also led him to develop two leadership programs at UT Health San Antonio. He serves as the program director for both the Executive Development Program for Emerging Health Leaders (EDP) and the Executive MBA for Health Professionals Program (EMBA), run through the Joe R. and Teresa Lozano Long School of Medicine. He started the programs about five years ago for faculty interested in business and leadership education. To date, 10 Long School of Medicine faculty members have graduated with MBA degrees through the EMBA program, and over 60 faculty have completed the EDP.

Dr. Cestero’s retractor has been used in surgery over 30 times at University Hospital with excellent results, and is currently being used in surgery in Austin at the Dell Seton Medical Center at The University of Texas.

“We’re excited to be able to bring this technology to the community to hopefully save lives and improve patient outcomes, and we’ve had good success so far,” Dr. Cestero said. “We wouldn’t have gotten here without the assistance of UT Health San Antonio and the OTC. I would encourage any faculty considering a new idea, concept, or better way of doing things to reach out to the OTC because they can provide significant guidance on how to develop a device or an idea and get it out into the community where it can benefit society.”

More information about Dr. Cestero’s retractor can be found at www.titanretractor.com.



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