case_images: PMC10649783_01
case_images: Exposure of left common femoral vessels using TITAN CSR surgical retractor. Left image: retractor expanded in abdomen and bowel retracted cephalad behind white laparotomy sponges using Bookwalter-compatible blades connected to TITAN CSR retractor frame. There is no attachment of the retractor to the surgical table. Right image: close-up of left image exposing left femoral artery (arrow) using Bookwalter-compatible Richardson blades connected to the TITAN CSR retractor frame.
case_images: tsaco-2023-001164f02.jpg
case_images: PMC10649783_01_tsaco-2023-001164f02.jpg
case_images: F2
case_images: He underwent emergent celiotomy with repair of multiple enterotomies, segmental small bowel resection, sigmoidectomy, and exploration of the left common iliac vessels (figure 2) which were found to be uninjured.
case_images: PMC10649783_02
case_images: Exposure of pelvis using TITAN CSR surgical retractor (view from head of bed towards feet). Retractor expanded in abdomen and bowel retracted cephalad behind blue towels using malleable Bookwalter-compatible blades connected to TITAN CSR retractor frame. There is no attachment of the retractor to the surgical table. Image is post-hysterectomy prior to surgical closure of cervical cuff.
case_images: tsaco-2023-001164f03.jpg
case_images: PMC10649783_02_tsaco-2023-001164f03.jpg
case_images: F3
case_images: Due to persistent hypotension and concern for uterine rupture and intrauterine fetal demise, she was taken emergently to the OR where she underwent supracervical hysterectomy and bilateral salpingectomy, requiring 25 units of whole blood (figure 3).
case_images: PMC10649783_03
case_images: Exposure of jejunum and stomach using TITAN CSR surgical retractor. Left image: retractor expanded in abdomen and transverse colon retracted cephalad behind two Richardson-type Bookwalter-compatible blades connected to TITAN CSR retractor frame. This provided effective exposure of the proximal jejunum and allowed repair of gunshot wound (GSW) enterotomies. There is no attachment of the retractor to the surgical table. Right image: exposure of GSW gastrotomies by retracting upper abdominal wall using Bookwalter-compatible blades attached to TITAN CSR retractor frame. Gastrotomies were repaired primarily.
case_images: tsaco-2023-001164f04.jpg
case_images: PMC10649783_03_tsaco-2023-001164f04.jpg
case_images: F4
case_images: He underwent exploratory laparotomy with left medial visceral rotation, gastrorrhaphy of anterior and posterior stomach, proximal jejunum enterotomy repair, and temporary abdominal closure (figure 4).
case_images: PMC10649783_04
case_images: Exposure of retroperitoneum and inferior vena cava (IVC) using TITAN CSR surgical retractor. Retractor expanded in abdomen engaging abdominal wall, and right colon and duodenum retracted medially using single large malleable-type Bookwalter-compatible blade connected to TITAN CSR retractor frame. This hands-free exposure allowed exploration of the IVC and retroperitoneum without an attachment to the surgical table.
case_images: tsaco-2023-001164f05.jpg
case_images: PMC10649783_04_tsaco-2023-001164f05.jpg
case_images: F5
case_images: He was taken for emergent exploratory laparotomy including exposure of the inferior vena cava and found to have multiple gastrotomies that were repaired primarily (figure 5).
case_images: PMC10649783_05
case_images: PMC10649783_06
case_images: Exposure of duodenum using TITAN CSR surgical retractor. Retractor expanded in abdomen engaging abdominal wall, and small bowel and right colon retracted medially (behind blue towel) using two malleable-type Bookwalter-compatible blades connected to TITAN CSR retractor frame. Tip of instrument depicts suture line at second portion of duodenum after repair (arrow). No table attachment was required for this exposure.
case_images: tsaco-2023-001164f06.jpg
case_images: PMC10649783_06_tsaco-2023-001164f06.jpg
case_images: F6
case_images: After initial evaluation and resuscitation, she underwent exploratory laparotomy and was found to have a perforation of the second portion of the duodenum and multiple colonic serosal injuries; the duodenum was repaired primarily with wide drainage (figure 6).