Military Experience Promotes Medical Advancement and Innovation- CDR (Ret) Ramon Cestero, MD, MBA, FCCM

WarDocs - The Military Medicine Podcast

Retired Navy Commander and Trauma Surgeon Dr. Ramon Cestero joins us to share his remarkable journey from the front lines to the forefront of surgical innovation. Imagine the battlefield's high stakes where every second counts, and the tools at your disposal can mean the difference between life and death. His tales of life-saving speed and adaptability in the most austere conditions reveal the genesis of his revolutionary contribution to surgical technology—a battlefield-optimized surgical retractor. Our conversation with Dr. Cestero isn't just a walk through his experiences; it's a masterclass in the resilience and resourcefulness required in military and civilian trauma surgery.

Throughout the episode, we witness the evolution of surgical retractors over the past few centuries, from their rudimentary origins to the state-of-the-art devices we see today. From the necessity that birthed his new retractor system to the behind-the-scenes look at transforming a concept into a globally utilized device, the narrative is as engaging as it is instructive. Dr. Cestero's insights into balancing the demands of a full-time surgical career with medical entrepreneurship are a candid reflection on the challenges and triumphs of innovation.

As we round out the discussion, Dr. Cestero doesn't just rest on his laurels; he casts a strategic eye toward the future of trauma surgery. With a nod to the lessons of past conflicts, we discuss the dynamic nature of military medicine and the implications for surgeons in rapidly evolving combat environments. We get into the Navy's shifting strategies, the importance of adaptable surgical teams, and the next wave of advancements set to revolutionize trauma care. It's a riveting exploration of how technologies like Dr. Cestero's retractor, along with advancements in operating room efficiency and training, stand to elevate patient care in both military operations and civilian trauma centers. Prepare to be inspired by the potential that lies ahead, as we uncover the innovations set to revolutionize the experience of patients and surgeons alike.

Chapters:

(00:04) Military Trauma Surgeon's Innovative Approach

(08:07) Innovating Surgical Retractors

(13:51) From Idea to Global Commercialization

(19:06) Innovative Surgical Retractor System Design

(31:10) Future Innovations in Trauma Surgery

Chapter Summaries:

(00:04) Military Trauma Surgeon's Innovative Approach

This chapter features retired Navy Commander and Trauma Surgeon Dr. Ramon Cestero, who shares insights from his multiple global deployments, emphasizing the importance of proper equipment, speed, and adaptability in trauma surgery under austere conditions. I discuss with him how these experiences led to his development of a battlefield-optimized surgical retractor and the challenges of bringing such innovations to widespread use. Dr. Cestero also reflects on the unique aspects of serving as a trauma surgeon in the Navy Reserves, highlighting the balance between maintaining military connection and civilian practice, and offers suggestions for enhancing reserve surgeons' team experience and training. We explore the current gaps in trauma surgery research and what future innovations Dr. Cestero envisions.

(08:07) Innovating Surgical Retractors

This chapter uncovers the pressing need for innovation in surgical equipment, specifically retractors, through a surgeon's experiences working in both austere military settings and a Level 1 trauma center. I discuss the challenges faced during surgeries without adequate resources, such as the absence of platelets and the struggle for exposure in critical procedures, which can lead to life-threatening delays. The narrative is anchored by a poignant case of a young soldier with severe injuries, whose outcome might have been different with better surgical tools. We explore the history of surgical retractors, from their evolution in the Renaissance to modern table-mounted systems, and the inspirations behind famous designs like the Balfour and Bookwalter retractors.

(13:51) From Idea to Global Commercialization

This chapter unfolds the journey of developing a new surgical retractor system, from the spark of innovation to international commercialization. Dr. Cestero shares his story of collaborating with a tech transfer office and co-inventing with a biomedical engineer to create a prototype, which we tested successfully on a cadaver. He highlights the challenges of balancing a full-time surgery career with entrepreneurship, leading to a gradual transition to dedicating myself fully to the company. Ramon also touches on the process of patenting, fundraising, and gathering feedback from various medical professionals to refine the prototype.

(19:06) Innovative Surgical Retractor System Design

This chapter, we explore the design and functionality of a revolutionary surgical retractor system that addresses common frustrations surgeons face with traditional retractors. We examine how its one-way assembly prevents incorrect setup, the satisfying ratchet sound that signals secure placement, and its adaptability to different incision sizes. The system's lightweight nature at only two pounds and compatibility with Bookwalter components are highlighted, along with its efficiency in providing exposure of the abdominal wall and retroperitoneum. A personal story reveals the retractor's surprising lightness and convenience in a combat environment, emphasizing its practicality for both the operating room and field surgery. Additionally, we discuss how the retractor can be adapted for upward lift, enhancing visibility in deep pelvic or upper abdominal procedures.

(31:10) Future Innovations in Trauma Surgery

This chapter focuses on the anticipated changes in military medical operations, drawing parallels with historical conflicts such as World War II and emphasizing the necessity for adaptability in modern warfare environments. We discuss the likelihood of increased casualties, the need for prolonged field care, and the possibility of surgeons re-operating on patients due to limited evacuation options. Additionally, we cover the Navy's evolving role and the potential shift toward more mobile surgical teams at sea. In terms of trauma surgery advancements, we touch on the ongoing efforts to improve blood product availability and the challenges faced by trainees with the transition from open to minimally invasive surgery. The conversation also highlights the importance of enhancing operating room efficiency, particularly through innovations in surgical retractors, lighting, and integration of suction to improve patient outcomes and the overall surgical experience.

**This Episode was supported in part by a generous educational grant from Advanced Surgical Retractor Systems, INC.**

Take Home Messages:

1. Military trauma surgery experiences have significantly contributed to the development and innovation of surgical technology, particularly in the design of surgical retractors optimized for battlefield conditions.
2. The evolution of surgical retractors has been influenced by the necessity to operate efficiently under resource-limited conditions, with historical designs like the Balfour and Bookwalter retractors laying the foundation for modern advancements.
3. A surgeon's ability to adapt and operate quickly in austere environments can have life-saving implications, underscoring the importance of equipment that is both effective and transportable.
4. Bringing a new medical device from concept to global commercialization involves collaboration with engineers, navigating the patenting process, fundraising, and obtaining feedback from medical professionals to refine the design.
5. The design of the discussed innovative surgical retractor system aims to address common frustrations, such as incorrect assembly, while providing rapid and secure placement, adaptability to different incision sizes, and compatibility with existing surgical components.
6. Future innovations in trauma surgery are anticipated to include improved blood product availability, more efficient operating room technologies, and training adjustments to accommodate the transition from open to minimally invasive surgery.
7. Military medical operations are likely to face changes with increased casualty numbers, necessitating adaptable and mobile surgical teams capable of prolonged field care and re-operation on patients.
8. Enhancements in surgical tools can lead to better patient outcomes by improving exposure and efficiency in the operating room, even under combat or emergency conditions.
9. Surgeons must balance maintaining traditional techniques with embracing new, potentially life-saving technologies, and training is essential for the successful adoption of innovative surgical devices.
10. Operating room efficiency is critical not only in civilian trauma centers but also in military operations, with technological advancements being crucial to adapting to future combat environments and potentially high-casualty scenarios.

Episode Keywords:

Military Trauma Surgery, Surgical Retractors, Innovation, Battlefield, Austere Conditions, Surgical Technology, Resilience, Resourcefulness, Operating Room Efficiency, Medical Entrepreneurship, Trauma Care, Navy, Surgical Teams, Blood Product Availability, Minimally Invasive Surgery, Operating Room Integration, Suction, Patient Outcomes

Hashtags:

#wardocs #military #medicine #podcast #MilMed #MedEd #TraumaSurgery, #SurgicalInnovation, #MilitaryMedicine, #CombatSurgeon, #MedicalBreakthroughs, #OperatingRoomTech, #SurgicalRetractor, #MedicalEntrepreneurship, #TraumaCare, #MilitaryHealthcare

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