Narcotic-Free Women’s Surgery!

By Susan A Crockett, MD
Thursday, June 14, 2018

Ease women’s suffering.

That is the primary goal Susan Crockett, MD, had in mind when she left a very successful general OB-GYN practice four years ago to found Virtuosa Gyn — San Antonio’s first medical practice dedicated to making surgery easier for women.

Susan A Crockett, MD
Minimally Invasive Gynecologic Surgeon

Now, after performing robotic surgery for almost nine years, Dr. Crockett has completed almost 900 cases, making her one of the top robotic specialists in the state of Texas. She has gone from doing about 50 robotic cases a year to around 200 a year, and she performs another 300 surgeries each year for pelvic prolapse, fibroids, endometriosis, ovarian cysts and abnormal bleeding.

“The idea was that we could focus on making surgeries, such as hysterectomy and pelvic prolapse procedures, minimally invasive and therefore easier for patients in lots of ways,” she explains. “We focus on developing and perfecting techniques that shorten the surgical time, minimize blood loss, lower complication rates, minimize pain and narcotic use postoperatively, lower costs, and shorten the patients’ time in the hospital, as well as their recovery time to return to normal, everyday life activities.

“One of the characteristics of advanced minimally invasive surgeons, like myself, is that we maintain around a 1 percent open surgery rate,” Dr. Crockett continues. “Almost everything, even very large fibroids, ovarian cysts or hysterectomies, can be completed safely through small incision surgery. In the past nine years, I’ve only had to open, or do a large incision, on 16 patients.”

In light of the nation’s narcotic abuse crisis, Dr. Crockett and other minimally invasive surgeons are now concentrating on offering narcotic-free surgeries. To see how they do it, take a look at “An Advanced Surgeon’s Toolbox.”

Susan A. Crockett, MD, Board-Certified Ob/Gyn
Minimally Invasive Gyn Surgeon at Virtuosa Gyn | 210-878-0090

An Advanced Surgeon’s Toolbox

da Vinci Robot

Minimally Invasive Surgical Platform

Cut less, hurt less. Robotics now enable 99 percent of all women’s gyn abdominal surgeries to be completed safely through small incisions.

Most major surgeries such as hysterectomy, myomectomy and sacrocolpopexy no longer need two- to three-night hospital stays. They are same-day surgeries, which in turn result in less cost, less pain, less narcotic use and fewer complications from wound infections and hernia.


Long-acting local anesthetic

Replacing older, larger pump-ball modes of delivering postoperative local anesthetic, EXPAREL uses micro technology to time release bupivacaine directly into the patient’s incision sites over three to five days.

To further enhance the postop anesthetic effect, Dr. Crockett injects it preemptively (before the incision is even made) which helps the nerve not ever feel the pain in the first place.


Modern fibroid blaster

Acessa is a new technology emerging for the treatment of fibroids. It uses an array of needle-like projections that the surgeon controls using an intra-abdominal ultrasound guidance system, to fulgurate fibroids.

Acessa is particularly useful in patients seeking future fertility, as it does not weaken the uterine wall as much as myomectomy or uterine artery embolization. Studies are currently underway demonstrating safety for vaginal delivery.


Nonmesh regenerative tissue matrix

In the wake of all the lawsuits surrounding mesh, new regenerative technologies such as Matristem are emerging.

This nonmesh tissue used for pelvic prolapse (bladder surgery) maintains and supports the affected area where it is placed. It then calls in the patient’s own connective tissue cells to the scaffolding. It absorbs over time, leaving no permanent mesh to hurt or erode!

Typical Patient Expectations

  • No more large incisions — One characteristic of high-volume MIGS is that they maintain an open surgery rate of around 1 percent. For patients, this means a 99 percent chance of completing their surgery minimally invasively.
  • Minimal pain with little or no narcotics — Most patients recover postoperatively using only pre-injected EXPAREL and NSAID for pain control. Tylenol #3 (codeine) is used as a backup only.
  • Same-day surgery — Most patients who undergo major gyn surgeries, including hysterectomy, prolapse surgery and myomectomy, go home in four to six hours.
  • Return to work in three to 12 days — Small-incision surgery patients — even those with major surgery — are typically off all pain meds, cleared to drive and return to work quickly.