Gynecologic Oncologist Sara Crowder, MD Ranks In Top One Percent Worldwide

Gynecologic oncologist Sara Crowder, MD recently performed her 1,000th surgery using the da Vinci surgical system. For the past two years, Dr. Crowder has performed more of these types of surgeries than anyone else in Missouri and is in the top one percent worldwide. Boone Hospital Center acquired the da Vinci system, which offers 3D imaging and 360-degree movement of instruments, in 2011. It allows surgeries to be minimally invasive, leading to shorter hospital stays and quicker recovery times.

What kind of surgery do you do?

I am trained as a gynecologic oncologist, which means I treat cancers of the female reproductive tract. I am board-certified in that subspecialty. So I perform hysterectomies, remove ovaries, lymph nodes and other abdominal tissues to determine if the cancer has spread. I do other types of surgeries to treat cancer as well.

What did it feel like hitting the 1000 mark?

In some ways, it felt just like any other day – and the case went great, so that made me happy! In other ways, it was a moment of pride, looking back and seeing how far we've come. Finding out the significance of doing 1,000 cases was really overwhelming. I was amazed.

What was the significance of 1,000 robotic cases.?

1,000 cases put me in the top 1% of gynecologic robotic surgeons in the US and worldwide. That made me feel like my commitment to this skill has been worth it. I think it's amazing that in the middle of the country, in a town the size of Columbia – my home town – you can have surgery with the top 1% level of expertise in the world.

Explain robotic surgery to a layperson who's not familiar with the technology.

Minimally invasive surgery is done through smaller incisions. This is typically done with standard laparoscopy equipment, which has some limitations. Robotic surgery has capabilities that overcome many of those limitations. The benefits basically boil down to visualization and ease of motion. 

For the visualization, the camera is much stronger, so you see the anatomy in a very magnified way. The camera actually has two camera heads, so it gives a three-dimensional view. 3D sounds fancy and exciting, but it has a practical application. It allows you to judge the depth of your motions. To see the difference between visualization with standard laparoscopy and robotics, reach for something and grab it with both of your eyes open. Then, close one eye and reach for it. You'll see how your brain has to work harder to judge how far to reach when one eye is closed. Standard laparoscopy is like that. Robotics allows you to operate with both eyes open. 

The ease of motion is due to the robotic instrumentation being wristed, so it has a full range of motion so that you can move the instruments more like you’d naturally move your hands and fingers. I think if you've ever had to wear a cast and then do things with that arm, it’s a good analogy for what standard laparoscopic surgery is like. You wouldn't have complete range of motion of your arm. You could adjust your body and grab what you need to grab, but again, it takes a lot more effort and you may not always grab it exactly the way you want to. Compared to standard laparoscopy, robotic surgery feels like getting your cast off. 

When and why did you become interested in pursuing robotic surgery?

I began in 2011. I wasn’t one of the earliest adopters of the technology, but I'd known about it for years. In 2001, I did my fellowship in Texas, and our institution had one of the first robotic systems in the country, when it was undergoing its preliminary clinical use. I didn't do robotic surgery at that time, but one of my mentors, Dr. Conception Diaz-Arristia was one of the first physicians in the US to do robotic cases. So I was aware of the technology in its infancy. Many years later, when robotics first came to Columbia, I was approached multiple times but declined because I was too busy with other things, one of which was completing my board certification in gynecologic oncology. If I was going to pursue robotics I wanted to put my best effort into it. There are rigorous training steps you have to go through just to start doing cases.

I was interested to use the technology for my cancer cases who need more extensive surgery, like lymph node removal. Robotics was a safer way to do complex cases with much more precision. Robotics essentially equalizes the playing field, allowing patients who otherwise wouldn't be candidates for minimally invasive surgery to benefit from it. I initially planned to only use it for a subset of my patients, but as I used it more, I realized the benefits of the technology and became a believer: it’s truly the future of surgery.

To what do you attribute your success?

Overall, having a great mother. In robotic surgery, I’d say focus and dedication. I’m an “all or nothing” person; if I commit to something, I like to give it my all. I also have benefitted greatly from a strong team in the operating room. Great nurses, scrub techs, and anesthetists can really make your job easier. 

What has surprised you the most about robotic surgery?

The complexity of procedures that I can do through tiny incisions. That's the beauty of experience – the more surgeries you do, the more you find ways to work around obstacles. 

I've also been pleased at how it's changed my patient’s lives. They recover from surgery much faster and with less pain. That’s more profound than it initially sounds. The less pain you have, the less pain medicine you take, the sooner you’re up doing your normal activities. You’re also less likely to have postoperative complications like blood clots, pneumonia or constipation. And for many of my patients, it means moving on to the next phase of treatments, like radiation or chemotherapy, that much sooner.

What do you most enjoy about being a surgeon?

The satisfaction of the case that goes perfectly. The challenges of complex cases and successfully meeting those challenges. I'm fascinated by anatomy and physiology and the endless complexity of the human body. I'm humbled by the strength and resilience of the human spirit and the body’s capacity both to mutate and to heal itself.

What practical advice would you give to someone who's facing surgery?

Ask questions. Bring someone with you to your appointment. Find out about your surgeon’s expertise if you can. Listen to your gut. If you're not comfortable, that may be a red flag. You have to put a lot of trust in your surgeon and you have to feel like you can communicate with them. Don't be afraid to get a second opinion. Oh, and of course, follow the doctor’s advice! Dos and don’ts about your post-op care can make a big difference in your recuperation.