On the operating table, surgery is unisex (at least in the results)

They are a minority and yet they are entrusted with the most difficult cases. Still victims of stereotypes, women specializing in surgery have been the subject of study by a group of Japanese researchers, who have just published the results of the research on the BMJ. The conclusion? There is no difference in performance between male and female surgeons.

No surprise then. So why this research? To call for more opportunities for women specializing in surgery and to help reduce gender inequality.

Low percentages

Surgeons in general accounted for 28% (in 2019), 22% (in 2019) and 33% (in 2017) of surgeons in Canada, the United States and the United Kingdom, respectively. In Japan, the percentage of female doctors is 22% and in surgery it is 5.9%. In Italy the presence of women who enroll in Medicine has increased, now they reflect almost 60 percent of the total, but those who then choose surgery remain few.

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Here too there are exceptions, as in the case of the Morgagni-Pierantoni hospital in Forlì, which has two women in its staff respectively at the head of the Urology department, Dr. Roberta Gunelli, and that of Breast Surgery, Dr. Annalisa Curcio. .

“The profession of the doctor is full of satisfactions, but demands absolute dedication and social and family life are strongly influenced by this need, so the choice, both for women and for men, must start from important personal motivations”, she explains. Roberta Gunelli, head of Urology and specialized in robotic surgery. “The operating room with her times, often unpredictable, makes compatibility with a ‘regular’ life even less easy”.

Duplicate energies are needed

Of the same opinion the doctor Annalisa Curcio, head of breast surgery. “Surgery requires physical as well as mental energies, skill in the use of hands, availability of unlimited and unspecified time, decision-making skills, qualities that have always been attributed to the male sex, but not exactly that specific of the gender, nor in contrast with motherhood. To be a mother and a surgeon you need duplicated energy, it is certainly more demanding and tiring, but not impossible if surgery is not just a professional choice but a vocation and a great passion “.

Women and men equal

Returning to the study on BMJthe researchers used Japan’s National Clinical Database (NCD), which includes data on more than 95 percent of surgeries performed in Japan, to compare the surgical outcomes of female and male surgeons from 2013 to 2017.

They also considered postoperative mortality (within 90 days of surgery), surgical complications (within 30 days), and the surgeon’s licensing terms.

Research was carried out on three common procedures for stomach and rectal cancer: distal gastrectomy, total gastrectomy, and low anterior resection. The analysis included 149,193 distal gastrectomy, 63,417 gastrectomy, and 81,593 low anterior resection.

To high-risk women patients

Only 5 percent of these interventions were performed by women and, according to the study, they were more likely to be assigned to patients at high risk, i.e. with advanced disease or malnourished. Despite this, the researchers found no differences in mortality rates or surgical complications between men and women. It then emerged that women also had fewer years of specialization and less experience in minimally invasive interventions. This is probably due to the fact that there are few training opportunities because they are linked to the archetype of the traditional role of women, including family care. The strengths of the study were the use of a very accurate clinical database in terms of patient preoperative conditions and surgical outcomes, as well as consideration of important patient-related factors for the individual procedures selected.

“I encountered great difficulties in my personal experience due to the hard course of surgical training which in Italy, compared to other European countries, is more complex especially in practical training – explains Dr. Curcio – The people you meet in your training course can have a important and decisive role. I was very lucky because the professionals I worked with were not conditioned in their evaluations and judgments by ‘gender’, but they enhanced my skills and abilities, giving me the opportunity to grow and opportunity to realize my projects. All this was possible for me thanks to the constant support of the family and the person by my side, with whom I was able to share aspirations and ambitions “.

But also of satisfaction

“I followed the evolution of urological surgery during my professional life and at first I supported laparoscopic surgery alongside traditional open surgery. Since 2007, when the da Vinci robotic system was acquired by our hospital, I was able to start the robotic activity and for me it was love at first sight “, says Dr. Gunelli. “Robotic surgery, at the moment, represents the ideal system for urological surgery, in particular in the field of oncological surgery, allowing excellent results, in particular in the treatment of prostate cancer and renal neoplasms, allowing radicality and reduction of the times of recovery for patients “.

Ideas for reducing gender inequality

An English proverb says: “A good surgeon should have three qualities: a lion’s heart, the eyes of a hawk and the hands of a woman”. So women who intend to specialize in surgery must persevere with determination without giving up on passion. And then something else could be done, as Dr. Curcio adds: “Supporting women’s careers with active policies for work-family reconciliation, in full awareness that motherhood is not a private matter but a responsibility of the whole society”. It is therefore essential to pay greater attention to social policies to respond to the needs of families and women, who are increasingly engaged in the world of work, “and that there is greater recognition of women in the scientific world and equal access to top management roles “. All the other satisfactions come from the affection and gratitude of the patients, “even when they call you a lady and not a doctor”.