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Page 85 Capelli et al. Art Int Surg 2023;3:80-9 https://dx.doi.org/10.20517/ais.2022.40

Along with these structural changes, a profound change in mentality is warranted, starting with the
engagement of men in the fight for gender equality. In recent years, the global movement HeForShe
brought together several leaders from different backgrounds, including government, business, non-profit,
[53]
and academia, to “accelerate progress toward gender equality” in a five-year span, starting from 2021 . In
the context of surgical departments, men can be allies by advocating for equal opportunities for their female
co-workers, offering advice and guidance on their clinical and academic careers, sponsoring and mentoring
them, and creating a safe and beneficial relationship that ensures reciprocal support and personal and
professional growth. Moreover, those who occupy leadership positions should be willing to guarantee equal
access to career opportunities, academic advancement, promotion, and remuneration and to provide
supportive work schedules for both men and women to create a healthy, thriving, organized and supportive
work environment. This will benefit both men and women surgeons, ultimately affecting patient care. As
stated by Dr. Wood in a recent review on gender equality for women in thoracic surgery: “Men have as
much to gain as women from a modernization of our specialty and mitigation of gender disparities that
undermine equal opportunity for career advancement” .
[54]
The role of artificial intelligence
A useful tool to overcome disparities could also be found in AI. The use of AI in medicine and surgery has
been growing consistently over the years, enhancing knowledge and helping to optimize technical skills and
clinical care . In surgery, AI application varies from pre-operatory evaluation to intra-operatory decision
[55]
making, to prediction of postoperative complications, to enhancing surgical skills and supporting surgical
training .
[55]

Even though the application of AI in everyday clinical practice is still limited, most surgeons have been
reported to believe that the implementation of AI technologies will improve both training and patient
care .
[56]

In recent studies, AI has been found to improve the management of peri-operative patients, as well as intra-
operative decision-making. Along with several tools improving diagnosis and pre-operative work-up, AI-
based platforms have been developed to help assess operative risk in both elective and emergency surgery
settings and to predict the occurrence of major complications . Moreover, AI can help identify the real-
[57]
time automatic surgical phase during complex laparoscopic procedures, favoring teaching and shortening
[57]
the learning curve .

AI can enhance surgical skills beyond the operating theatre through digital technology, video case review,
and telementoring [58-61] . In this setting, AI can be used to obtain an objective assessment of surgical
performances, eliminating both implicit and explicit bias, as well as offer advanced training to surgeons
unable to attend in-person education or practice in a rural/low-income setting [42,62-65] . Moreover, various
authors underline the efficacy of skill transfer between clinicians through mentored training and digital
tools [66-69] .

Given the ability of AI to provide universal access to high-grade educational tools, technology could help to
not only equalize training possibilities for female surgeons or trainees, especially when those possibilities are
not yet guaranteed inside the operating theatre, but also maintain or enhance already-acquired skills during
pregnancy or maternity leave. It should be noted that in a recent survey among members of the World
Society of Emergency Surgery, male and female respondents showed no differences in ability, interest in
training, or expectations regarding AI, thus confirming its potential role as an equalizer .
[56]