ロボット支援手術の執刀機会に男女差! — 新規術式導入に潜むジェンダーバイアス— Surgeryに発表

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2026-08-06 大阪医科薬科大学,東京大学,星薬科大学,日本消化器外科学会

大阪医科薬科大学、東京大学などの研究グループは、日本消化器外科学会のNational Clinical Database(NCD)を用いて、ロボット支援手術導入初期における男女外科医の執刀機会を全国規模で解析した。幽門側胃切除術と低位前方切除術を対象に、ロボット支援手術、腹腔鏡手術、開腹手術の執刀件数を経験年数別・男女別に比較した結果、開腹手術や腹腔鏡手術では男女差が改善傾向にあった一方、ロボット支援手術では男性外科医は経験年数とともに執刀数が増加したが、女性外科医では同様の増加は認められなかった。男女差は医師免許取得後約10年から拡大し、新規術式導入時に女性外科医へ十分な修練機会が配分されていない可能性が示された。ロボット支援手術は今後の消化器外科医療の中核技術となるため、導入初期の経験機会の偏在は将来の技術習得や指導的立場への昇進にも影響する可能性があり、公平な教育・修練機会を確保する重要性が示された。

ロボット支援手術の執刀機会に男女差! — 新規術式導入に潜むジェンダーバイアス— Surgeryに発表

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ロボット支援手術の早期導入に伴う手術機会における性差 Sex differences in operative opportunities with early adoption of robot-assisted surgery

Emiko Kono MD, PhD, Hiroyuki Yamamoto MD, MPH, PhD, Sachiyo Nomura MD, PhD, Chie Tanaka MD, PhD, Hideki Ueno MD, PhD, Yoshihiro Kakeji MD, PhD, Ken Shirabe MD, PhD
Surgery  Available online: 14 July 2026
DOI:https://doi.org/10.1016/j.surg.2026.110441

Abstract

Background
Early adoption of new surgical technologies represents a critical period for acquiring operative experience that may influence surgeons’ careers. However, whether access to operative opportunities during the introduction of robot-assisted surgery differs according to the surgeon’s sex remains unclear.

Methods
This retrospective observational study used data from the National Clinical Database, a multicenter database covering more than 95% of all surgeries in Japan. Male and female gastroenterological surgeons who performed distal gastrectomy or low anterior resection between January 1, 2023 and December 31, 2024 were included. The primary outcome was the number of operations performed per surgeon, stratified by sex and years since medical registration.

Results
A total of 47,934 distal gastrectomies and 38,230 low anterior resections were included in the analysis. For both procedures, the proportion of operations performed by female surgeons was lowest for robot-assisted surgery. For distal gastrectomy, the proportions were 4.32%, 9.47%, and 11.86% and for low anterior resection, 5.41%, 8.41%, and 8.57% (robot-assisted, laparoscopic, and open, respectively). For robot-assisted procedures, the number of operations performed per surgeon increased with years since medical registration among male surgeons, whereas no comparable increase was observed among female surgeons. Sex differences became apparent at approximately 10 years after medical registration.

Conclusion
Substantial sex-based disparities in operative opportunities were observed during the early adoption phase of robot-assisted surgery. These disparities were most pronounced for robot-assisted procedures compared with laparoscopic and open surgery. Inequities in access to newly introduced surgical technologies may contribute to persistent sex disparities in surgical careers.

医療・健康
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