Authors: Mallory Johnson, Meghan Etsey, Dr. Divya Krishnan on behalf of AMWA’s Gender Equity Task Force
It’s no secret that surgery has historically been and overall remains a male-dominated field but what often goes unnoticed is that even the very instruments surgeons use were designed with men in mind. Despite the overall increase in women entering the field, the manufacturing of these instruments have not been adequately adjusted to accommodate this shift. Devices and instruments are designed to be large and heavy, making them less ergonomic for women (Fackler et al., 2016). This offers less control and produces an unnecessary level of difficulty for instrument usage, compromising training, performance, and outcomes. While growing awareness has promoted the development of more inclusive designs, further advancements are vital for gender inclusivity within the field. This bias in surgical device design reflects a broader trend in medicine, where male standards have historically been the default, affecting both female surgeons and the patients they treat.
Historically, women have been underrepresented in clinical trials, often excluded due to concerns that hormonal fluctuations would act as “confounding factors” (Williams et al., 2014). This has created major gaps in understanding how drugs affect women differently, with standard dosages calibrated to male physiology—sometimes leading to preventable adverse effects (Williams et al., 2014). While this bias in pharmacology is widely recognized, less attention has been paid to how similar assumptions shaped the design of surgical instruments. Early instruments such as forceps, scalpels, and scissors were developed with the hand size, grip strength, and body proportions of male surgeons in mind. For women, and those of different ethnicities, who on average have smaller hands and different grip dynamics, these tools compromised precision and increased physical strain (Hallbeck and Lal, 2023). It was only after women began entering surgery in greater numbers during the 20th century that these limitations were acknowledged (Vance et al., 2003).
This mismatch continues to have consequences. To compensate for ill-suited instruments, women surgeons often adopt awkward hand positions, which accelerates fatigue during long procedures and raises the risk of musculoskeletal injury, including carpal tunnel syndrome and tendonitis (Gensini et al., 2017). Chronic pain from repetitive strain not only undermines performance but also contributes to early career retirement (Schlussel 2019). Beyond instruments, protective equipment such as gloves, gowns, surgical scrubs, and masks are still predominantly sized for male standards, creating fit issues that hinder precision and even compromise safety not only for the surgeon, but for the patient as well. Meanwhile, women remain underrepresented in the design and testing phases of new surgical devices, allowing gendered assumptions to persist in equipment considered standard for all users.
These design gaps are not only challenges for surgeons, they carry direct implications for patients. When surgeons experience fatigue, discomfort, or chronic pain, their ability to maintain precision and endurance in the operating room is compromised. Suboptimal tools and poorly fitting protective equipment can insidiously erode surgical performance, meaning patients may not always receive the full standard of care that is achievable if surgeons are equipped with ergonomically appropriate instruments (Putnam et al., 2024). In this way, gender bias in surgical design is not just an equity issue for physicians, but also a matter of patient safety and outcomes.
Encouragingly, there are signs that the field is beginning to shift. A growing body of research is examining ergonomics and gender differences in surgical practice, highlighting the need for more inclusive design (Li et al., 2016). Women surgeons have increasingly advocated for tools and equipment that reflect the diversity of those using them, bringing attention to issues long overlooked. In response, some medical device companies have begun to incorporate a broader range of perspectives into the development and testing of surgical instruments and protective equipment. While these changes are promising, they remain uneven and incremental. To build on this momentum, there are several areas that should be reformed including inclusive design principles, representation in innovation, established policy and standards, and cultural change.
Women now make up a growing share of the surgical workforce, yet many of the tools they rely on were not built with them in mind. This paradox not only burdens surgeons with unnecessary strain but also risks undermining patient care. The path forward requires rethinking design from the ground up starting with inclusive instruments and protective equipment that improve precision, reduce injury, and ultimately benefit all surgeons, not just women. They also safeguard patients and strengthen the future of surgical innovation. When the tools of medicine are built to fit everyone, the profession takes a vital step toward equity, ensuring that excellence in care is shaped not by outdated assumptions, but by inclusive progress.
References:
- Gensini, G. F., et al. (2017). Gender and Ergonomics in the Operating Room: Exploring the Impact on Surgical Performance and Musculoskeletal Health. Ergonomics, 60(5), 642-651.
- Hallbeck, M. S., & Lal, G. (2023). Surgical instrument fit—What’s (hand) size got to do with it? American Journal of Surgery, 225(3), 447–449. https://doi.org/10.1016/j.amjsurg.2022.08.002
- Li, Z., Wang, G., Tan, J., Sun, X., Lin, H., & Zhu, S. (2016). Building a framework for ergonomic research on laparoscopic instrument handles. International Journal of Surgery, 30, 74–82. https://doi.org/10.1016/j.ijsu.2016.04.027
- M. A. Vance and E. D. Burns (2003). The Impact of Gender on Surgical Instrument Design: A Look at Historical Bias and Modern Solutions. Annals of Surgery, 238(3), 372-377.
- Mesiti, A., & Yeo, H. (2023). Surgical device design: do instruments fit today’s surgeons? BMJ Surgery, Interventions, & Health Technologies, 1, e000159. https://doi.org/10.1136/bmjsit-2022-000159
- M. L. Williams et al. (2014). Gender differences in cardiovascular drug treatment: A review of the evidence. Journal of the American Medical Association, 311(8), 799-806.
- M. L. Fackler and J. A. Birkett (2016). Ergonomics and surgical tool design: A historical perspective. Journal of Surgical Research, 210(2), 116-122.
- Putnam, J. G., Kerkhof, F. D., Shah, K. N., Richards, A. W., & Ladd, A. (2024). Helping surgeons’ hands: A biomechanical evaluation of ergonomic instruments. Journal of Hand Surgery, 49(9), 933.e1–933.e6. https://doi.org/10.1016/j.jhsa.2022.12.006
- Schlussel, A. T., & Maykel, J. A. (2019). Ergonomics and musculoskeletal health of the surgeon. Clinical Colon and Rectal Surgery, 32(6), 424–434. https://doi.org/10.1055/s-0039-1693026
About the Authors
Mallory Johnson, MS4
Mallory Johnson is a fourth-year medical student from St. George’s University. She holds a Bachelor of Science in Forensic Science and a Bachelor of Science in Chemistry from Tiffin University. She worked as an Analytical Chemist at P&G and KAO before medical school. She is passionate about giving back to vulnerable communities and providing equal access and opportunity to medical care. She is a member of the Domestic Violence and Music in Medicine Committees within the American Medical Women’s Association. When she’s not doing schoolwork, you can find her playing her cello, reading cozy mysteries, and playing with her poodles, Gertie and Maple.
Meghan Etsey, MS4
Meghan Etsey is a fourth year medical student from St. George’s University. She has a Bachelors of Arts in Biology and a Bachelors of Arts in Nutrition and Dietetics from Bluffton University in Bluffton, Ohio. She served as the President of the St. George’s University’s Women in Medicine chapter in St. George, Grenada where she expanded relationships with the community and worked towards educating women and helping the youth. She is also a member of the Gender Equity Task Force and Sex and Gender Health Collaborative Committees within the American Medical Women’s Association. When she is not pursuing medicine, you can find her with her friends and family on different road trips and adventures exploring the world.
Divya Krishnan, MD
Dr. Divya Krishnan obtained a medical degree with honours at the University of Medicine and Health Sciences, St. Kitts. She is passionate about preventative medicine and community medicine. She believes that we can only begin to move towards good health for all patients, with health equity and consistent community education led by healthcare workers. When not working in the medical world, she spends her spare time learning outdoors (hiking, rock climbing, gardening), learning indoors through reading books, and studying to brainstorm creative ideas for how to improve her practice as a whole- for her patients and for her co-workers.