HPB Oncology to Global Mentorship - Empowering the Next Generation

Join us in Guts and Glory for ‘HPB Oncology to Global Mentorship - Empowering the Next Generation.’ Our esteemed guest, Prof. Catherine SC Teh, MD, MSc—FRCSEd, HonFACS—has revolutionized minimally invasive HPB surgery, authored landmark guidelines, and leads international societies shaping surgical excellence worldwide. Her vision empowers the next generation of surgeons. She is a champion for women in surgery and HPB. Tune in to experience her journey from oncology innovator to global mentor!”

Transcript

SPEAKER_01 0:12

Good morning. Welcome to this episode of Guts and Glory, where we dive deep into the world of GI and HPB surgery. Today is World Women's Day, and how apt it is that we have one of the leading figures in the world with tremendous contribution to women empowerment and surgery. Let me introduce Professor Katherine They, a trail-basing HPB surgeon from Manila, Philippines, who is a global leader in fluorescence-guided surgery and minimally invasive HPB oncology surgery. She has been honored with many awards and distinctions, which is a whole lot of them, and difficult to recount all of them here. But a few of them are the first Filipino to be included as an honorary member, fellow of the American Surgical Association, SSAT Distinguished Service Award. And she's been rated as top three researchers globally. I'm so delighted to have Catherine on this podcast. Catherine, welcome to this podcast, which I'm going to title it as revolutionizing HPB Oncology to Global Mentorship, Empowering the Next Generation.

SPEAKER_00 1:34

Thank you so much. Thank you very much for having me today in your podcast, and really I'm very honored. And um I feel indeed very apt for today, for this celebration of International Women's Uh Day. I am very privileged, I should say, I'm very privileged to be able to um lead, to be able to uh share my journey, my experience, and to be able to influence um the younger generation.

SPEAKER_01 2:14

Absolutely. Yes, I've seen that uh many times when I've met and seen a lot of people around you, and I realize that you play a remarkably in inspiring and empowering role on this global stage. My question is, how did this journey begin? What influenced you to pursue this path?

SPEAKER_00 2:34

I think I I I need to look at it in two different stages, where the the first stage really is that one needs to be a physician first. So I I really wanted to be a doctor since I was young. My mom told me that I wanted to be a doctor since I was three, and it really never changed. But then to get into this um uh global stage to get into the HPB uh scene and to be um working alongside a lot of most of the pioneers and giants in the field of HVB surgery, um it really was not uh purely by design but an interaction between chance, opportunity, and and really taking that opportunity and um transforming it into something worthwhile. In fact, I wasn't really planning to be an HB surgeon. The fellowship uh training that was available and were taken by many others were breast, upper GI and all the rest, but HPB was empty. So that's the reason why I took it, thinking that I'd have a better chance, and that was in the early 2000s. So HPB was still in its uh in its beginning.

SPEAKER_01 4:04

Yes.

SPEAKER_00 4:04

So yeah, so that was the opportunity at the time, which I took everything.

SPEAKER_01 4:09

It's in the right place at the right time.

SPEAKER_00 4:10

It's at the right place. That's true. Yes, yeah, yes.

SPEAKER_01 4:16

But I want to know about your uh uh days of surgical training in the sense that you know these are difficult areas. How did you navigate that phase to build the confidence and the skill set which you have uh developed over the years? I mean, you know, specifically, you know, when you do this training, you go through this long period, you need a good support system and a whole lot of mentors. So tell us something about this uh support system, mentors, and your phase of training.

SPEAKER_00 4:48

Yes. It was very difficult in the beginning because I came from a uh low-middle income country, and the as we said, the HV surgery was not very common at that time. So all I saw was wedge resection, a lot of bypass surgeries, and in our in our side of the world, most patients come at a very late stage. So uh surgeries of this magnitude today were not really seen before. So when I was during during my my fellowship, my my mentor, and and as as you said aptly, mentorship is crucial. My mentor was the best, and really he from Singapore General Hospital, he he gave me the guidance in technical, non-technical, academic, research, everything. And I remember there was one yeah, there was once he he he told me, he said, you don't really need to be the best in doing everything um in your skill, but you need to make sure that you understand what the patients are going through, they understand what the problem is. You need to build this connection with your patients. So you see, it wasn't really truly uh a mentorship just for skills alone, it was 360 degrees, everything all around being a good physician, being a competent and a compassionate um surgeon who who would also be able to align with what is current and what is developing, and to be able to adapt to change. So what my mentor uh taught me from then on uh really has shaped who I who I am today, and because I was not really able to uh feel that when I was younger, when I was you know, when you're a resident, you just want to go through it. You just want to go through your your residency and um emerge successful. But in fellowship, that was a time when I really had the chance to look into each patient, into each case, and reflect on each case, what went wrong, what went well, and how could have how could we have done things better? At each stage, I meet the best mentors in the field. And until today, I go back to them, I and we we we really establish that connection and that support system. And I think that was that's what truly matters.

SPEAKER_01 7:24

You know, you're absolutely right, because a lot of times the residents and fellows get caught up in acquiring the skill, yes, the holistic development, and which is very critical because skill a lot of people can acquire. But the looking at the problem and how to adapt to the problem to a particular patient, I think that's what mentorship gives. And I I quite agree with you uh in that sense. But uh Catherine, tell me, like you know, when you are doing HPB surgery, uh you know, what barriers do HPB surgeons face, especially women surgeons? Uh and how do you I mean how did you deal with it? And how do you help people now at this stage to you know get through this HPB conundrum?

SPEAKER_00 8:21

Because at any point in time, all the challenges that come with it, and especially as a woman, and especially as a woman in HPV, where at that time really there was extremely little number, almost none, during that time when I was a fellow. Number one, you you need to build that support system during your training, after your training. Um, of course, being a woman, one of the you know, we we we've had several surveys, and one of the surveys that that we've looked into last year were the barriers. Up to 70 percent of the barriers were about childbirth, about family, about um uh mental mental health, and and this is where family support really comes in. I think mainly number one is to be able to recognize that there are barriers, and we we just need to accept this vulnerability. We we do not have to to force, yeah. We don't have to create this front because we need to tell people that we need support, we need help, and there's no shame in it. And as a woman, sometimes we feel that we know it all because this this is the maternal instinct. Um, I think in Asia, in India, and even in the Philippines, I think it's the same. We also don't want to feel uh burdened to other people because we are so used to caring for other people. Yes, but but it is necessary for others to know that we need help too. So that is something that uh I would like to share. Um, letting people know that um support is needed, especially family support in in the um reproductive age. Professionally, it's important to develop collaborations. We we we cannot we can we cannot advance just by ourselves. So being able to establish network and create um um opportunities for collaboration will definitely uh help us uh overcome the barriers where we're we're in if you are it not in a very strong academic um environment, then these will definitely help. Thirdly, is um clinically, there will always be challenging cases. Do not I I never felt um inferior, and I never felt like um it it is uh uh embarrassing or it is a shame that I don't know. I would always I would always call a call a friend. I'd always go back to my mentors and say, hey, I have this case, I saw this, and I like your opinion. I may not follow the opinion, but at least I can pick somebody else's brain. So I think it's it's important to to do that. Uh um so many developments in in um genetic uh profiling and targeted systemic treatment that that that really um develops and and advances at a very, very fast pace with immunotherapy. I feel some of us as surgeons are lagging behind. It's because we feel that we need to operate and we need to behave as surgeons, but in reality, um it's not all about cutting. We need to know biology, we need to know many other things alongside surgery because we need to integrate this treatment as uh a holistic uh approach.

SPEAKER_01 12:02

Yeah, no, I think uh you you make some very important points. Basically, what you said no that uh you should not portray a picture of that you can do it all, and asking or saying I can't do this is a sign of weakness. That cannot be true. And I think uh the other point reflects the fact that you know in HPB and in modern times, you need to work collaboration and have good teams, isn't it? Unless you have good teams, you can't produce results, it's not a single-handed person.

SPEAKER_00 12:38

So yeah, I think uh these are very important points which you raise in a I also wanted to share with you something about because you mentioned about teams, and in the beginning, when I came back, and I felt like I know I know a lot more than than what I used to know, and I know that I have honed my skills much, much more, but the truth is my outcomes are not as great, not as great as where I came from. So it all boils down to developing your team. If your team members, if you're an astrologist, your nurses, your administration, uh medical departments, gastroenterologists, your radiology, if they do not uh upgrade and they do not uh come uh um upscale and and align with no, you will you will never achieve that. Yeah, so it's really a team sport, and we need to use our uh passion to try to influence others to be aligned and work towards the same goal.

SPEAKER_01 13:49

It's a good leadership, yeah. So I mean just continuing with that, Catherine, that uh you've been at the forefront of this minimal invasive uh sort of revolution in HPB oncology and lacroscopic and robotic domains. Uh if I ask you that, what do you think is the contribution which you are very proud of, or you feel that you have made a tremendous contribution in this field? I want to hear from you according to you. We know a lot, many of them, but what do you think?

SPEAKER_00 14:29

I think one of the most important contributions I feel that I I I I've shared and I've done, at least locally, is that I do um a a lot, a fair bit, almost 90% of my work uh has become minimally invasive, even in complex, um complex uh um situations. Yeah. I was able to contribute 65 cases of complex iwate complex cases of more than a score of more than 10, which is only for experts. I'm the only woman who has contributed to that in the entire world. So I think that is one contribution for for um laparoscopic liver resection. More importantly, I think to be able to show women that we can coexist in this field and we are able to do it as good as um the rest. I think that, or even better, yes. I think that is one of the most important contributions for me as a woman, as a surgeon, doesn't have to be a woman, but as a surgeon, also coming from a low-middle-income country, because we do a lot of creative approach compared to the standard uh approach where they have everything in the West, but to be able to pursue and to be able to achieve um these complex uh laparoscopic liver resections, we need uh to think out of the box, we need a lot of creativity because we have minimal instruments and and we are still able to do it. So I I think it really boils down to to me is if there's a will, there's a way.

SPEAKER_01 16:26

And we call this jugar in India. So jugar means to sort of make up what is lacking by some local things. Yes, that's right. That's what it is. But uh I don't know. I mean, you know, I I I'm talking uh from what I see around me, that a lot of surgeons are still very hesitant to embark on minimal invasive surgery for uh complex diseases, HPB diseases. As a matter of fact, uh if you look at pancreatic or dubilectomies being done across the world, only about 20% are being done by minimal invasive means. So my question is what convinced you to push the boundaries and adopt this in the scenario that you were you know evolving as a surgeon or developing as a surgeon? And how did you know it was the right direction to choose?

SPEAKER_00 17:24

Yeah. So um firstly, I think it all boils down to challenges and frustrations. When I started, I I don't get referrals, patients don't come to me. Patients ask me um how many cases have you done? Yes. How old are you? You know, I I don't need to be asked these questions, right? Yeah, um, but but these are the common questions that I I get. And even if I sit in my clinic all day, I will not receive, I do not receive any referral for a liver or a pancreas, but I do get referrals for excision of lumps and bumps. I would get uh referrals for hemorrhoids for for bed sores. So I I did not train for those, and you know, I to me in my mind, I did not do my training just to do all these. So I need to reinvent myself, I need to think of something, and I how can I make myself different from the rest? So everybody will be every surgeon, you know, will know how to operate, but how can I make myself different? So that was a time when I thought I needed to do something more than what the rest my seniors are doing, and that was how I came into minimally invasive surgery and really pursued no matter how difficult it was. And you know, when we look at all the consensus guidelines, you see all the guidelines come down to how to deliver uh safe laparoscopic liver resection, how to deliver uh safe pancreatic odidenectomies. Any on any of those consensus guidelines all boils down to safety, and that perhaps that's the reason why um the pickup rate is so slow because we ourselves are are very hesitant to diffuse it widely because of the safe, because we know that uh the the learning curve is very steep, yeah, and say patient safety is paramount. So and even today there's still a lot of debate about laparoscopic, open. So I I think that's also one of the reasons why it it takes a while before this really becomes a a um more adopt adaptable, plus the cost, the cost of of all these um uh instruments that that's needed. Because without I mean without the energy devices, it's impossible to do a a uh minimally invasive liver or pancreatic resection.

SPEAKER_01 20:12

No, also, you know, uh one of the common uh arguments against it is that a surgeon who has experienced and learned uh through a procedure well in a particular way, now if they he or she has to go through another learning curve with the uh minimal invasion. So what how does it weigh in with the patients? Like, you know, I I'm very good at this, but now I'm going to do this, and your results may not be as good. So, you know, that may be one of the uh something which holds back people to adopt that. This is what uh I feel and I think I hear this around a lot.

SPEAKER_00 20:59

Yes, I I think that's also one. Um, but it will change because uh this every I'm sure you also hear this because every time people patients ask, can can can you do it minimally invasive?

SPEAKER_02 21:14

Um, laparoscopic.

SPEAKER_00 21:18

Yeah. So patients ask for it. So I think in the next few years it will change. I I just don't know how training should be and how training will happen when we come to the age just like laparoscopic colysystectomy when our trainees nowadays don't even know how to do it open.

SPEAKER_01 21:38

Yes, yes. But uh uh just continuing with this, uh Catherine, when you offer minimal invasive surgery for HPB oncology to patients, um, of course, they have a lot of questions. And so, what guides your approach? Is it all commerce minimal invasive? You offer open, you have an option. Robotic. I mean, how do you choose?

SPEAKER_00 22:04

Um, it depends on the face as well. In the past, when I was just beginning, I started offering them to highly selected patients, in patients where I know I would be able to do the minimally invasive approach successfully, such as those, you know, as in the guidelines periphery, left lateral, um segment 4b, 5, 6, things like that. Um, although I have to admit that at one point in time I wasn't really following the guidelines accordingly, um, because I believe I I have a vast uh experience in open. I felt that I knew um how to go through it, and also because of my training in in advanced laparoscopic, which I was doing bariatric surgeries, colorectal surgeries. So trans transferring of skills for HBB um was probably one of the reasons why I was able to adapt very quickly. So at that point, what I did was um, and I I still I still advocate this, is to do it on a stepwise approach, meaning that in very complex, uh let's say we are faced with um uh right hepatectomy for a big tumor, the the approach will be such that very candid and and very honest to the patient that we will try, we will try a laparoscopic approach, but in the event that there is any safety issue, I will have to convert. So I always tell the patient that in the beginning, um first two years, two to three years of when I was starting laparoscopic approach, especially for big tumors and for major hepatectomies like that. But what's important there is building confidence. It was important to build the confidence step by step because it is these are the times when you tell yourself in your mind that you will most likely convert at some point in time, but not when the patient is crashing, it is up to a certain level where you cannot proceed um as planned, but also there are um certain times when um you would be able to do this stepwise in a way that you can achieve springles, you can achieve pyrenchymal transection, you can achieve uh vascular uh um occlusion, yes, and ligation. And sometimes the only the only thing that you won't be able to finish is towards the end, especially in the large tumors where it's very difficult to approach the hepatic veins. But having said that, you have minimized the incision because uh it was all only uh perencarmal transaction was already almost finished. So these are a lot of a lot of times in the beginning this was happening, but my patients still um appreciate it because it's what's important really is that relationship with your patient, absolutely, and and the the honesty that from the very beginning they know what to expect, and you also know what to expect, even your anesthesiologist, because we don't want crash conversion, conversions electively rather than as a uh emergency need.

SPEAKER_01 25:39

But conversions, how do you view conversions? I mean, in terms of you know as what how it impacts the outcome and how it impacts what patients think about conversions.

SPEAKER_00 25:53

So we looked at our data actually. Um, even if we converted all of our conversions, patients still do better, and patients still go home. Um, I mean their hospital stay is still one or two days less, and the pain is still less. So the conversions, um, in this scenario, we're not talking about crash conversions and an unexpected conversions, we're talking about expected conversions. Um, or should I say the better term is like a hybrid approach more than a conversion?

SPEAKER_01 26:26

So in this in this scenario, patients are both approach, yeah.

SPEAKER_00 26:32

Yes, so it is important to to be uh able to strategize fully uh prior to surgery and make sure that your plans are in place. Option A, option B, option C, and uh not be surprised at all. So everything has to be strategically planned.

SPEAKER_01 26:52

Yeah, as they say now that we do most of the surgeries before the actual surgery and have everything sorted out, and as you said, have all the plans in place.

SPEAKER_00 27:02

Yes, that is so true because every surgery that I schedule um actually happens uh in my mind before the surgery happens. Yeah, the night before I and and I even joke about this with my trainees, I tell them, you know, I'm constantly dreaming about the scan of my patient procedure that I'm supposed to do at 7 o'clock in the morning. So it's in my dreams every night. Even after if even if it is the 150th liver section, no matter which number it is, it happens all the time, and I still cannot cannot um do away with not flipping a book or a reading something just before the operation, just to make sure that you know am I not missing anything, going back, going through all the the data, and also um something might something might be helpful. So it's it's it's been a habit. I think it's habit forming, yeah.

SPEAKER_01 28:18

So Katherine, I want to take you back to what you said as the transformative contribution or so, which is the ICG revolution in HPB surgery. Uh I remember that I heard you in Korea a couple of years back, and I mean, actually the whole hall and everyone was really astounded by the uh data which you presented. So, how did you pick this up? How did you get into this ICG scene? And uh what do you think now has been its impact and utility in HPB oncology?

SPEAKER_00 28:56

I was actually very skeptical in the beginning. And as as anyone, any surgeon would say, I don't need it. That's what I said as well. So I was agnostic in the beginning, but I just fell in love with it when I tried it. So one of my one of my colleagues um brought it in and he said you should try it, you know. Um if you want to to do your livers, um, why don't you try this even for your gallbladder? So I first use it to identify a tumor because it was a small tumor from a neuroendocrine. Um it's a neuroendocrine metastasis. So I wanted to see if if there are um tumors elsewhere. So I used it to identify the tumor, and subsequently I was so happy because it really showed me where the tumors were. Um one tumor that I did not see on the scan and led to another, so that was like, you know, um very magical for me. So indications change, um, the way you use it change over time. So in the beginning, it was purely to identify the tumor, and then next to identify the segmentation, helping in precision, um precision hypoctomy, and then there was a uh there was an uh incidental or accidentally I also saw um a variant, a a a posterior biliary um segment seven dot that was arising from the left with the ICG. It was it was all by accident. So the more I use it, the more I realize that it is helpful. And that's why I became such an advocate of it. And and really it it is an additional tool that in our toolbox, if if we have the ability or if we have the capability and the resources available, why not? Right? Because it can only help us see better. And once you see better, you can do better. People ask me as well, like, why do you use it routinely in laparoscopic cholysystectomy? And and in the beginning, when I used it, it was out of novelty. So the more I used it, then I realized that we are able to identify more and more variants of the biliary tree. And then it was such a great tool for teaching and training. Every every person in the operating room, whether it be a student, uh a trainee, a surgical trainee, a nurse, they can see what we're talking about. And if we think about it, a patient for elective. So pe people ask me, even for elective, and the truth is even more so for elective, because these are the patients who should not, who should not have any error, who should not have any bulduct injury at all. And if and if for a fraction of, I mean for for an additional cause, it gives you peace of mind, it makes sure of the anatomy, and and it improves a safety. We're not saying that this can absolutely prevent bulduct injury, but definitely adding one layer of uh safety.

SPEAKER_01 32:40

So I'm a great fan of uh ICG uh and uh I use it quite liberally, and we have done uh uh work in acute cholestitis, and you know, we looked at direct ICG injection in the gallbladder because sometimes if you don't give pre-operatively, you may not be able to visualize so whether we can do it like a cholangiogram and things like that. So I I love ICG, I love the colors it shows on the screen. So, and as you said, everyone can see it. So uh fantastic.

SPEAKER_00 33:14

Uh I think it's really it's really a good tool that lessens your cognitive workload. A lot of people who don't use it, they keep saying, I don't need it, I know what I'm doing. It's sometimes it's not about just knowing what you know and what you're doing, there are several factors, even environmental factors and uh factors that sometimes we don't know or we are unconscious with, and it impacts our decision making. But with something adding a layer of patient safety, I think it's it's absolutely I agree with you.

SPEAKER_01 34:00

I want to hear about the HPB cancer care in the Philippines, which you've brought a transformation by getting all stakeholders together, ensuring equity of care. So tell me a little about it because you know how you've brought this together and how what has been its impact.

SPEAKER_00 34:23

Actually, we started with the National Integrated Cancer Control Act. So it is for shaping the the uh cancer care landscape in the Philippines, and in fact, um more recently your colleagues from India to share with us your experience in the national cancer grid.

SPEAKER_02 34:44

Cancer grid.

SPEAKER_00 34:45

Yes, yes, yes, so that is uh the same path that we are looking at. So we started with the National Integrated Cancer Control Act in 2019, and because of that, for the entire for for all the different cancers in a jet in a general um cancer care aspect, I had to segue into the the HPB aspect because uh HEC is very common in in this country, and we don't really have any guideline of any sort, so I put it up to the uh Department of Health to come up with a national guideline for um hepatocellular carcinoma. Together with our hepatologist, we created or we we actually advocated for what we call as a liver cancer awareness month. So every January uh from then on in 2020, we had to we sell sort of we call it a celebrate, but we improve we enhance the awareness, prevention, screening, early detection, and so we involve also um delay people, which we call as the yellow warriors, because they they are these these are patients with hepatitis. So hepatitis um B is uh incidence is very high, it's in endemic in our country. So we have these yellow warriors who are together with us um advocating for increasing the awareness on and then with my with my involvement in in the cancer commission, because I'm the director of the cancer commission, we also hold um these kinds of multidisciplinary tumor board nationally uh for for all the all the diseases, all the different organ systems, but um in terms of HPB, we include also biliary cancer, pancreatic cancer, colorectal liver metastasis, and and uh primary HDC. So those are some of the things that I have uh personally been able to move things forward. Yeah.

SPEAKER_01 36:52

Fantastic. You know, uh I was doing some research, and uh maybe I could address you as a modern-day Babylon in Filipino tradition because of your desire to you know serve the community, look after their well-being, for justice, equity, all those things. What do you think? That uh is apt uh title for you in the modern day.

SPEAKER_00 37:22

It's such a privilege to be given that uh title, but really what I I feel is that each one of us, all of us, would really have something to offer um in our own little ways. Whatever that I do is very small. It doesn't really um I don't think it's a huge um uh contribution, but the truth is that no matter how small our contribution is, when we put everyone's small contribution together, it becomes big.

SPEAKER_01 37:55

Yes, absolutely. Yeah. Uh maybe some final thoughts now, Katherine. Uh for trainees and fellows who are aspiring to be HPB surgeons, I mean, what do you recommend as timelines and training and methods to adopt? Like I'm sure you have a fellowship program. So how structured is it and uh how do you sort of figure out that they've come to the appropriate level of skill and proficiency?

SPEAKER_00 38:30

So we we do have a very structured uh program in the country. So this is um created by our association by the Philippine chapter. Um and and every every trainee, I I think it's important for the trainee to know that at certain levels of their training and proficiency they will see things differently. As a as a fellow HUB fellow in training, it is important to learn the the uh necessary advanced skills for complex HPB with um integrating the current advances um in the clinical application, but also need to contribute back to the community by looking at um our outcomes and how we can improve it. And these this can contribute to research, mentor, teach others, train others, and not only um within the country, but also share our outcomes and share um your views, your experience internationally in the global stage.

SPEAKER_01 39:45

So I think and also I feel you know, one of the things in modern times is you have to continuously upgrade your skills and knowledge because you can't just sit on that, as you mentioned, that you know, think the landscape is changing so fast. Some surgical things coming in that you can't just sit back and say, I have become a fellow, I've learned from Katherine Tay, and now that's it. Uh, I don't need to worry too much about it. But going on mentorship, uh I know that you would be mentoring again as a holistic thing, but what is that one thing you continuously emphasize on your trainees or fellows when they pass through your portals? Some one thing which you may tell them all the time.

SPEAKER_00 40:40

Um I think one important thing that I always tell them is to ask them to look inwards, reflect, and see um how they can make a difference. Because first we look at the precision in surgery. Definitely I make sure that they they are up to date, they are precise, they use technology to their advantage. Second, is that you need to know how to integrate biology with surgery, it's not all about surgery. Yes, so my trainees know that I'm I'm always talking about uh biology, talking about NGS, the DSCT DNA, talking about systemic treatment and all of these. Last but not the least is um systems innovation and integration. We must build healthcare systems that would allow complex care, complex cancer care to reach uh more patients, and especially in the um less accessible, less uh resource area. So, those are the three things that I always tell my my trainees.

SPEAKER_01 41:51

Catherine, thank you so much for being on this podcast. I've really enjoyed this conversation with you, and I'm sure the listeners would feel very, very enlightened to listen to you. Thank you so much.

SPEAKER_00 42:06

Thank you very much for having me. But also in the light of uh International Women's Month, because I think it's important to um sort of encourage our uh women viewers or listeners. Um we used to always talk about whether uh how how to how to gain equity, right? But I think from now on we shouldn't be thinking about it. I think the most important question really is that um we do not have to think whether we we need to ask for having a place in the in the operating room or in a table, but we just really need to show up, go lead, innovate.

SPEAKER_02 42:54

And own the place.

SPEAKER_00 42:56

Yes, own the place, and together I think we can reshape the future of surgery.

unknown 43:01

Yeah.

SPEAKER_01 43:02

Thank you very much. Happy Women's Day.

SPEAKER_00 43:05

Thank you so much for having me. It's really an honor.