Championing Change: Empower, Innovate and Transform Gynecologic Care – Building Cathedrals in Women’s Healthcare

This is the Honorary Chair Address presented by Dr. Linda D. Bradley at the 53^rd AAGL Global Congress.

Today I feel the weight of history and the pull of the future in equal measure.

For the title of my talk, Championing Change: Empower, Innovate, and Transform Gynecologic Care—I’ve taken the liberty to add Building Cathedrals in Women’s Healthcare, because it weaves together three powerful metaphors that guide our work: the cathedral builder’s vision, the canary’s vigilance, and the carob planter’s patience. We also reflect on why do we build cathedrals. Is it to honor the builders? Or is it to provide a place of safety, respite, and healing for those who will utilize what was built for generations to come.

To President Dr. Michel Canis, Dr. Ted Anderson, scientific program chair, the Board of Directors, the Scientific Program Committee, and our dedicated administrative staff– you have assembled not just a congress, but a cathedral of minds.

You’ve brought together surgical innovators, trailblazers, and visionaries from every corner of the globe, each carrying their own stones to add to our collective edifice of knowledge.

And to our members—you are the master builders of this cathedral. You are more than physicians; you are architects of change—vibrant, intelligent, ambitious, highly skilled, supremely aware, and deeply humane. You represent the cornerstone of all that is right and best in our profession. Your energy in this room isn’t just palpable—it’s structural, supporting the very foundations of what we build together. Our patient, the woman at the end of the speculum, is the reason why we do what we do.

Before I share my vision for our future, let me acknowledge the extraordinary initiatives that make AAGL a beacon of excellence in our field. Our Surgery U platform has revolutionized surgical education, making world-class surgical videos and techniques accessible across the globe. Our commitment to the more than 60 FMIGS fellowship programs has created a pipeline of surgical excellence that spans generations. Our eight Special Interest Groups (SIGS), provide guidance in developing future programs, and our AAGL Foundation Board helps secure funding for academic research. The recent launch of our global outreach program has extended our reach to underserved regions, proving that the cathedral we build has no borders.

We gather today not merely as healthcare providers, but as architects of transformation. Like the medieval cathedral builders before us, we work knowing that our greatest achievements may not be completed in our lifetime. Every procedure we perfect, every technique we teach, every innovation we pioneer becomes another stone in a magnificent structure that will shelter and serve generations to come.

Every person in this room holds the power to transform women’s healthcare. Perhaps not globally in a single moment, but certainly for the next patient who enters your clinic. And isn’t that how all great cathedrals began? One stone, one arch, one spire at a time. One patient, one innovation, one determined physician at a time.

We were born for a time such as this—to be both builders and guardians, both innovators and preservers of our craft.

Three decades ago, I sat in the back row of my first AAGL congress, watching surgical legends at work. I particularly remember Dr. Jay Cooper, who would become my mentor, masterfully wielding an operative hysteroscope to address an intracavitary fibroid. I had never seen hysteroscopy during my residency—it was like watching someone paint with light inside the human body. In that moment, I made two pledges: to learn hysteroscopy and to one day achieve that same apparent calm in the operating room.

Now, thirty years later, I can share a secret: that surgical calm is just like the steadiness in my voice right now—it’s all about hoping nobody notices your knees shaking under the surgical gowns! But isn’t that true of all great builders? They too must have trembled as they laid the first stones of what would become magnificent cathedrals.

Looking across this room today, I see the master builders whose techniques I’ve adopted, whose innovations I’ve studied, whose wisdom I’ve absorbed. Though I must confess—some of your surgical videos are so masterful, I had to watch them in slow motion just to believe they weren’t special effects!

During my speech today, I hope to inspire “cathedral thinking”—a mindset that embraces long-term planning, unwavering patience, and collaborative spirit to create something extraordinary for future generations.

Do you possess “cathedral thinking?”

Medieval cathedral builders would lay the cornerstone knowing they would never see their vision completed. Yet they worked with precise calculation, each stone placed with purpose, each arch designed with intention, each spire reaching toward something greater than themselves.

Let me share a story that illustrates why we do what we do. Last month, a colleague operated on Sarah, a concert violinist who hadn’t performed in two years due to debilitating endometriosis symptoms. As my colleague saw her for her pre-operative visit, the patient clutched her violin case in one hand and her surgeon’s hand in the other.  “This isn’t just about the pain,” she whispered. “This is about my voice. My music.” Three weeks after her laparoscopic excision of endometriosis, she played her first solo in 24 months.

That’s not just surgery—that’s restoring someone’s soul.

And there’s Maria, a mother of three from rural Mexico, who traveled eight hours by bus to receive hysteroscopic myomectomy for her submucous fibroids. For years, she had been told hysterectomy was her only option. Today, she runs a support group for women with fibroids, spreading the message that less invasive options exist. One patient, one story, one ripple of change that becomes a wave.

As our surgical prowess grows in leaps and bounds, we must embrace something equally important as innovation: a culture of safety. In this cathedral we’re building, safety isn’t just a cornerstone—it’s the very ground beneath our feet. It’s what the woman at the end of speculum deserves.

We must listen, watch, and be aware of potential hazards as we work. As surgeons, our steel toed boots, hard hats, and harnesses include surgical checklists, surgical count sheets, and the ritual surgical timeout before each procedure. These policies aren’t just protocols—they’re our protective gear, our first line of defense, our ‘canaries in the coal mine.’

Let me share a story that bridges the gap between ancient cathedral builders and modern surgical innovators.

My grandfather was a coal miner in West Virginia, and he taught me something profound about medicine, though he never set foot in a medical school. Every day, miners would carry canaries into the depths of the earth—tiny sentinels whose silence would warn of invisible dangers.

“Listen to the canary,” my grandfather would say, “before the danger becomes visible.” His wisdom resonates deeply in our field. Like those vigilant birds, we gynecologic surgeons often serve as society’s early warning system. His wisdom resonates deeply in our field. When we observe patterns in our operating rooms—rising rates of adhesive disease, C/section niche, increasing risks of placenta accreta, pelvic floor dysfunction, early diagnosis of endometrial cancer in pre-menopausal women, abdominal wall endometriomas, increasing cases of early-onset endometriosis, clusters of rare gynecologic cancers—we’re not just documenting surgical findings. We’re detecting tremors in the foundation of public health.

This brings us to our third guiding metaphor. Nelson Henderson once said, “The true meaning of life is to plant trees under whose shade you do not expect to sit.”

There’s an ancient tale that has always moved me deeply. A traveler comes upon an old man planting a carob tree and asks, “How long until this tree bears fruit?” The old man replies, “Seventy years.” The traveler, puzzled, asks, “Are you so sure you will live another seventy years to eat its fruit?” The old man smiles and says, “I found carob trees in the world when I was born. As my ancestors planted for me, I plant for my children’s children.”

This wisdom echoes profoundly in our surgical theaters today. Like that old man, we too are planting seeds we may never see fully bloom. Think of the first surgeons who dared to dream of minimally invasive approaches – they planted their carob trees of innovation in rocky soil, faced skepticism and resistance, yet they persisted. They never saw the full flowering of robotic surgery, never witnessed the 3D visualization we now take for granted, never imagined the AI-assisted precision we’re developing today. Yet they planted anyway.

When I teach residents their first laparoscopic suture, I’m reminded of both the carob planter and the cathedral builder. That single suture is like a seed planted, a stone laid, the carob. It might take thousands of repetitions, years of refinement, before that resident performs their first solo complex procedure.

I might never see them at the height of their surgical mastery, just as the cathedral architect never saw their spires touch the clouds. But like the carob planter, we understand that our role is not just to build, but to nurture growth that extends far beyond our own time.

Like that carob tree’s deep roots, the fundamental principles of surgical technique – careful tissue handling, precise dissection, meticulous hemostasis – were planted by generations before us. Each tiny surgical step, like a tree’s annual rings, marks our growth.

Just last week, as I guided a fellow through her first complex endometriosis excision case, I was struck by how perfectly this wisdom parallels our surgical journey.

Look at what’s happening across our global cathedral. Our global cathedral of care rises differently across the world. In Montgomery County, Maryland, a woman with symptomatic fibroids has access to seven different treatment options. Two hundred miles away in rural Appalachia, her sister might have just one option. This disparity isn’t just a healthcare gap; it’s a challenge to build bridges between our towers of innovation.

• In Seoul, surgeons develop AI-powered navigation systems.
• In São Paulo, pioneers advance robot-assisted techniques.
• In Singapore, teams revolutionize single-port platforms,
• while in Amsterdam, augmented reality transforms surgical visualization.
• In Cairo, innovative use of 3D-printed surgical tools is making advanced surgery possible in resource-limited settings

To those working in state-of-the-art hospitals with the latest technology—your privilege carries the responsibility to innovate, to push boundaries, to show what’s possible in women’s healthcare. But remember, the most powerful tool you have isn’t in your OR. It’s your voice, your influence, your power to mentor others and advocate for change.

To those serving in resource-limited settings—you who perform miracles with basic equipment and limited supplies—your ingenuity, your resilience, your ability to do so much with so little isn’t a limitation. It’s a superpower. Some of the most brilliant innovations in medical history came from doctors who had to think creatively with limited resources.

To those practicing in remote areas—you who might be the only gynecologist for hundreds of miles—your impact is profound. Every woman you treat, every provider you train, every community health worker you mentor creates ripples that transform entire communities.

Each innovation adds another stone to our global cathedral of care.

Just last week in our simulation lab, I watched a first-year resident struggle with basic laparoscopic skills, his frustration palpable. “I’ll never get this,” he sighed. I shared with him how my own mentor once told me, “Every master was once a disaster.” We laughed together, and in that moment of connection, I saw the carob tree growing – from struggling seedling to strong sapling to mighty tree.

My mentor once told me something I’ll never forget. She said, “Every time you enter the operating room, remember: your hands are guided by the wisdom of a thousand surgeons before you, and your work guides a thousand surgeons yet to come.” Today, those words echo with new meaning as I watch our fellows master techniques that seemed impossible when I began my journey.

We stand on the shoulders of giants. Hundreds of colleagues in our midst who are Change champions who empowered, innovated, and transformed our specialty. Drs. Barbara Levy, Roseann Kho, and Lelo Mettler—they laid cornerstones in vaginal hysterectomy, practice guideline development, and laparoscopic surgery. Their wisdom flows through our hands every time we operate.

Remember Dr. Harry Reich, who in 1988 performed the first laparoscopic hysterectomy in Kingston, Pennsylvania. Like a medieval architect proposing an impossibly high spire, he was called reckless and unethical. Yet today, we stand upon the foundation he laid, building ever higher.

Dr. Jordon Phillips, our founder and Dr. Frank Loffer our previous Medical Director are other esteemed builders and who laid “cornerstones.”

In our operating rooms, we work with the precision of cathedral architects, the vigilance of canaries, and the patience of carob planters.

Consider how far we’ve come. In just the past decade, we’ve seen a staggering 510% increase in robotic gynecologic procedures across the United States. We went from asking “Is this science fiction?” to demanding “Is the robot available?” Some hospitals acquire a new robot faster than it takes to get approval for a new coffee machine in the doctor’s lounge!

But our progress isn’t measured just in robots and devices. It’s measured in the lives we transform. In India, the integration of laparoscopic surgery in rural centers has reduced surgical site infections by 60% and hospital stays by 70%. These aren’t just statistics—they’re testimonies to what happens when surgical innovation meets unwavering commitment.

As we champion change in gynecologic care, we must embody all three of our guiding metaphors: the vigilant canary, ever alert to emerging challenges; the patient carob tree planter, investing in future generations; and the visionary cathedral builder, laying cornerstones for structures yet to come.

Let our warnings be as clear as a canary’s song. Let our patience be as deep as a carob tree’s roots. Let our vision be as grand as a cathedral’s spires.

I invite you to imagine that you’re standing in the greatest cathedral ever built. But this cathedral isn’t made of stone and glass—it’s built of something far more precious. Its foundations are laid with the trust of our patients. Its walls are built with the innovations we pioneer. Its arches are shaped by the lives we save. Its spires reach toward a future we dare to imagine.

Our cathedral rises in every operating room where we teach. It grows with every patient we heal. It strengthens with every innovation we share.

When I think of all of you today – masters and learners, pioneers and students, each of us simultaneously harvesting and planting – I feel the profound beauty of our shared purpose.

Every time you gently guide a resident’s hands, every time you perfect a new technique, every time you push the boundaries of what’s possible, you’re not just performing surgery – you’re participating in something sacred. Something eternal.

This is our noble challenge and our profound privilege: to be worthy of the surgical legacy we’ve inherited and bold in the surgical future we help create. Like the carob planter, like the cathedral builder, we stand at the intersection of gratitude and possibility – grateful for the wisdom of our surgical ancestors, excited by the innovations of our present, and hopeful for the advances our successors will achieve.

Let us be worthy of this trust. Let us be generous with our knowledge. Let us be bold in our innovations. And let us be humble enough to know that our greatest achievement may not be in what we complete, but in what we begin.

Together, let us teach generously, build wisely, dream boldly, build boldly, and build for eternity.

For in this great continuum of surgical innovation, we are all links in an unbroken chain of progress, all planters in an eternal garden of healing.

For in passing the architect’s compass and the baton to the next generation, we ensure that our cathedral of care will continue to rise, reaching heights we can only imagine today.

They say a society grows great when old men and women plant trees whose shade they know they shall never sit in.

I say a surgical profession grows great when surgeons dare to innovate beyond their time, teach beyond their reach, and build cathedrals of care they may never see completed.

For in the end, our greatest legacy lies not in the procedures we master, but in the future we dare to imagine and help create.

This is how we truly Champion Change: Empower, Innovate, and Transform Gynecologic Care—by building a cathedral that will shelter generations to come.

And as we build this cathedral together, remember: every time you enter your operating room, you’re not just performing surgery. You’re laying another stone in humanity’s greatest cathedral—one dedicated not to any deity or doctrine, but to the simple, sacred act of healing.

The foundation is laid. The plans are drawn. The work continues.

And the cathedral rises, stone by stone, innovation by innovation, life by precious life.

We were born for a time such as this.

The women at the end of the speculum are trusting in us.

And our time is now.