Introduction Despite increasing numbers of women in surgical training, gender inequity persists in academic surgery, particularly in visibility at major conferences. Invited speaking roles are key markers of academic recognition and career advancement, yet women remain underrepresented. This study evaluated the gender distribution of invited speakers at major international surgical conferences, the prevalence of all-male panels (“manels”), and factors associated with female representation, including academic merit, conference format, specialty, and temporal trends. Methods We performed a retrospective, multi-specialty, international, longitudinal cohort study of surgical conference programs from 2016 to 2021. Conferences across all ten surgical specialties recognised by the Royal College of Surgeons of England, as well as pan-specialty meetings, were included. The primary outcome was the proportion of female speakers per session. Secondary outcomes included manel prevalence, temporal trends, differences by specialty and conference platform, and the association between speaker gender and academic merit using the H-index. Results In total, 39,052 speakers from 211 conferences were analysed; women comprised 15.0% (n = 5,859). Among 5,889 panel sessions, 61.6% were manels, most commonly in Trauma and Orthopedic Surgery (76.4%), Oral and Maxillofacial Surgery (75.1%), and Urology (68.2%). Manel prevalence declined from 67.6% in 2016 to 53.6% in 2021 (p < .001). Online conferences had fewer manels than in-person or hybrid meetings (p = .044). Across comparable H-index quartiles, men were more likely than women to be invited speakers. Conclusion Men remain almost four times more likely than women to be invited speakers at surgical conferences. Although manels have decreased over time, marked gender disparities persist, even among equally academically qualified surgeons, underscoring the need for targeted strategies to improve female representation in academic surgery.