Meeting the Editorial Board Member of GPM: Prof. Philippe R. Koninckx

Posted On 2024-07-05 11:44:13


Philippe R. Koninckx1, Jin Ye Yeo2

1Department of Obstetrics and Gynecology, Catholic University of Leuven, Leuven, Belgium; 2GPM Editorial Office, AME Publishing Company

Correspondence to: Jin Ye Yeo. GPM Editorial Office, AME Publishing Company. Email: gpm@amegroups.com

This interview can be cited as: Koninckx PR, Yeo JY. Meeting the Editorial Board Member of GPM: Prof. Philippe R. Koninckx. Gynecol Pelvic Med. 2024. https://gpm.amegroups.org/post/view/meeting-the-editorial-board-member-of-gpm-prof-philippe-r-koninckx.


Expert introduction

Prof. Philippe R. Koninckx (Figure 1) is the primus perpetuus of a Latin–Greek high school and is certified in OBGYN and nuclear medicine in vitro. He started as a student with the radioimmunoassays of angiotensin I and II. As a registrar, he introduced the assays of luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, estradiol, and progesterone. Following a PhD in steroid chemistry, endometriosis, and infertility, he became a full Professor at KU Leuven. Besides radioimmunoassays, his interests include endocrinology, infertility, and surgery. In 1981, he started the first menopause clinic on the continent, and in 1986 endoscopic surgery while being responsible for in vitro fertilization (IVF). Milestones in endoscopic surgery were the "discovery" of deep endometriosis in the late 1980s, and the first Belgian laparoscopic cholecystectomies, pneumothorax, bowel resections, and ureter anastomoses in the early 1990s, together with the departments of urology, abdominal and thorax surgery followed by the development of deep endometriosis surgery.

In 1996, endoscopic surgery made him a visiting professor at Oxford and an honorary consultant in the UK. In 2003, he became a visiting professor in Rome (Università Del Sacro Cuore) and later an honorary professor in Moscow. He became an Honorary Fellow of the Australian Endoscopy Society (1992) and founder of the Indonesian Endoscopy Society, the Japanese Endometriosis Society, and the Italian Endoscopy Society. He also received the Distinguished Surgeon Award of the American Society for Reproductive Medicine (ASRM) in 2004, and in 2024, a career award at ENDO-Dubai, Dubai, UAE and Endofound America, New York, USA.

Figure 1 Prof. Philippe R. Koninckx


Interview

GPM: What motivated you to pursue obstetrics and gynaecology? Subsequently, how did your interest in endocrinology and infertility develop?

Prof. Koninckx: As a medical student, I started working in Prof Wattiaux's lab on lysosomes at Facultés Notre Dame de la Paix (FNDP)  and later in Prof Amery's lab of hypertension (KU Leuven), where I started the radio-immuno-assays of angiotensin I and II. Being interested in surgery, OBGYN was a logical choice, combining surgery and hypertension. However, as a resident, the OBGYN department asked to introduce the radioimmunoassays of LH, FSH, prolactin, estradiol, and progesterone. This resulted in a PhD in steroid biochemistry and infertility, more specifically on peritoneal fluid, luteinized unruptured follicle (LUF) syndrome, and endometriosis. A menopause clinic and laparoscopic surgery were later developments.  

GPM: Could you provide an overview of the current publications landscape on diagnosing and treating endometriosis? Are there any articles that impressed you?

Prof. Koninckx: What I consider as milestones are.

  • End of the 1970s: with the introduction of laparoscopy, we realized that typical endometriosis lesions were very frequent in women with pain or infertility (1, 2)
  • Mid 1980s: discovery of non-pigmented Endometriosis (3), later called subtle endometriosis (4). The clinical significance of subtle lesions remains unclear (5-7), leading to the endometriotic disease theory (8) and later the genetic-epigenetic (9) theory of endometriosis and the role of infection (10)
  • 1990: accidental discovery of deep endometriosis during CO2 laser excision (11) and its association with severe pelvic pain, the different types (12), decreased natural killer cell activity (13) and the development of deep endometriosis surgery (14), and the importance of adhesion prevention (15, 16)
  • Medical therapy has been around since the 1970s with only recently better data (17, 18) but also the inappriopirate use of frequentist statistics (19)
  • Immunology (20) and molecular biology (21)
  • Pathophysiology. The genetic-epigenetic theory is essential for new concepts (22, 23) and understanding that endometriosis is more than one disease with all the consequences for management.
  • Recently, we have begun to understand the limitations of evidence-based medicine and the importance of experience (24)

GPM: You highlighted the invisible barriers for endometriosis surgeons to do research in a recent article (25). What are some changes that you hope to see in the future to reduce these barriers and promote research among endometriosis surgeons?

Prof. Koninckx: This is a difficult question since it involves many social and political aspects. The sequence in the list below does not reflect its importance.

  1. Working hours used to be excessive in the 1970s and 1980s. However, to keep up with endocrinology, surgery, and laboratory work, 8 to 10 hours a day are insufficient. Together with the feminization of OBGYN, this is a difficult problem to solve.
  2. Academic appointments, private practice, income, and power are problematic combinations. Especially in surgery, we should realize the vicious circle: a reputation is needed to get referrals, and a large volume is needed to train and acquire a reputation. In this competition, which also involves income and power, research is less important than all other mechanisms (25).
  3. Statistics and OBGYN have always been a difficult marriage. Only very recently have we begun to understand the importance of experience (Bayesian thinking) besides EBM (24) and why randomized controlled trials (RCTs) for endometriosis surgery is close to impossible since endometriosis is too multivariate for the number of patients available  (19).
  4. Finally, surgery risks a Wild West mentality without rules in the absence of evidence and without quality control (26). For 20 years, I have tried to make systematic video registration mandatory (27), but the opposition is strong for many reasons.

GPM: With research being limited by the invisible barriers mentioned in your paper, what are some aspects of endometriosis research that you believe have been overlooked or received insufficient attention?

Prof. Koninckx:

  1. Research needs the cooperation of a dedicated surgeon who understands research to procure the necessary samples for younger researchers. A major problem of research in endometriosis is accurate sample collection and quality.
  2. I think that the microbiota of bowel, vagina and peritoneal cavity will be important for endometriosis.
  3. I do not believe in non-hypothesis-driven research since it is too expensive and time-consuming.

GPM: GPM holds an international Elite Gynecologic Surgery Competition almost every year, and its fourth cycle has just concluded (https://gpm.amegroups.org/announcement/view/256). As one of the judges for this year's competition, what advice do you have for surgeons who wish to excel in such video competitions?

Prof. Koninckx: For the ESGE video competition and for video articles, my advice was:

  1. Short videos showing nice surgery are not useful.
  2. Videos should give ONE clear message. This can be a heuristic 'how to do' or a demonstration of why some approaches are better.
  3. Only, look what I do, is not enough.
  4. Rare but well-known cases need a stricter data format.  

GPM: As an Editorial Board Member, what are your expectations for GPM?

Dr. Koninckx: The journal should devote more time teaching juniors how to write a paper. I was lucky in life to have a mentor like P De Moor, teaching us how to write a protocol and an article. Not all young people have this opportunity. Therefore, I believe in some assistance in reviewing protocols before research is done, reviewing manuscripts limited to one line for each paragraph but detailing the sequence of thinking, and pre-reviewing manuscripts. The first two suggestions are not time-consuming, the latter takes more time but is still reasonable.  


Reference

  1. Brosens IA, Koninckx PR, Corveleyn PA. A study of plasma progesterone, oestradiol-17beta, prolactin and LH levels, and of the luteal phase appearance of the ovaries in patients with endometriosis and infertility. Br J Obstet Gynaecol. 1978;85(4):246-50.
  2. Koninckx PR, Meuleman C, Demeyere S, et al. Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril. 1991;55(4):759-65.
  3. Jansen RPS, Russel P. Nonpigmented endometriosis: Clinical, laparoscopic, and pathologic definition. Am J Obstet Gynecol. 1986;155:1154-9.
  4. Stripling MC, Martin DC, Chatman DL, et al. Subtle appearance of pelvic endometriosis. Fertil Steril. 1988;49(3):427-31.
  5. Koninckx PR. Is mild endometriosis a condition occurring intermittently in all women? Hum Reprod. 1994;9(12):2202-5.
  6. Evers JL, Dunselman GA, Groothuis P. Now you see them, now you don't. Fertil Steril. 2005;84(1):31-2.
  7. Koninckx PR, Donnez J, Brosens I. Microscopic endometriosis: impact on our understanding of the disease and its surgery. Fertil Steril. 2016;105:305-6.
  8. Koninckx PR, Barlow D, Kennedy S. Implantation versus infiltration: the Sampson versus the endometriotic disease theory. Gynecol Obstet Invest. 1999;47 Suppl 1:3-9.
  9. Koninckx PR, Ussia A, Adamyan L, et al. Pathogenesis of endometriosis: the genetic/epigenetic theory. Fertil Steril. 2019;111:327-39.
  10. Koninckx PR, Ussia A, Tahlak M, et al. Infection as a potential cofactor in the genetic-epigenetic pathophysiology of endometriosis: a systematic review. Facts Views Vis Obgyn. 2019;11(3):209-16.
  11. Cornillie FJ, Oosterlynck D, Lauweryns JM, et al. Deeply infiltrating pelvic endometriosis: histology and clinical significance. Fertil Steril. 1990;53(6):978-83.
  12. Koninckx PR, Martin DC. Deep endometriosis: a consequence of infiltration or retraction or possibly adenomyosis externa? Fertil Steril. 1992;58(5):924-8.
  13. Oosterlynck DJ, Cornillie FJ, Waer M, et al. Women with endometriosis show a defect in natural killer activity resulting in a decreased cytotoxicity to autologous endometrium. Fertil Steril. 1991;56(1):45-51.
  14. Koninckx PR, Ussia A, Keckstein J, et al. Review on endometriosis surgery. Gynecology and Pelvic Medicine. 2021;4:38-.
  15. Koninckx PR, Gomel V, Ussia A, et al. Role of the peritoneal cavity in the prevention of postoperative adhesions, pain, and fatigue. Fertil Steril. 2016;106(5):998-1010.
  16. Gomel V, Koninckx PR. Microsurgical principles and postoperative adhesions: lessons from the past. Fertil Steril. 2016;106(5):1025-31.
  17. Cetera GE, Merli CEM, Facchin F, et al. Non-response to first-line hormonal treatment for symptomatic endometriosis: overcoming tunnel vision. A narrative review. BMC Womens Health. 2023;23(1):347.
  18. Becker CM, Gattrell WT, Gude K, et al. Reevaluating response and failure of medical treatment of endometriosis: a systematic review. Fertility and Sterility. 2017;108(1):125-36.
  19. Koninckx PR, Koushik A, Tulandi T. Truth, Soft Lies, Statistics, and Experience in Managing Endometriosis. J Obstet Gynaecol Can. 2024;46(5):102421.
  20. Paul Dmowski W, Braun DP. Immunology of endometriosis. Best Pract Res Clin Obstet Gynaecol. 2004;18(2):245-63.
  21. Bulun SE, Yilmaz BD, Sison C, et al. Endometriosis. Endocr Rev. 2019;40(4):1048-79.
  22. Amro B, Ramirez Aristondo ME, Alsuwaidi S, et al. New Understanding of Diagnosis, Treatment and Prevention of Endometriosis. Int J Environ Res Public Health. 2022;19(11).
  23. Koninckx PR, Fernandes R, Ussia A, et al. Pathogenesis Based Diagnosis and Treatment of Endometriosis. Front Endocrinol (Lausanne). 2021;12:745548.
  24. Wattiez A, Schindler L, Ussia A, et al. A proof of concept that experience-based management of endometriosis can complement evidence-based guidelines. Facts, Views and Vision in ObGyn. 2023;15(3):197-214.
  25. Koninckx PR, Ussia A, Guo SW, et al. The glass ceiling of endometriosis surgeons is research. Facts Views Vis Obgyn. 2024;16(1):1-3.
  26. Koninckx PR, Ussia A, Adamyan L. Evidence-based medicine without multivariate Bayesian thinking and heuristics risks Black Swans when managing endometriosis. submitted. 2024.
  27. Koninckx PR. Videoregistration of surgery should be used as a quality control. J Minim Invasive Gynecol. 2008;15(2):248-53.