[The Doctor: Master Clinician Report] The Doctor Who Never Overlooks a Patient's Pain .... Professor Kim Do-kyun, Hope for Deep Infiltrating Endometriosis Patients

■ The path Professor Kim Do-kyun has walked

Professor Kim Do-kyun chose deep infiltrating endometriosis (DIE) — a condition still little known in Korea — as his specialty and has walked this single path for more than 20 years. Unlike surgery that deals with a single organ, deep infiltrating endometriosis surgery requires "nerve-sparing surgery" performed together with complete lesion excision — preserving the pelvic autonomic nerves that control the bladder, rectum and sexual function. That is why it demands both a deep understanding of pelvic neuroanatomy and highly advanced surgical skill at the same time.

Believing that someone had to diagnose and treat deep infiltrating endometriosis — which causes even greater pain than ordinary endometriosis — Professor Kim traveled to seek out experts overseas and learned the techniques firsthand. As a result, he has established himself as Korea's only recognized master surgeon for deep infiltrating endometriosis surgery. He has performed more than 3,000 laparoscopic surgeries for deep infiltrating endometriosis and more than 450 successful surgeries using the da Vinci robotic system.

"I heard that a patient I operated on just yesterday urinated on her own for the first time. It put me in such a good mood that I even went to sweat it out at the sauna."

Although the interview location changed from Gyeongju to Seoul, Professor Kim's expression showed relief more than fatigue. In deep infiltrating endometriosis surgery, nerve preservation is critical — the fact that the patient was able to urinate means the nerves responsible for bladder function were not damaged. He said that no matter how long a surgery runs, hearing news like this melts his fatigue away instantly.

■ Invading multiple organs, triggering diverse symptoms

Endometriosis is a gynecological condition that occurs in about 10–15% of women of reproductive age, causing severe pain that disrupts normal daily life. Normally, endometrial cells are shed along with menstrual blood when pregnancy does not occur; but when some of these cells implant on organs other than the uterus, they trigger repeated inflammation and pain with each monthly cycle.

Deep infiltrating endometriosis in particular is a severe form of the disease that burrows deep beneath the peritoneum, as though digging a tunnel. Autonomic nerves that control the function of organs such as the bladder and rectum run beneath the peritoneum, and when a lesion invades these nerves and tissues, it produces a wide range of symptoms.

For example, when a lesion invades the autonomic nerves around the bladder, patients feel the urge to urinate even when the bladder is not full, leading to frequent bathroom trips; when a lesion spreads near the sciatic nerve, patients feel pain in the lower back or legs. In such cases patients often visit urology or orthopedics departments, but without a clear cause identified, they continue to suffer from pain for a long time.

■ Learning "pelvic neurology" on the road, becoming a deep infiltrating endometriosis specialist

Professor Kim chose to specialize in deep infiltrating endometriosis after repeatedly encountering patients whose lives were falling apart from pain with no cause ever identified. He traveled to experts in Europe and Brazil to learn ultrasound diagnostic techniques for deep infiltrating endometriosis, and studied pelvic neurology in Switzerland.

Deep infiltrating endometriosis is not a simple gynecological condition; it requires the ability to understand and operate on multiple organs together — the rectum, bladder, ureters and pelvis — and at the time there was no educational system for this in Korea whatsoever.

"Deep infiltrating endometriosis surgery is a highly difficult procedure that must take into account not only the surrounding organs but also the autonomic nerves running through the narrow, deep pelvis. It is difficult to succeed simply by removing the lesion. You have to think about how to save the nerves while removing as much of the lesion as possible."

He said that the recent introduction of the da Vinci robotic system at the hospital has made more precise surgery possible. Securing an accurate field of view is essential to preserving autonomic nerves as thin as a strand of hair, and the robotic system helps with precise surgery by finely distinguishing soft tissue, fascia, blood vessels and nerves beneath the peritoneum.

■ A new life through surgery — something someone has to do

While deep infiltrating endometriosis surgery gives patients a new life in this way, interest and institutional support within Korea's medical community remain lacking. Even so, Professor Kim's reason for staying on this path is clear: patients suffering from deep infiltrating endometriosis exist, and a treatment that can reliably help them also exists. He said that seeing patients regain their lives after being freed from pain has only deepened his sense of how necessary this field is.

How does he want to be remembered by his patients?

Without a moment's hesitation, he said: "a doctor who understands the patient's most uncomfortable symptom." Patients who visit his clinic are often surprised by his unexpected questions — but they quickly feel a sense of relief at having their pain properly understood for the first time.

That is because Professor Kim, after fully listening to the patient's story and reviewing the ultrasound, asks first whether they experience pain with bowel movements during menstruation, whether they urinate unusually often, or whether they experience dizziness or migraines.

■ A doctor is someone who recognizes and resolves a patient's discomfort

"I approach every consultation believing that unexplained symptoms surely have a reason behind them. It is enough for me to be remembered as a doctor who thinks alongside the patient about what is causing their suffering and works together to find a solution."

Finally, Professor Kim introduced Nancy's Nook, a community for endometriosis patients in the United States, emphasizing that patients, too, need to actively speak up.