Minimally Invasive Surgeries for: Hysterectomy, Myomectomy, Treatment of Pelvic Organ Prolapse — Expert Interview with Assoc. Prof. Dr. Ermis

Assistant Professor Dr. med. Dr. Resmiye Ermis is an outstanding gynecologist, founder of the MIC and Myoma Center Rhein-Main, and Chief Medical Officer at the Red Cross Clinic within the Frankfurt Red Cross Hospitals. With her expertise and passion for minimally invasive surgery, she has made the center a leading facility for gynecological procedures. Under her leadership, the gynecology department has earned an excellent reputation based on thousands of successful surgeries performed using state-of-the-art techniques.

Asst. Prof. Dr. med. Dr. Ermis is a MIC-III certified surgeon and one of the few gynecologists in Germany to hold the highest certification from the Working Group for Gynecological Endoscopy (AGE). This underscores her outstanding position in minimally invasive surgery. The MIC and Myoma Center offers a wide range of specialized services, including laparoscopic removal of fibroids, hysterectomies, and various treatments for pelvic organ prolapse that preserve the uterus.

Assoc. Prof. Dr. med. Dr. Ermis works closely with other specialized departments at the Red Cross Clinics to ensure comprehensive care of the highest standard. Her innovative approaches, such as the introduction of morcellation in a bag for safe abdominal removals, have set new standards and are highly regarded far beyond the region. The center is distinguished not only by medical excellence but also by a friendly and supportive atmosphere that contributes to patient satisfaction.

Assoc. Prof. Dr. med. Dr. Ermis and her dedicated team are continuously committed to improving their patients’ quality of life by understanding individual needs and offering highly specialized, personalized treatment plans. Thanks to her high level of professional expertise, her commitment to research, and her role as an expert reviewer for the Hessian State Medical Association and Arbitration Board, Asst. Prof. Dr. med. Dr. Ermis is a highly regarded figure in the medical community, and it is no coincidence that she has been awarded the MIC III certificate for the third time—making her the only physician in Hesse to have received this distinction. The MIC and Myoma Center Rhine-Main is highly regarded by both patients and colleagues alike for its excellent patient care and outstanding treatment outcomes.

Our editorial team took the opportunity to speak with Assistant Professor Dr. med. Dr. Ermis and learned more about minimally invasive surgeries for hysterectomy or the removal of fibroids, as well as treatments for pelvic organ prolapse.

Gynecology encompasses a broad spectrum of medical specialties that deal with the health and diseases of the female reproductive system. Some of the most common procedures in this field include hysterectomy, myomectomy, and treatment for pelvic organ prolapse, all of which aim to relieve women of distressing symptoms and improve their quality of life.

“Fibroids are among the most common benign conditions affecting women. Some patients are even affected as young as 20. The ‘peak age’ for this, however, is between 40 and 50, though I have also operated on women over 60 for fibroids. So there’s no real respite, even after menopause has passed. And since fibroids calcify significantly, they can also cause pain by putting pressure on the ureters or surrounding organs and must be removed. Fortunately, fibroids don’t always cause symptoms, and fortunately, they don’t always need to be removed. However, fibroids that appear in one’s mid-20s and continue to grow should definitely be removed. “You shouldn’t wait until you’re 50–60 years old,” explains Asst. Prof. Dr. med. Dr. Ermis, highlighting a problem:

“One problem, however, is that ultrasound is no longer part of routine preventive care but is now only offered as a self-pay service. And so it happens that I sometimes see women in their 30s with massive fibroids in their abdomen. Because of the slow growth of the fibroids, patients hardly notice them—if at all—unless a fibroid presses against the uterine cavity and causes severe symptoms in the form of bleeding. But even then, neither general practitioners nor the patients themselves often pay much attention to it. And since fibroids are one of my areas of expertise, I see patients from near and far with a wide variety of fibroids. And when a young woman comes to see me with a 4–5 cm fibroid, I think to myself, “Finally, something small!” It would be wonderful if all rapidly growing fibroids in women between the ages of 40 and 50 could be removed and if fibroids weren’t downplayed. After all, every second or third woman in that age group is affected. In Africa, for example, the rate is even higher, with the result that women in their 30s are having hysterectomies performed en masse because they have no other options.”

Fibroids can cause various symptoms, including pain and difficulty conceiving. 

“With fibroids, the patient herself decides whether to preserve or remove the uterus. Some patients want to definitively rule out the possibility of further fibroids and, if in doubt, do not want to undergo surgery again—in such cases, the uterus is removed, because a fibroid rarely occurs alone. But for a 30-year-old, I wouldn’t remove the entire uterus because of a 5–10 cm fibroid, even if she doesn’t want to have children. In this case, I would tend to take a wait-and-see approach. At this age, a hysterectomy can certainly disrupt hormonal balance, since the uterus also helps support blood flow to the ovaries to some extent. Several factors play a role in deciding between a total and a subtotal hysterectomy. “A total hysterectomy involves the removal of the entire uterus, including the cervix, whereas in a subtotal hysterectomy, the cervix is preserved,” explains Asst. Prof. Dr. med. Dr. Ermis.

When removing fibroids, doctors typically use various minimally invasive techniques aimed at gently removing the fibroids, shortening recovery time, and minimizing the rate of complications. The most commonly used methods are laparoscopy (abdominal endoscopy) and hysteroscopy (uterine endoscopy).

Laparoscopy is a minimally invasive procedure in which fibroids are removed through small incisions in the abdomen. A laparoscope—a thin tube equipped with a camera and light source—is inserted through one of the incisions to provide a clear view of the uterus. Using special instruments inserted through the other incisions, the fibroids can be precisely excised and removed. This technique is often used for larger fibroids or those located deep within the uterine muscle. The recovery time after laparoscopic fibroid removal is generally shorter than after open surgery, and the complication rate is lower. Patients can usually resume their normal activities after a few weeks. 

Hysteroscopy is another minimally invasive technique used to remove fibroids that protrude into the uterine cavity. During this procedure, a hysteroscope—a thin, lighted instrument—is inserted through the vagina and cervix into the uterus. The fibroids are then removed using special surgical instruments inserted through the hysteroscope. This method is particularly gentle, as it does not require any incisions in the abdomen. Recovery time is often very short, and many patients can resume their normal activities within a few days. The complication rate for hysteroscopic procedures is also low, as the risks of infection or injury to neighboring organs are minimal.

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