Asst. Prof. Dr. med. Dr. Resmiye Ermis is an outstanding specialist in gynecology and the founder of the MIC and Fibroid Center Rhein-Main. She is also Chief Physician at the Rotes Kreuz Hospital within the Frankfurt Red Cross Clinics. With her expertise and passion for minimally invasive surgery, she has developed the center into a leading institution for gynecological procedures. Under her leadership, the gynecology department has gained an excellent reputation, based on thousands of successful operations 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 highlights her exceptional standing in minimally invasive surgery. The MIC and Fibroid Center offers a broad range of specialized services, including laparoscopic fibroid removal, hysterectomies, and various uterine-preserving prolapse treatments.
Asst. Prof. Dr. med. Dr. Ermis works closely with other specialized departments at the Red Cross Clinics to ensure comprehensive, top-level care. Her innovative approaches, such as the introduction of contained morcellation for safe intra-abdominal tissue removal, have set new standards and are highly regarded far beyond the region. The center stands out not only for medical excellence but also for its friendly and supportive atmosphere, contributing to high patient satisfaction.
Asst. 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 competence, her involvement in research, and her role as a medical expert for the State Medical Association and Arbitration Board of Hesse, she is a respected figure in the medical community. She is the only physician in Hesse to have been certified with the MIC III certification for the third time. The MIC and Fibroid Center Rhein-Main is highly valued by both patients and colleagues for its excellent care and outstanding treatment outcomes.
The editorial team took the opportunity to speak with Asst. Prof. Dr. med. Dr. Ermis to learn more about minimally invasive procedures for uterus and fibroid removal, as well as prolapse treatment.
Gynecology encompasses a wide range of medical specialties focused on women's reproductive health and related conditions. Some of the most common procedures in this field include hysterectomy, fibroid removal, and prolapse treatment—all aimed at relieving symptoms and improving patients' quality of life.
“Fibroids are among the most common benign conditions affecting women. Some patients are as young as 20, but the 'peak period' is typically between ages 40 and 50. I’ve even performed surgery on women over 60. So fibroids don’t necessarily stop growing after menopause. Because they often calcify, they can cause pain by pressing on the ureters or other organs and need to be removed. Fortunately, fibroids don’t always cause symptoms and don’t always require removal. However, any fibroid that begins growing steadily in a woman’s mid-20s should definitely be removed—we shouldn’t wait until she’s 50 or 60,” explains Asst. Prof. Dr. med. Dr. Ermis, highlighting a challenge:
“One issue is that ultrasound is no longer part of standard preventive care—it’s only offered as an individual health service. As a result, I sometimes see women around age 30 with massive findings in the abdomen. Because fibroids grow slowly, patients often don’t notice them unless they press into the uterine cavity and cause severe bleeding. Even then, neither the attending doctors nor the women themselves are always alert to the signs. Since fibroids are one of my specialties, I treat patients from near and far with a wide variety of fibroids. And when a young woman comes in with a 4–5 cm fibroid, I think, ‘Finally, something small!’ Ideally, all rapidly growing fibroids in women aged 40–50 should be removed and not dismissed as trivial. After all, every second or third woman in that age group is affected. In Africa, the rate is even higher—leading to hysterectomies in many women in their 30s because there are few other treatment options.”
Fibroids can cause a variety of symptoms, including pain and fertility issues.
“With fibroids, the decision to preserve or remove the uterus lies with the patient. Some want to avoid recurrence and prefer not to face another surgery—so the uterus is removed, as fibroids rarely occur alone. But I wouldn’t recommend a hysterectomy for a 30-year-old with a 5–10 cm fibroid, even without a desire for children. I’d rather monitor the situation. At that age, removing the uterus can affect hormonal balance, as it plays a role in ovarian blood supply. The choice between total and subtotal hysterectomy depends on several factors. A total hysterectomy removes both the uterus and cervix, while a subtotal leaves the cervix intact,” says Asst. Prof. Dr. med. Dr. Ermis.
For fibroid removal, physicians typically use various minimally invasive techniques designed to gently remove fibroids, shorten recovery time, and minimize complication rates. The most common methods include laparoscopy and hysteroscopy.
Laparoscopy is a minimally invasive surgery in which fibroids are removed through small abdominal incisions. A laparoscope—a thin tube with a camera and light—is inserted to provide a clear view of the uterus. Specialized instruments are used to cut and remove the fibroids. This technique is commonly used for larger fibroids or those embedded deep within the uterine wall. Recovery is typically faster and complication rates lower than with open surgery. Most patients can resume normal activities within a few weeks.
Hysteroscopy is another minimally invasive technique used for fibroids protruding into the uterine cavity. A hysteroscope—a thin, lighted instrument—is inserted through the vagina and cervix into the uterus. Surgical instruments are then used to remove the fibroids. This method is especially gentle, as it requires no abdominal incisions. Recovery is usually quick, and many patients can return to normal activities within a few days. Complication rates are also low, with minimal risk of infection or injury to adjacent organs.
The MYOBLATE™ RFA Procedure
“As an alternative to surgical fibroid removal, we offer high-frequency ablation using the Myoblate system. This is a minimally invasive procedure. By applying targeted high-frequency energy, we reduce symptoms, slow or stop fibroid growth, and shrink fibroid volume over time. The treatment is performed under ultrasound guidance during a 20–30-minute anesthesia session. Ablation is conducted transvaginally or transcervically using a probe and, if needed, laparoscopically,” explains Asst. Prof. Dr. med. Dr. Ermis.
MYOBLATE™ RFA is a certified radiofrequency ablation system (RFA) in compliance with the European Medical Device Regulation (MDR) and is intended for the minimally invasive treatment of symptomatic uterine fibroids. It offers low complication rates and excellent clinical outcomes, resulting in fewer symptoms during and after the procedure.
New at the MIC and Fibroid Center Rhein-Main: vNOTES Technique (vaginal Natural Orifice Transluminal Endoscopic Surgery)
The vNOTES technique (vaginal Natural Orifice Transluminal Endoscopic Surgery) is an innovative form of minimally invasive surgery that allows abdominal procedures without incisions in the abdominal wall. This new method is now being performed at the MIC and Fibroid Center Rhein-Main. Access is exclusively through natural body openings—typically the vagina in gynecological surgery. Unlike traditional laparoscopy, which requires multiple abdominal incisions, instruments are inserted through the vagina under continuous visual guidance. This method is suitable for removing the uterus, fallopian tubes, or ovaries. Benefits include reduced postoperative pain due to the absence of abdominal wounds, a lower need for pain medication, shorter hospital stays, and no visible scarring. While promising, this technique is still rarely used in Germany.
Many international patients also choose the MIC and Fibroid Center Rhein-Main—and with good reason.
“We remove fibroids every day—sometimes 30–40 of them, each about 8–10 cm in size. In such cases, an abdominal incision may be necessary, but I always try to keep it as small as possible, often combining it with laparoscopy. This shortens the operation time. An 8–10 cm fibroid is actually a standard size for us. Most of our removals are minimally invasive; only about once or twice a month do we require a small abdominal incision—for fibroids that have grown up to the navel. Hysteroscopy also allows us to remove fibroids embedded in or beneath the endometrium. Patients recover much faster from these. Only the general anesthesia needs to wear off,” says Asst. Prof. Dr. med. Dr. Ermis.
Following a hysterectomy, patients should observe certain postoperative restrictions to ensure proper healing and avoid complications.
Initially, patients should avoid physical exertion and heavy lifting. For six to eight weeks post-surgery, lifting heavy objects should be avoided to protect the surgical site, especially after an abdominal hysterectomy. “Patients should refrain from sexual activity, bathing, and exercise for the first six weeks. Often, by day two or three post-op, patients look and feel perfectly well. Gentle walks support recovery and can be gradually increased. The risks are comparable to other surgeries. There’s a small risk of ureteral injury—mainly in cases where the cervix is also removed. Our complication and revision rates are very low—nearly zero—and our patient satisfaction is almost 100%,” explains Asst. Prof. Dr. med. Dr. Ermis.
Pelvic organ prolapse in women is often due to weakening or damage of the pelvic floor, which supports the uterus, bladder, and bowel.
Factors such as pregnancy, childbirth, hormonal changes (especially after menopause), obesity, or chronic coughing can weaken the pelvic floor and lead to organ descent. This may cause symptoms like incontinence, a feeling of pressure, or pain. A prolapse repair surgery repositions the organs to their original location.
“In prolapse surgery, we use a special mesh that is inserted into the abdominal wall and has the lowest complication rate. The goal is to strengthen the pelvic floor and relieve prolapse symptoms. This mesh is fixed to the vagina and uterus—in contrast to older methods where it was anchored to the spine, often causing back pain. Our approach is also laparoscopic, preserving vaginal functionality and allowing intercourse after a healing period. We also use vaginal mesh for older patients,” explains Asst. Prof. Dr. med. Dr. Ermis.
Patients can support their recovery after prolapse surgery with rest, hygiene, balanced nutrition, and pelvic floor training. Long-term outcomes are typically very positive, with significant symptom relief and improved quality of life. Regular follow-up and adherence to medical advice are key to achieving optimal and lasting results.
Asst. Prof. Dr. med. Dr. Ermis also offers some preventive advice: “Neither women nor men should lift heavy objects. Regular pelvic floor exercises, sports, healthy digestion, and good nutrition are essential. Personally, I wish for more empathy toward patients—many feel quite lost on their journey,” she concludes.
Thank you very much, Asst. Prof. Dr. med. Dr. Ermis, for this valuable insight into gynecology and, in particular, the highly specialized field of fibroid removal!
