Vaginal myomectomy involves removing fibroids through the vagina; as with hysteroscopic myomectomy, therefore, there are no external scars. This operation is done when the fibroids are moderate in size but too deep or numerous for hysteroscopic or laparoscopic myomectomy. It is easier in women who have children as there tends to be more space in the pelvis for this type of surgery.

The procedure is easiest when the fibroid(s) are at the back of the uterus, and most difficult when they are mainly at the top; in that situation, laparoscopic myomectomy may be preferred. Because conventional instruments are used, vaginal myomectomy generally takes less time than laparoscopic myomectomy and the repair of the uterus is stronger. Recovery in terms of hospitalisation and return to normal activities is similar, and faster than with laparotomy.

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