Uterine fibroids (hysteromyoma), also known as uterine smooth muscle tumors, are the most common type of benign tumors in the female reproductive organs. It can be divided into submucosal leiomyoma, subplasma leiomyoma and interstitial leiomyoma according to the location. Indications for surgery (1) Excessive menstrual flow or even secondary anemia due to leiomyoma, for which drug treatment is ineffective. (2) Myoma causing severe abdominal pain or painful intercourse or chronic abdominal pain, or subplasmalemmal myoma with torsion. When symptoms of compression appear. (3) When the leiomyoma is determined to be a cause of infertility or recurrent miscarriage. (4) When the growth rate of the myoma is accelerated and malignancy is suspected. Transvaginal myomectomy (TVM) is suitable for submucosal fibroids with tissues protruding from the vagina, with a low tip and a palpable tip in the cervical canal; loose vagina, no pelvic adhesions, good uterine mobility, single or less than 3 subplasmic or interstitial fibroids, without ovarian lesions; cervical fibroids with a low tip and a low root. TVM has the advantage of being minimally invasive compared to laparoscopic myomectomy, and has some of the advantages of transabdominal surgery, i.e., it is palpable, reduces leakage, and closes the tumor cavity more precisely when suturing. Hysteroscopic myomectomy According to the classification criteria of the International Hysteroscopy Center of the Netherlands, there are three types of submucosal fibroids: type 0 fibroids, tipped submucosal fibroids that do not extend to the muscular layer; type I fibroids, tipped submucosal fibroids that extend to the muscular layer by less than 50%; and type II fibroids, tipped submucosal fibroids that extend to the muscular layer by more than 50%. The indications for hysteroscopic fibroid surgery are (1) type 0 submucosal fibroids; (2) type I-II submucosal fibroids with a fibroid diameter ≤125px; (3) intramural interstitial fibroids with a myometrium covering ≤12.5px on the surface of the fibroid; (4) various types of uterine or cervical submucosal fibroids that prolapse into the vagina; (5) uterine cavity length ≤300px; (6) uterine volume <8-10 weeks of gestation; (7) exclusion of malignancy of the fibroids. For patients with a length < span=""> >5 cm and a myoma located in >50% of the myometrium, hysteroscopic surgical resection is difficult. Contraindications include (1) acute stage of reproductive tract infection; (2) severe cervical scarring that cannot be adequately dilated; (3) acute stage of serious medical disorders such as heart, liver and kidney failure that cannot tolerate surgery. Laparoscopic myomectomy Currently, laparoscopic myomectomy is considered appropriate for subplasmaline or broad ligament fibroids, multiple 3 to 4 medium-sized (≤6 cm) intermyometrial fibroids, and single intermyometrial fibroids of 7 to 10 cm in diameter. Laparoscopic myomectomy is difficult in patients with interstitial fibroids >10 cm in diameter, more than 4 fibroids or those near the submucosa, and cervical fibroids. Transabdominal myomectomy (TAM) is suitable for all young patients who wish to have children and have indications for surgery, regardless of the location, size and number of fibroids, especially those with multiple fibroids that are estimated to be difficult to remove by other methods, those with a history of multiple pelvic surgeries, those with heavy adhesions, those with a uterine volume greater than 12 weeks of gestation, and those with recurrent fibroids by various routes. The hysterectomy is a very important part of the procedure. Hysterectomy Transvaginal hysterectomy is indicated for those without a history of multiple pelvic surgeries, no pelvic adhesions or inflammation, no adnexal masses or no need for exploration or removal of adnexa, individual abdominal obesity, uterine volume not exceeding 3 months gestation, medical comorbidities such as diabetes, hypertension, coronary artery disease, obesity, etc. who cannot tolerate open surgery; the advantages of hysterectomy by the feminine route are the same as above, but the management of adnexal problems can be difficult. The advantages of hysterectomy are the same as above. The size and mobility of the uterus, the elasticity and volume of the vagina, and the presence of adnexal lesions need to be evaluated before surgery. Laparoscopic hysterectomy has the advantage of being a minimally invasive procedure and can be chosen except in cases of large tumors (uterus larger than 14 weeks of gestation), severe pelvic adhesions, and suspected malignant tumors of the reproductive tract. Transabdominal hysterectomy has good visual field exposure, facilitates the management of difficult operations, and allows the completion of hysterectomies that cannot be done vaginally or laparoscopically, especially in cases of recurrence after myomectomy, suspected malignancy, and heavy pelvic adhesions. The disadvantages of the procedure are the large abdominal trauma, the interference with the abdominal cavity, and the slow recovery of the patient after surgery. Laparoscopic assisted negative hysterectomy (LAVH) can overcome the shortcomings of narrow field of view of negative surgery, unfavorable treatment of adnexa and separation of pelvic adhesions, and has minimally invasive features. Special types of fibroids (1) cervical fibroids If you choose to remove them, laparoscopic and transvaginal are more difficult, and transabdominal complications are relatively small; if you choose total hysterectomy, you can choose the surgical route according to the operator’s ability to undertake such complex surgery. Transabdominal surgery is relatively safe because of the history of cervical stump leiomyoma and the complexity of this procedure, which is prone to side effects. (2) Broad ligament fibroids Transvaginal surgery is more risky, and laparoscopic or open surgery is often chosen, depending on the operator. Different surgical approaches for uterine fibroids have their own advantages and limitations, and therefore each has its own indications and contraindications. Therefore, the choice of surgical approach should be considered in terms of effectiveness, safety and invasiveness.