According to the location of the gestational sac, cesarean scar pregnancies can be categorized as ectopic or intraparenchymal. For exophytic cesarean scar pregnancies, the established treatment options are open or laparoscopic excision and repair of the scar lesion, so is it possible to perform transvaginal surgery? In this study, we evaluated transvaginal cesarean scar pregnancy resection, and the inclusion criteria for patients were ectopic cesarean scar pregnancies. A total of 23 transvaginal keloidectomies were performed from 2008 to 2012, with 22 successes and 1 failure. The main surgical steps were to open the vaginal mucosa, expose the vaginal bladder space, push up the bladder to expose the cesarean section scar site, excise the original scar tissue and perform myometrial suture. Postoperative T-tube drainage and uterine tube drainage were left in place. The results showed a shorter operative time, less bleeding, shorter hospitalization, and the same postoperative decline in HCG as in transabdominal surgery compared to the transabdominal approach. The authors also cautioned that the surgeon needs to have good skills in negative surgery.