Study Objective To demonstrate the importance of resecting large intracavitary fibroids using a combination of minimally invasive techniques, particularly vaginal morcellation and hysteroscopy. Design Video case presentation. Setting A major urban teaching institution. In the operating room, the patient was placed in dorsal lithotomy. Patients or Participants 22-year-old G0 with a 12 cm intracavitary fibroid causing heavy vaginal bleeding with a starting hemoglobin of 7.3 g/dL. She was a Jehovah's Witness and would only accept a blood transfusion in the case of an absolute emergency. Interventions The patient was admitted to the hospital and underwent a gel foam uterine artery embolization preoperatively. She was also given preoperative misoprostol and tranexamic acid. She underwent a transvaginal myomectomy with hysteroscopic assistance. Measurements and Main Results Complete resection of the large intracavitary fibroid was achieved using the combined vaginal and hysteroscopic myomectomy techniques demonstrated in this video. Minimal blood loss, decreased length of stay, reduced recovery time, and decreased need for future surgery were also achieved in this case. Conclusion The preoperative blood loss reduction strategies and combined vaginal and hysteroscopic surgical approaches minimized blood loss, hospital stay, recovery time, and need for future surgery in this patient. Additionally, a blood transfusion was avoided in a patient who is Jehovah's Witness. This video demonstrates that even large intracavitary fibroids can be resected using minimally invasive techniques.