Objective: To investigate the effects of laparoscopic and open myomectomy on intraoperative blood loss and postoperative hemoglobin (Hb) level in patients with uterine fibroids. Methods: 100 patients with uterine fibroids admitted to our hospital from February 2022 to February 2024 were selected as the study objects. Patients were divided into control group and observation group by random number table method, with 50 cases in each group. The control group was treated with laparotomy myomectomy. The observation group was treated with laparoscopic myomectomy. The perioperative indexes, Hb levels, uterine microcirculation (Vm, RI value) and postoperative complications of the two groups were analyzed and compared. Results: The intraoperative blood loss in the observation group was significantly shorter than that in the control group, and the operation time, gastrointestinal function recovery time and postoperative hospitalization time were significantly shorter than those in the control group (P < 0.05). 3 days after surgery, Hb levels in both groups were significantly lower than those before surgery, but Hb levels in observation group were significantly higher than those in control group (P < 0.05). At 7 days after surgery, Hb level in both groups was significantly higher than that at 3 days after surgery, and Hb level in observation group was significantly higher than that in control group (P < 0.05). 7 days after surgery, Vm and RI values in both groups were significantly higher than before surgery, and RI values were significantly lower than before surgery. Vm in observation group was significantly higher than that in control group, RI value was significantly lower than that in control group (P < 0.05). The complication rate of the observation group was significantly lower than that of the control group (P < 0.05). Conclusion: Compared with open myomectomy, laparoscopy has the advantages of less intraoperative blood loss, less influence on postoperative hemoglobin level and better surgical effect.