Vaginal endometriosis is defined by the presence of endometriotic nodules within the vaginal wall and is associated with debilitating chronic pelvic pain. Diagnosis can be made on physical exam alone. Studies demonstrate diagnostic sensitivity and specificity of pelvic exams as 73% and 98%, respectively, which is similar to the validity of imaging modalities. Surgical excision is the recommended treatment for symptom resolution; however, the complexity of these cases is influenced by the proximity of lesions to bowel, and the risk of ureteric and vascular injury. To achieve complete surgical excision, studies recommend a combined vaginal-laparoscopic approach which has been shown to significantly reduce dyspareunia, dysmenorrhea, and chronic pain scores. This video summarizes a stepwise surgical approach to vaginal endometriosis excision and reviews important considerations for pre-operative planning. Dissection of the perirectal and rectovaginal pelvic spaces are illustrated, as well as a concurrent laparoscopic-vaginal approach to performing this minimally invasive surgery.