OBJECTIVE Posthysterectomy vaginal vault prolapse repair is a challenge for urogynecologists. Surgical management can be successful with native tissue by the vaginal approach with sacrospinous ligament fixation. However, severe complications have been described, including nerve injury and life-threatening hemorrhage. METHODS A 68-year-old woman with symptomatic stage III vaginal vault prolapse was admitted for transvaginal sacrospinous ligament fixation according to the described technique. RESULTS The surgical procedure was successful without complications. The final examination revealed excellent apical support and preservation of vaginal length. This step-by-step video tutorial may be an important tool for improving surgical knowledge, thus leading to a reduction in the risk of complications. In particular proper suture positioning requires adequate preparation of the pararectal space and exposure of the sacrospinous ligament, as shown in the video. CONCLUSIONS Transvaginal sacrospinous ligament fixation is a safe and effective technique for apical support without the use of prosthetic materials. Adequate preparation of the pararectal space, direct visualization of the sacrospinous ligament and proper suture positioning are the key points in minimizing the risk of complications.