The aim of this study was to describe an approach for performing a high uterosacral vaginal vault suspension and to report anatomical and subjective results. Anatomic measures and validated symptom-specific questionnaires were performed pre- and postoperatively. Patient satisfaction was also ascertained. Thirty-five women, who underwent a two-suture high uterosacral suspension, participated. Mean follow-up interval was 23.1±10.1 months. Postoperative point C was -7.8±1.60 (median, -8.0, range, -4.0 to -10.0), and the mean preoperative to postoperative change in point C was 5.9±5.56 cm (median 4.75, range -3.0 to 20.0, p-value<0.0001). Patient satisfaction was high with 88.9% indicating that they would have the surgery again. There were no ureteral injuries or kinks noted on intraoperative cystoscopy. No patient required reoperation for recurrent prolapse or urinary incontinence. Overall, the two-suture high uterosacral vaginal vault suspension is an acceptable technique for repairing apical prolapse. © International Urogynecology Journal 2007.