Reconstructive Pelvic Surgery may include different approaches, such as an open abdominal, a laparoscopic, a robotic and a vaginal one. The general effort in all the surgical disciplines to encourage minimally invasiveness has dramatically reduced laparotmic operations for prolapse with a constant increase in laparoscopic and robotic procedures. Vaginal approach has always been performed by gynaecologists to repair pelvic organ prolapse. Technical changes and new procedure have been proposed secondary to new functional anatomical knowledge. However in many Countries vaginal surgery is not taught anymore and young gynaecologists are loosing this skills in favour of laparoscopy and robotic procedures. This despite the fact that vaginal surgery should be considered, by all means, as the less invasive approach being a natural orifice procedure. In this lecture evolution of vaginal surgery will be reported.