Laparoscopic reconstructive pelvic surgery requires a thorough knowledge of pelvic floor anatomy and its supportive components before repair of defective anatomy is attempted. This chapter reviews the anatomy and laparoscopic repair of vaginal vault prolapse and enterocele with Y-mesh sacral colpopexy. We have performed more than 300 laparoscopic Y-mesh sacralcolpopexies with macroporous soft polypropylene mesh in the past two years and have had excellent clinical results with a very low rate of complications. Our cure rate is greater than 94% and we have had only two mesh erosions (0.6%) to date and both patients did have concomitant hysterectomy. The authors’ personal experience, is the operative time is similar and in many times reduced, especially for patients with a high body mass index. However, complex operative laparoscopy is associated with a steep and lengthy learning curve after which operative time can be significantly reduced, based on surgeons experience and laparoscopy skills as well as the quality of the operative team. A thorough knowledge of pelvic floor anatomy is essential before undertaking any type of reconstructive pelvic surgery and advanced knowledge of laparoscopic surgery and suturing are essential to perform the surgical procedures discussed in this review. Despite the paucity in the literature, laparoscopic pelvic reconstructive surgery will continue to be driven by patient demands as well as surgeon preference. With increasing experience, greater data should support its continued use and favorable long-term outcomes.