Patient is positioned lateral decubitus with proper padding and a deflatable beanbag for stability.

Incision follows the curve of the superior iliac crest from anterior to posterior choosing the distance between the bone and incision such that the incision is centered over the level of vertebra desired.

Divide the external oblique muscle and aponeurosis in direction of fibers from the edge of the rectus posteriorly to the front edge of the latissimus dorsi.

Divide across the internal oblique muscle fibers.

Carefully divide the transversus abdominus muscle, preserving the peritoneum, pushing it anteriorly and bluntly dissecting it off of the underside of the flank body wall. This is easier in the posterior portion of the transversus abdominus where it is not so densely adherent to the peritoneum. Repair any holes created in the peritoneum with absorbable suture.

Continue mobilizing the peritoneum and viscera contained within to the front of the body, working around the posterior edge until the spine comes into view. Often there is a layer of fat in this plane that facilitates dissection.

Retroperitoneal structures, namely ureter, aorta, and vena cava branches, are carefully identified and retracted anterior, suture ligating the segmental vertebral venous and arterial branches as necessary.