Your surgeon signs their name to the side of your body that's about to be operated on to ensure that nobody on the surgical team makes a malpractice-worthy mistake. You kiss your tearful family and friends goodbye as you're whisked off to the operating room. Once inside, you climb aboard the cold, stainless steel table before being tucked in under a heavy warming blanket. Within a few minutes, your anesthesiologist has you count down from ten, even though you won't get past seven. That's the last thing you ever remember about your minimally invasive "keyhole" nephrectomy procedure. That's the last thing you ever remember about that time you entered a room with two kidneys, and were wheeled out with one.

The Donor and recipient are worked on simultaneously in separate operating rooms, with the donor organ harvested first. In most cases, you're turned onto your right side—also known as a modified flank position—while propped up with pillows and strapped to the table to allow access to the left kidney. You've been catheterized so that you don't urinate on yourself and/or the surgical team. Your legs have been wrapped in intermittent pneumatic compression devices which are like large blood pressure cuffs used to prevent blood clots from forming while you're immobilized. You've already undergone a spiral computer tomography (CT) scan with intravenous contrast administration and vascular reconstructions to properly assess the renal hilum prior to surgery. This is the "map" your surgeon uses to study the anatomy of your kidney to ensure it looks healthy to sew into another person. The left kidney is more commonly used for transplants as it has a longer renal vein—the vein that carries blood filtered by the kidneys back to the heart.

Wielding a #10 scalpel, the surgeon slices three to four half-inch incisions into different areas of the abdominal wall. With a blade that thin, bleeding is minimal to non-existent, and a cautery device is used to sizzle away the now ruptured blood vessels before they have a chance to bleed. With the abdominal muscles moved aside with retractors, carbon dioxide is pumped in to insufflate, or distend the abdomen to give the surgical team enough room to access your kidney, and to avoid nicking any of the network of veins, arteries, and your other organs—there's a lot less room inside of the abdomen than one would think, as many anatomical illustrations are misleading.

A silicone-like sleeve known as a GelPoint device is placed over one of the incisions, as rods called trocars are slipped into what are now essentially puncture wounds. One trocar is a camera that broadcasts a live view of your insides onto a screen, as the rest feature instruments and tools which are used to delicately dissect and separate your kidney from its soon-to-be former home. Your liver, pancreas, and spleen are all moved out of the way in order to reach your kidney. With the renal artery and vein dissected, the kidney is detached. Through a series of delicate procedures similar to operating an arcade claw machine, the kidney is gently placed into an Endocatch bag and removed through a roughly three-inch-long horizontal incision just below your belly. As the trocars are removed, all of your incisions are sutured with dissolving internal stitches. Your now former kidney is carefully transported and handed off to the transplant team next door.