The fascia and muscle layers of the obliques and transversus are divided just lateral to the edge of the rectus abdominis sheath. The superficial epigastric artery can be either ligated and divided, or spared and mobilized medially. In females, the round ligament is divided to mobilize the peritoneum, which is moved superiorly and medially to uncover the external iliac artery and vein. In males, the spermatic cord structures are preserved and mobilized medially to allow retraction of the peritoneum from the abdominal wall.

Anastomosis is performed between the renal allograft vein and external iliac vein, then between the renal allograft artery and external iliac artery. The ends of the allograft vessels are sewn into the sides of the iliac vessels. After the vascular reconstruction is complete, the graft is immediately reperfused. The donor ureter is then anastomosed to the recipient’s bladder. The abdomen is then closed, typically with no drains required.