INTRODUCTION Lumbar spine surgery by anterior median approach has been more intensively developed in recent years, mainly for interbody fusion and disc replacement. The classical retroperitoneal approach described in the literature is mostly accessed from the left side and the main complications associated with it include retrograde ejaculation, venous injury and arterial thrombosis. The aim of this prospective study was to describe and evaluate the feasibility and complication profile of a surgical approach to expose the lumbar spine from the mid-abdominal line through the right side, which bifurcates from the abdominal aorta to L5-S1, and pushes the vena cava from the right side to the left side in the range of L2-5. Methods A total of 469 patients were enrolled in this prospective study between August 2003 and November 2010, and the procedures performed were transforaminal anterior interbody fusion or disc replacement in one or more segments within the range of the L2-3 hiatus to the L5-S1 hiatus. Results The vena cava was moved intraoperatively in a total of 154 patients, all without injury. Vein-related complications were seen in only 4 patients. No arterial complications were seen, only 1 patient had an interruption of the oxygen saturation monitoring index, and no patient had retrograde ejaculation. DISCUSSION AND CONCLUSION: The safety of the midline abdominal approach via the right side is reliable, and the lower incidence of venous injury may be related to the difference in thickness between the walls of the vena cava and the iliac vein. Compared with the left-sided approach, exposure of L4-5 and structures above is less disruptive to the vasculature and less prone to arterial obstruction, making it safer for patients with atherosclerosis. The results without retrograde ejaculation corroborate the conclusions of previous studies of anastomosis of the inferior epigastric plexus nerves within the left-sided approach: the surgical access via the left side of the anterior approach and the relative likelihood of complications from intraoperative movement of the structures involved.