The prone transpsoas (PTP) approach is an innovative evolution of the lateral lumbar interbody fusion (LLIF), designed to address key limitations of traditional lateral techniques, including suboptimal lordosis restoration and the inability to perform posterior instrumentation in a single position. Since its formal description in 2020, PTP has gained attention for its biomechanical and anatomical advantages. Prone positioning enhances lumbar lordosis, facilitates posterior instrumentation, and may increase the safe working corridor by shifting the lumbar plexus dorsally. Indications align with those for LLIF but are expanding to include complex deformities and anatomically challenging cases. Preoperative imaging is critical for surgical planning, particularly to assess alignment, psoas morphology, and vascular anatomy. Surgical steps mirror those of LLIF but are adapted for the prone position, with the use of tailor-made positioners and instrumentals. While complications resemble those of traditional LLIF, transient neural deficits and rare vascular injuries, prone positioning may reduce risks in select contexts. The PTP approach, supported by growing clinical evidence, represents a promising strategy for both degenerative and more complex spinal surgeries, combining indirect decompression and easiness for performing posterior maneuvers, with optimized biomechanical correction in a single operative setting.