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After spending approximately 4 hours, I succeeding in changing my Acura MDX 2004 Driver's Door Actuator. There are good how to posts available elsewhere. So I will summarize the key points that were most difficult:

Tools Needed
1. Flathead and Phillips Screwdrivers (#3 for the Lock Mechanism)
2. A small mirror
3. The right replacement part (I incorrectly purchased the passenger side)
4. Patience

See image for reference.
See Photo at (it won't let me upload so here we go):

http : // cimg5.ibsrv.net/gimg/acurazine.com-vbulletin/548x622/80-acura_mdx_door_actuator_replace_diy_marty_zigman_20141018_8f24b83d2bdad49feb9b9acba14829f8e989b809.png

Key Steps

Easy ones first:
1. Remove Door Panel and peel back protective plastic.
2. Keep Window Up (it doesn't need to be down to remove panel)
3. Remove Window Guide Mechanism (lower 10mm bolt)
4. Remove Upper Lock Rod White Protector Backing (upper phillips screw)
5. Remove Rod A by flipping the plastic lock mechanism. Slide rod to right to get out of the way of the door hole.

Now for the harder parts:
1. Using your mirror, find the single small phillips screw that holds a white flexible protective panel on the lock/actuator unit. Bend it out of the way to reveal the plastic black flip lock mechanism (E) in the image to remove the external key door rod. It's trick to get at.

2. Now remove the three screws at the end of the door. Be very careful to not strip them. Push hard and deliberate while you twist off. Use your number #3 Phillips. I had extra screw on hand because someone did work here once before and stripped one of the screws. See part number in image.

3. Now lower the entire unit about an inch and should be able to remove electrical connectors (B) in the image.

4. I could not remove Rod (D) in the image. It appears I would have had to take off the external door lock to get to the lock screw. I wasted about 45 minutes until I gave up.

5. Rod (F) required that I unscrew the plastic decorative door lock and with just enough clearance, I was able to get the rod inside the hole so that I could manipulate the entire unit by slightly twisting. Lower the entire lock unit and be patient.

6. I had to carefully twist the entire unit while Rod (D) was attached enough so that I could get the unit out the door panel hole so I could work on it. I suspect I put a bit more pressure on it than I wanted but I became desperate while trying not to break anything.

Finally, replace the Actuator:
1. There are effectively two or three (I think three but I lost one putting it back and I used another) screws holding the actuator unit to the door latch. Note, one screw looks like it removes but it doesn't. There is a back clip. I highly recommend studying your new part and the old part before you remove any screws to get your action plan ready. Push hard with right phillips screw driver. I think there is locktight on the bolts.

2. After replacing the actuator, go in the reverse order to reassmble.

3. The hardest part is getting Rod (E) back on. The only way I could do it is to bend back the flexible white protective cover discussed earlier so I could see what I was doing.

4. Assemble back and carefully check the operation by plugging your electrical components back in to see that everything works. Check the key and the outside door handle as well. Remember, the door will not lock via the up / down central lock mechanism while the door is opened. This fooled me twice.
 
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