The repair of large incisional hernia is challenging and has evolved at a high pace in recent decades, since Ramirez described the open anterior component separation, dividing the external oblique aponeurosis. Endoscopic anterior component separation is a minimally invasive approach to this technique, which also serves as an adjunct to open repair of large incisional hernia. Popularized by Michael Rosen's group in 2007, this technique has become one of the many important tools every abdominal wall surgeon should master. In the current paper, we review the technique, from preoperative considerations and patient placement to specific technical details, and discuss pitfalls and potential limitations.