eTEP access surgery has emerged as a preferred technique for ventral hernia repair, offering a safe and effective method for trained surgeons. Initially developed for groin hernias, after almost 10 years of its initial descriptions, we have come to learn its benefits and very few shortcomings. The eTEP preperitoneal ventral hernia repair method preserves the retrorectus space, mitigating potential complications associated with traditional approaches that involve division of the posterior rectus sheath. This chapter outlines the procedural specifics of the eTEP technique, which includes well-defined steps for accessing and development of the preperitoneal space, maintaining posterior layer integrity, restoring the central tendon of the abdomen and mesh placement. While challenges remain, particularly regarding peritoneal integrity and the necessity for a skilled surgical team, eTEP preperitoneal presents a promising solution for treating small-to-medium ventral hernias and associated diastasis with minimal invasiveness and improved outcomes.