The earliest descriptions of ventral hernia repair by means of an endoscopic component separation date back to 2000 [16]. The first report detailed a technique utilizing a subcutaneous balloon dissector placed in the mid-axillary line which bluntly dissected the external oblique muscle and aponeuro­sis from the overlying soft tissues (Fig. 31.1). The aponeuro­sis was then fully divided lateral to the semilunar line with electrocautery from the costal margin to the level of the ante­rior superior iliac spine. This initial series reported a dra­matic reduction in wound infection, seroma rates, and necrosis without impacting hernia recurrence rates. However, the technique was not widely adopted at that time. Building upon the endoscopic component separation technique of Maas et al. [17], refinements in the endoscopic component separation technique were subsequently reported which described the technique in the management of infected abdominal wall hernias [18]. In this description, an incision was made 1 cm below the costal margin with dissection of the abdominal wall to identify the external oblique muscle. Following division of the external oblique fibers, a balloon dissector was utilized to dissect the inter-oblique space (Fig. 31.2). Following removal of the balloon dissectors, additional trocars were placed into the inter-oblique space to accommodate division of the external oblique aponeurosis. This report detailed seven patients that underwent endo­scopic component separation with minimal postoperative wound morbidity despite the complexity of the patient popu­lation and significantly contributed to the popularization of the procedure.