<p>Endoscopic anterior component separation technique (eACS) facilitates tension free midline closure of wide ventral hernia defects. We describe a novel approach with a precostal incision and a cylindrical ballon trocar system. The technique offers advantages in terms of determination of the correct entry point for eACS regardless of abdominal wall conditions and the precostal access allows for unidirectional dissection towards the inguinal ligament with only two trocars in total. The cylindrical shape of the ballon trocar provides adequate widening of the working space and ensures good overwiev for safe dissection.</p>