The enhanced-view totally extraperitoneal (e-TEP) approach evolved from the classical totally extraperitoneal (TEP) technique. By refining the optic trocar placement, endoscopic visualization was optimized to accommodate hernia repair at various sites. Initially applied to complex inguinal hernias, e-TEP was subsequently adopted for primary ventral hernias and small- to medium-sized incisional hernias, with ongoing attempts to extend its use to large incisional hernias. The incorporation of robotic surgical systems, single-port platforms, and the component separation technique has further facilitated this expansion. At present, e-TEP remains in a phase of active exploration and refinement. Its short- and mid-term outcomes are generally comparable to those of alternative procedures, although long-term follow-up data are still unavailable. Surgeons may therefore adopt the technique selectively based on their expertise. Guided by the principles of minimally invasive surgery and plane-oriented dissection, e-TEP offers theoretical advantages but presents notable technical challenges. Limited operative space and a prolonged learning curve remain key barriers to wider implementation of e-TEP, while key issues such as avoiding excessive abdominal wall dissection and preventing emerging procedure-specific complications continue to draw attention. With advances in minimally invasive platforms, e-TEP—alongside other minimally invasive repair techniques—is expected to benefit and ultimately contribute to more precise, individualized hernia management.