Fetoscopic three-port, three-layer open spina bifida repair

Prenatal surgery for open spina bifida has demonstrated improved neurological and functional outcomes compared to postnatal closure. However, open fetal surgery is associated with increased obstetric complications. Minimally invasive fetoscopic approaches were developed to decrease maternal morbidity from large hysterotomies while preserving fetal benefits. Single- and two-layer fetoscopic closure techniques have been described but there is concern for the ability to achieve watertight closure. Watertight closure is critical for preventing postoperative complications, particularly cerebrospinal fluid leakage and wound dehiscence. This video describes a case presentation for a novel three-port, three-layer fetoscopic repair modeled after a postnatal closure technique. The video can be found here: https://stream.cadmore.media/r10.3171/2026.1.FOCVID25230.