Achieving water-tight open spina bifida closure through a novel three-port three-layer fetoscopic repair

About 3,000 individuals in the United States are born with spina bifida each year. Prenatal surgery for open spina bifida has demonstrated improved neurological and functional outcomes compared to postnatal closure. However, open maternal fetal surgery is associated with increased obstetric complications, such as uterine ruptures and need for cesarean deliveries in the current and any subsequent pregnancies. Minimally invasive fetoscopic approaches were subsequently developed to decrease maternal morbidity from large hysterotomies while preserving the fetal benefits of prenatal repair. Single and 2-layer fetoscopic closure techniques have been described, but concerns remain regarding the ability to achieve water-tight closure via minimally invasive approaches. Water-tight closure is critical for preventing postoperative complications, particularly cerebrospinal fluid (CSF) leakage and wound dehiscence. This report describes a novel 3-port, 3-layer fetoscopic repair technique. The accompanying video demonstrates the technique and procedural steps in detail. This method may facilitate higher rates of water-tight dural closure via the fetoscopic approach, potentially reducing postoperative complications.