The option of intrauterine surgery, i.e. an operation on the fetus, is only ever considered if it has the potential to prevent threatened intrauterine death or prevent – or at least significantly reduce – the severity of extremely severe lifelong disability. Some malformations and tumors can become so large that they will kill the fetus unless surgically removed during pregnancy. By far the most commonly performed intrauterine operation, however, is that on spina bifida (myelomeningocele). Intrauterine surgery is the only available means of favorably influencing the otherwise inevitable severe and lifelong multiple disabilities that result from this condition. To the best of our knowledge, ours is the only center in Europe to perform all these open surgical procedures.