*4.2.2 Surgical approach*

Currently, fetal surgery can be classified into three broader areas; open fetal surgery, minimally invasive fetal surgery and EXIT procedures. Each procedure is subdivided into several subdivisions, in an attempt to treat a wide number of severe pathologies that would compromise the fetus. During minimally invasive fetal surgeries a small skin incision on the mother's abdomen was done. The location of the placenta, as well as the intrauterine pathology will guide the site of the planned incision. 1–2 mm instruments were used to access the fetus are to minimize maternal morbidity. Also, curved instruments may be used to avoid injury to anteriorly placed placenta. During fetal access, any present fluid (ascites, pleural effusions,

cystic structures, or the bladder) are aspirated or shunted into the amniotic space. During fetal cardiac valvuloplasty and radiofrequency ablation for treatment of complicated twin gestation, needle-based access is very helpful [15–20].
