To describe a case of laparotomy-assisted fetoscopic prenatal repair of a large myelomeningocele with a three-layer closure technique of the defect, which includes an autologous implant free of fetal skin. The procedure was performed at the Clínica General del Norte in Barranquilla on a 24-year-old woman at 23 weeks of gestation, with prior approval from the patient and the institution's ethics committee. The prenatal evaluation included ultrasound and MRI demonstrating myelomeningocele with 5 x 4 cm dimensions in the lumbosacral region (L1-S1). The malformation was accompanied by moderate ventriculomegaly and Arnold-Chiari malformation. Inclusion and exclusion criteria were per the MoMs Study trial. Prenatal correction by fetoscopy was performed assisted by laparotomy. The myelomeningocele was dissected; then a dural patch (Duragen) was placed over the defect with medullary retubulisation with separate sutures, leaving an exposed area of 5 × 4 centimetres comprising 80% of the lumbosacral region. Myofascial flaps are cut parallel to the spinal defect with monopolar and a fetal skin flap is excised from the skin overlying the repaired myelomeningocele and sutured over the defect with 4 3-0 monocril, achieving a triple layer closure. Vaginal delivery occurred at 37 weeks. Report of the first successful fetal autologous skin graft for fetoscopic repair of myelomeningocele, with a favourable postnatal evolution and avoiding the need for relaxation incisions that provides an optimal esthetic result. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.