© 2010 THE AUTHORS 962 BJU INTERNATIONAL © 2 0 1 0 B J U I N T E R N A T I O N A L | 1 0 7 , 9 6 2 – 9 6 9 | doi:10.1111/j.1464-410X.2010.09706.x 2010 THE AUTHORS; BJU INTERNATIONAL 2010 BJU INTERNATIONAL Laparoscopic and Robotic Urology RALIMA: FEASIBILITY AND INITIAL EXPERIENCE GUNDETI ET AL. Paediatric robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy (RALIMA): feasibility of and initial experience with the University of Chicago technique Mohan S. Gundeti, Sujeet S. Acharya, Gregory P. Zagaja and Arieh L. Shalhav Pediatric Urology, Section of Urology, the University of Chicago Medical Center and Comer Children’s Hospital, Chicago, Illinois, USA Accepted for publication 22 April 2010 RESULTS • One patient required conversion to open ileal augmentation because of failure to progress and another underwent augmentation ileocystoplasty without appendico-vesicostomy. The average age of patients was 9.75 years (range 8–11 years). • Average operative time was 8.4 h (range 6–11 h). There were no intraoperative complications. One patient had a postoperative wound infection, one had a lower extremity venous thrombus, and another had temporary unilateral lower extremity paresthesia that has resolved. Three patients required revision of their stoma at the skin-level. • Perioperatively, patients only required oral analgesia for 24–36 h (excluding one patient with paralytic ileus), started on liquid diet after 7.5 hours (range 6–10 h), on regular diet after 24 h (range 12–36 h) and were discharged home within 7 days. • Postoperatively, patients demonstrated no leak on follow-up cystogram, and were catheterizing per apendico-vesicostomy (three patients by 6 weeks) or urethra (1 patient at 4 weeks). • All patients now have day and night-time continence with no UTIs, and bladder capacity of 250–450 mL. CONCLUSION • While longer follow-up will be necessary to see if these results are durable, this series demonstrates that RALIMA is a safe, feasible and effective procedure in the short term, with the possible added benefits of reduced analgesia, shorter recovery time and improved aesthetic appearance. KEYWORDS robotic, cystoplasty, laparoscopy, neurogenic bladder, mitrofanoff What’s known on the subject? and What does the study add? There is no information on robotic laparoscopic approach for reconstruction of the bladder and this is the first study to find out the feasibility and technique with this approach and see if there are any outcome differences. In the short term we have seen the advantages of early recuperation and less need of analgesic medication. Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE • To present the first series of complete intracorporeal robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendico-vesicostomy (RALIMA) in a paediatric population. PATIENTS AND METHODS • From February to November 2008, six patients with neurogenic bladder secondary to spina bifida (status post corrective spine surgery) were selected to undergo RALIMA by a single surgeon (MSG) at the University of Chicago Medical Center. • Patients had constipation, day and night- time incontinence, with recurrent urinary tract infection (UTI), and failed attempts at anticholinergic therapy and clean intermittent catheterization. All had low- capacity bladders with poor compliance and high leak point pressures. • Preoperative bowel preparation was not performed. Mean follow-up is 18 months. INTRODUCTION Owing to its inherent advantages over conventional laparoscopy, robotic surgery has become a standard technique in the armamentarium of adult urology. While it has been suggested that robotic pyeloplasty may become the new standard of care [1], it represents the only reconstructive procedure routinely performed with robotic-assistance in paediatric urology. The challenges that hamper the development of the robotic approach in reconstructive paediatric urology include the complicated nature of these technically demanding reconstructive procedures, the limited space found in smaller patients, and no standardized training programs exist to cultivate necessary surgical expertise. Reconstruction of the lower urinary tract using laparoscopic and robotic-assisted BJUI BJU INTERNATIONAL