Study Type – Therapy (case series) Level of Evidence 4 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. 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. 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.

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The present case scenario deals with an acute on chronic symptomatology, and collapsed state of the patient with poor vitals on admission in casualty. Clinical work up pointing to an elevated serum CA 125 levels and USG pelvis suggesting peritoneal adhesions with cystic to firm mass in left ovary and minimal free fluid in abdomen and cul de sac, X Ray chest suggesting right sided Pleural effusion. It was after careful evaluation of the case, with past and present history along with signs, symptommatology and intraoperative findings that differentials like Chronic granulomatous lesions, endometriosis, Neoplastic lesions with metastasis and Meig’s syndrome or Pseudo Meig’s were evaluated. Finally, a diagnosis of genital tuberculosis with enodmetriosis was confirmed on histopathological evaluation. DOI: http://dx.doi.org/10.3126/jcmsn.v7i1.5975 JCMSN 2011; 7(1): 57-64