title: Robotic-assisted laparoscopic approach for posterior bladder neck dissection and placement of pediatric bladder neck sling: initial experience.
abstract: OBJECTIVE
  Bladder neck sling cystourethropexy is a common procedure used to correct intrinsic sphincter deficiency in children with spinal dyspharism. Various modifications of the procedure have been made but all involve circumferential dissection of the bladder neck and proximal urethra. The posterior dissection can be challenging and can result in injury to the rectum, urethra, or vagina. The posterior approach to the bladder neck as reported by Lottmann and later by de Badiola addresses these potential complications. Using these principles of the posterior approach, we performed a robotic-assisted laparoscopic placement of an acellular human dermal allograft bladder neck sling in 2 patients. We present our initial experience regarding this surgical technique.
  
  
  METHODS
  The diagnosis of intrinsic sphincter deficiency was established in 2 female patients, aged 9 and 10 years. Both patients had a neurogenic bladder secondary to spina bifida. Video urodynamics confirmed adequate bladder compliance and intrinsic sphincter deficiency. Robotic-assisted laparoscopic placement of a bladder neck sling was performed in both patients.
  
  
  RESULTS
  Both procedures were completed intracorporeally. The mean blood loss was 20 mL. The mean operative time was 189 minutes. No intraoperative or postoperative complications occurred. The mean hospital stay was 3 days (range 2-4). The follow-up ranged from 13 to 22 months. Postoperative studies revealed continued low-pressure, compliant bladders and stable upper tracts. At last follow-up, the 2 patients were using catheterization without difficulty and were continent.
  
  
  CONCLUSIONS
  The robotic-assisted laparoscopic approach to performing bladder neck dissection and placement of a bladder neck sling in children is technically feasible.
authors.affiliation: Department of Urology, Geisinger Medical Center, Danville, Pennsylvania, USA. Douglas.Storm@nationwidechildrens.org
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Storm
authors.forename: Brant R
authors.initials: BR
authors.lastname: Fulmer
authors.forename: Joel M
authors.initials: JM
authors.lastname: Sumfest
mesh_terms: D002648:Child; D004210:Dissection / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D019919:Prosthesis Implantation / Q000379:methods*; D012371:Robotics; D016135:Spinal Dysraphism / Q000150:complications; D053825:Suburethral Slings; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000601:surgery*