technique. The use of the Da-Vinci robot offers excellent anatomicvisualization and enhanced surgical precision when performing achallenging dissection within the deep pelvis. Further case studiesare necessary to verify the reproducibility of our experience.

Source of Funding: None

V540ROBOTIC ASSISTED LAPAROSCOPIC PIPPI SALLE BLADDERNECK RECONSTRUCTION

Janelle Fox*, Anne Dudley, Glenn Cannon, Pittsburgh, PA

INTRODUCTION AND OBJECTIVES: Robotic assisted blad-der neck reconstruction has been recently described using a Leadbet-ter-Mitchell technique in conjunction with bladder neck sling to treatneurogenic bladder neck incompetence. Therefore, we sought a tech-nique that could be performed in a minimally invasive fashion withmaximal intravesical urethral lengthening without need for concurrentsling procedure. We present the feasibility of a robotic Pippi-Sallebladder neck reconstruction in conjunction with appendicovesicostomy.

METHODS: An 8 year old boy, with lumbosacral myelomenin-gocele and history of ventriculoperitoneal shunting on clean intermittentcatheterization plus anticholinergics, was found to have bladder outletincompetence, normal compliance, and reduced capacity to 106mL.Bladder capacity as measured under anesthesia with gravity fill at�40cm of water was 230cc. Concurrent bladder augmentation was notperformed. The patient then underwent a robotic-assisted laparoscopicPippi-Salle bladder neck reconstruction with appendicovesicostomy.Open bilateral orchiopexy was also performed for bilateral palpableundescended testes.

RESULTS: Using a 5-port technique with the da Vinci® Si HDSurgical System, the anterior bladder neck and proximal prostate weremobilized allowing a trapezoid shaped flap to be configured from theanterior bladder wall in the manner of Pippi Salle. After mobilization oftriangular urothelial flaps distal to each ureteral orifice, the urothelium ofthe anterior flap and posterior bladder wall were sewn over an 8Frurethral stent to a level just below the ureteral orifices. Ureteral reim-plantation was not required. Appendicovesicostomy was then per-formed along the posterior bladder wall. The patient was continent attime of urethral catheter removal and developed no signs of ureteralobstruction. Procedure duration was 543 minutes, with estimated bloodloss of 100cc, and 5 day hospitalization.

CONCLUSIONS: Robotic-assisted laparoscopic bladder neckreconstruction is an evolving art in which the optimal reconstructivetechnique has yet to be determined. More extensive urethral lengthen-ing procedures for bladder neck reconstruction, including the Pippi-Salle repair, can be accomplished in a laparoscopic fashion with roboticassistance. Long term follow up is necessary to determine comparativesuccess of this new technique.

Source of Funding: None

V541ROBOTIC INTRAVESICAL URETEROCELE EXCISION

Brian Rosman*, Courtney Rowe, Alan Retik, Hiep Nguyen,Boston, MA

INTRODUCTION AND OBJECTIVES: Ureterocele excision is aprocedure that is typically performed in an open fashion. The roboticapproach has many challenges associated with it, as well as manyadvantages. This video will demonstrate several techniques, includingbladder fixation and port closure techniques, which can make a roboticapproach a feasible, safe, and effective option for ureterocele excision.

METHODS: A suitable patient was selected that had a largeenough bladder, clinical indication for ureterocele excision, and interestin a robotic approach. The patient had a right sided congenital multi-cystic kidney without much function, and underwent a rightnephroureterectomy previously. He had recurrent episodes of hematu-ria, and a ureterocele was identified. The ureterocele was a simple

orthotopic stenotic ureterocele, seen on VCUG as a filling defect, andconfirmed cystoscopically. The decision was made to definitively treatthe ureterocele after cystoscopic de-roofing failed to relieve the symp-toms.

After cystoscopy was performed, two stay sutures were placedthrough the rectus muscle and all bladder layers to hitch the bladder tothe abdominal wall during the procedure. This prevented the bladderfrom falling away from the abdominal wall during surgery, and pullingout the robotic ports. The ports were placed, along with a Veressneedle. The bladder was drained of urine and insufflated, and thecamera and instruments placed. The ureterocele was identified, andexcised with monopolar scissors. The defect in the detrusor musclewas closed in two layers. This patient had a previous nephroureterec-tomy on the ipsilateral side, therefore no re-implant was required. Theports were removed, and the port holes closed using a “suture suspen-sion disc”. This disc was used before port placement, and acts as astencil for proper port and suture placement, ensuring that the pre-placed sutures are able to tightly close the port site.

RESULTS: This patient did very well post-operatively, withminimal pain, quick return to eating and drinking and ambulating, andwas discharged from the hospital 24 hours after his procedure. He hadno further hematuria or obstructive symptoms on repeat follow-upexaminations.

CONCLUSIONS: With the techniques detailed in this video, thedifficulties of robotic ureterocele excision can be easily overcome,allowing the benefits of the minimally invasive approach to be appliedto intravesical ureterocele excision. Robotic intravesical ureteroceleexcision is a safe and effective procedure.

Source of Funding: None.

V542ROBOT-ASSISTED LAPAROSCOPIC URETEROURETEROSTOMYFOR ECTOPIC, DUPLICATED URETER: CASE SERIES ANDDESCRIPTION OF TECHNIQUE

Ken Haberman*, David Leavitt, Aksharananda Rambachan,Minneapolis, MN; Romano DeMarco, Sioux Falls, SD;Aseem Shukla, Minneapolis, MN

INTRODUCTION AND OBJECTIVES: Standard laparoscopicipsilateral ureteroureterostomy (IUU) for the management of an ectopicduplicated ureteral system without evidence of reflux is well estab-lished, but can be technically challenging. We report our experienceand technique with robot assisted laparoscopic IUU in the distal ureterfor management of ureteral duplication with ectopia in children.

METHODS: A single surgeon performed 5 cases betweenDecember 2010 and October 2011 at the University of MinnesotaAmplatz Children’s Hospital. Presentations included antenatal hy-dronephrosis, febrile urinary tract infection, and incontinence. Wedemonstrate and describe our technique while discussing outcomesincluding operative time, hospital course, blood loss, complications,and follow-up.

RESULTS: Four females and one male with ages ranging from6 months to 15 years underwent the procedure. With mean follow up of8 months, all patients have had successful outcomes with improvementin hydronephrosis, resolution of incontinence when present, and norecurrent urinary tract infections. Mean operative time was 225 min-utes, estimated blood loss was 4 mL, and hospitalization was 1.2 days.One patient developed pyelonephritis associated with ureteral stentremoval, but no long term complications have occurred.

CONCLUSIONS: Our experience indicates that robot assistedlaparoscopic ipsilateral ureteroureterostomy at the level of the distalureter is safe and effective in the management of ureteral duplicationanomalies in children.

Source of Funding: None

e222 THE JOURNAL OF UROLOGY� Vol. 187, No. 4S, Supplement, Sunday, May 20, 2012