Purpose To the best of our knowledge we present the first series of complete intracorporeal robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy (RALIMA) in a pediatric population. Material and Methods From February to July 2008, five patients with spina bifida and neurogenic bladder were selected to undergo RALIMA by a single surgeon at the University of Chicago Medical Center. All had constipation, day and night-time incontinence, with recurrent urinary tract infection (UTI), and failed attempts at anticholinergic therapy and clean intermittent catheterization. Urodynamics showed all had low capacity bladders with poor compliance and high leak point pressures. Pre-operative bowel preparation was not performed. Mean follow-up was six months. Results One patient required conversion to open ileal augmentation due to kyphoscoliosis, adhesions and failure to progress, while another underwent augmentation ileocystoplasty without appendicovesicostomy. Of the patients who had robotic augmentation ileocystoplasty, average age was 9.75 years (range 8-11 years). Average operative time was 8.5 hours (range 6-11 hours). There were no intra-operative complications. One patient had a wound infection after surgery. Post-operatively, patients only required oral analgesia for 24-36 hours, were started on liquid diet on average after 7.5 hours (range 6-10 hours), on regular diet after 24 hours (range 12-36 hours), and were discharged home within 6 days. Post-operatively, all patients demonstrated no leak on follow-up cystogram, and were catheterizing per apendicovesicostomy (3 patients by six weeks) or urethra (1 patient at 4 weeks). All patients now have day and night-time continence with no UTIs, and bladder capacity between 250-450 mL. Conclusions While longer follow-up is 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 shorter recovery time and analgesia.