We compare intraoperative profiles and outcomes of hand-assisted retroperitoneoscopic nephroureterectomy (HARNU) with bladder cuff excision with traditional open nephroureterectomy (ONU) to treat upper urinary tract urothelial carcinoma. Methods: Between January 2000 and December 2005, 65 patients underwent nephroureterectomy and bladder cuff excision for upper urinary tract urothelial carcinoma in Tri-Service General Hospital (TGSH). Of these, 34 were treated using HARNU and 31 with ONU. Both groups were reviewed for operative time, estimated intraoperative blood loss (EBL), tumor stage, postoperative pain, time to oral intake and ambulation, and postoperative hospital stay. Results: The average operative time for HARNU was 238.6 min versus 310.8 min for ONU. The average EBL was 181.6 ml versus 242.6 ml. There was no significant difference in tumor stage between the two treatment groups. The average time to oral intake was 0.8 days for HARNU versus 1.6 days for ONU; time to ambulation 2.5 days versus 3.3 days; and hospital stay 8.2 days versus 10.8 days. No major surgical complications occurred in either group. Conclusion: While ONU still represents the gold standard for the treatment of upper urinary tract urothelial carcinoma, our experience suggests that HARNU results in a shorter operative time, less blood loss, shorter postoperative hospital stay, more rapid oral intake, and an early return to ambulation; and is an effective and safe alternative technique for upper urinary tract urothelial carcinoma.