Articulating Hem-o-Lok–assisted single-position laparoscopic nephroureterectomy for UTUC: a feasibility study with preliminary oncological outcomes

Radical nephroureterectomy (RNU) with bladder cuff excision is the standard treatment for high-risk non-metastatic upper tract urothelial carcinoma (UTUC). This feasibility-oriented study aimed to describe articulating Hem-o-Lok–assisted single-position laparoscopic nephroureterectomy (AHOL-SP-LNU) and to preliminarily evaluate its perioperative outcomes and oncological follow-up results compared with laparoscopic nephroureterectomy with transurethral resection of the ureteral orifice (LNU+TURUO). This single-center retrospective study included 49 UTUC patients who underwent surgery between January 2015 and December 2025, including 22 patients in the AHOL-SP-LNU group and 27 in the LNU+TURUO group, with follow-up data updated until May 2026. IPTW based on propensity scores was applied to reduce measured baseline imbalance. Stabilized IPTW weights were calculated and an upper truncation threshold of 10 was prespecified. Perioperative outcomes, hospitalization costs, and exploratory survival outcomes were evaluated. After IPTW adjustment, AHOL-SP-LNU was associated with shorter operative time (β = −34.69 min, P = 0.002), shorter hospital stay (β = −3.42 days, P = 0.040), reduced risk of non-minimal intraoperative bleeding (OR = 0.13, 95% CI 0.02–0.66; P = 0.015), and lower hospitalization costs (β = −8270 RMB, P = 0.023). No statistically significant differences were observed in BRFS, CSS, or OS, although these oncological analyses were limited by the small number of events. AHOL-SP-LNU was associated with improved perioperative efficiency, reduced non-minimal intraoperative bleeding, and lower hospitalization costs. Given the small sample size and limited number of oncological events, the survival findings should be interpreted as preliminary and hypothesis-generating. Larger multicenter studies with longer follow-up are required to evaluate long-term oncological outcomes, delayed clip-related complications, and the generalizability of this technique.