Port site metastasis following laparoscopic removal of a urological malignancy is an extremely rare complication but still a concern for urologists. We report a 69-year-old male who proved to have left renal urothelial carcinoma after left percutaneous nephroscopic lithotripsy (PCNL). Then hand-assisted retroperitoneoscopic nephroureterectomy and bladder cuff excision were performed. Neither a commercial hand-assisted device nor commercial organ entrapment sac was used. Hand port site recurrence was noted 15 months later, but no recurrent tumor was noted in the left renal fossa or previous PCN tract. While reviewing similar reports, the reason why commercial hand-assisted device systems prevent port site recurrence is still undetermined, but an organ entrapment sac during laparoscopic surgery for specimen removal should be a standard of care.