Three-dimensional laparoscopic partial nephrectomy for hilar versus non-hilar tumors: outcomes from a large...

The management of renal hilar tumors remains a technically demanding aspect of nephron-sparing surgery. Although robotic partial nephrectomy has been widely reported in this setting, evidence from large series of purely laparoscopic procedures performed with three-dimensional vision is still limited.

We retrospectively evaluated 342 consecutive patients who underwent 3D laparoscopic partial nephrectomy between July 2022 and July 2025 at a high-volume tertiary center. Tumors were stratified as hilar (n = 55) or non-hilar (n = 287). The primary endpoint was warm ischemia time. Secondary endpoints included operative time, estimated blood loss, perioperative complications, need for postoperative ureteric stenting, renal function preservation, and trifecta achievement.

Median operative time was modestly longer in the hilar group (78 min vs 73 min, p = 0.04). Median warm ischemia time was also higher for hilar tumors (24 min vs 16 min, p <0.001) but consistently remained within the accepted threshold (<25 min). Estimated blood loss was comparable (270 ml vs 250 ml, p = 0.39). Overall complication rates were similar, though postoperative stent placement was more frequent in the hilar cohort (28% vs 7%, p <0.001). Median postoperative eGFR decline at 3 months was similar between groups. Trifecta achievement was 67.2% for hilar and 71.1% for non-hilar tumors (p = 0.27).

Three-dimensional laparoscopic partial nephrectomy for hilar tumors is associated with slightly longer operative and ischemia times and a higher need for postoperative stenting, but without an increase in major morbidity. In experienced hands, the functional and oncological outcomes were comparable between hilar and non-hilar tumors.