2D Versus 3D Laparoscopy in Partial Nephrectomy: A Concurrent, Equipment-Allocated Three-Centre Comparison of...

Warm ischaemia time is the main modifiable determinant of early renal functional loss after partial nephrectomy, and it is governed largely by the speed of intracorporeal suturing. Three-dimensional (3D) laparoscopy restores binocular depth cues and might shorten the reconstructive phase. Earlier comparisons have largely been before-and-after series, in which a secular trend cannot be separated from the optics.

We analysed 209 consecutive laparoscopic partial nephrectomies performed at three private Jordanian hospitals between January 2023 and December 2025, 102 with two-dimensional (2D) and 107 with 3D visualisation. Both systems were in concurrent use throughout, and allocation followed rotation of a shared 3D tower rather than calendar period. Groups were compared with Welch t, Mann-Whitney U, chi-square and Fisher exact tests with Benjamini-Hochberg control of the false discovery rate. Multivariable models with heteroscedasticity-consistent standard errors and stabilised inverse probability of treatment weighting estimated the adjusted effect.

Baseline characteristics were balanced (all standardised mean differences below 0.20). The 3D group had shorter warm ischaemia (adjusted beta -4.76 min, 95% CI -6.28 to -3.24), shorter renorrhaphy (-5.06 min), shorter operative time (-12.35 min), lower blood loss and shorter stay. Warm ischaemia of 25 min or less occurred in 90.7% versus 53.9%. Complications, margins and readmission did not differ.

With allocation independent of calendar time, 3D visualisation was associated with a faster reconstructive phase and better ischaemia control.