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

Introduction: 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. Material and methods: 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. Results: 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). Conclusions: 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.