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

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