BackgroundThis study aimed to compare the clinical outcomes of patients who underwent three-port laparoscopic radical cystectomy (LRC) with orthotopic neobladder (ONB) and traditional five-port method.MethodsFrom January 2017 to November 2020, 100 patients underwent LRC + ONB at a third-level grade A hospital.ResultsOur study included 55 patients who underwent three-port LRC and 45 patients who underwent the five-port method. There were no significant differences in perioperative data such as operation time (253.00 ± 43.89 vs. 259.07 ± 52.31 min,P= 0.530), estimated blood loss (EBL)(97.64 ± 59.44 vs. 106.67 ± 55.35 min,P= 0.438), day to flatus (2.25 ± 1.49 vs. 2.76 ± 1.77 days,P= 0.128), day to regular diet (7.07 ± 2.99 vs. 7.96 ± 3.32 days,P= 0.165), day to pelvic drain removal (9.58 ± 3.25 vs. 10.53 ± 3.80 days,P= 0.180), and hospital stay after operation (11.62 ± 3.72 vs. 11.84 ± 4.37 days,P= 0.780) between the two groups. The only significant difference was in the treatment cost (P= 0.035). Similarly, postoperative complications, quality of life, and tumor outcomes were not significantly different between the two groups (P> 0.05).ConclusionsThe three-port method is safe and feasible for patients suitable for traditional five-port LRC with an orthotopic neobladder.