Objective To investigate the efficacy and safety of three hole laparoscopic radical cystectomy(LRC) in comparison with five hole LRC. Methods The patients who underwent radical cystectomy from January 2019 to March 2021 in our hospital were retrospectively analyzed.Basic information and preoperative and postoperative data were collected(such as gender, age, hemoglobin, creatinine, operation time, blood loss, ventilation time, etc).Statistical analysis was used to determine whether there was statistical significance between the two groups(3-hole VS 5-hole). Results A total of 99 patients with radical cystectomy and urinary diversion were collected.Three hole laparoscopy included 33 cases and five hole laparoscopy included 66 cases.The basic characteristics of the two groups of data did not have significant statistical significance.The operation time and exsufflation time of 3-hole method were significantly shorter than that of 5-hole method in patients with ileal conduit. In patients with orthotopic neobladder, the exsufflation time and postoperative hospital stay of 3-hole method were significantly shorter than that of 5-hole method.Total laparoscopic surgery has shorter ventilation time than in vitro urinary diversion. Conclusions Compared with 5-hole LRC, 3-hole LRC can reduce the operation time, shorten the hospitalization time, reduce the hospitalization cost and save medical resources. However, due to the small sample size and short follow-up time, the long-term benefits need to be further observed.