Background: To explore the safety, efficacy, and oncological outcome of 3-port laparoscopic radical cystectomy(LRC) compared to open radical cystectomy (ORC) in patients older than 75 years. Materials and Methods:From June 2010 to July 2014, we analyzed 16 radical cystectomies in patients older than 75 years (LRC group=8;ORC group=8). Demographic parameters, operative variables, and perioperative outcome in the 2 groups wereretrospectively collected, analyzed, and compared. Results: Patients in both groups had comparable preoperativecharacteristics. A significantly longer operating time (476 vs. 303 min, P=0.0002) and less estimated blood loss(627 vs. 2,106 mL, P=0.021) were observed in the LRC group compared to the ORC group. Infection and ileuswere the most common early complications after surgery. Patients who underwent ORC suffered from morepostoperative infection (22.2% vs. 0.0%, P=0.054) and ileus (25.0% vs. 12.5%, P=0.521) than the LRC group, butthe difference was not significant. Conclusions: Judging from this initial trial, 3-port LRC can be safely carriedout in elderly patients. We suggest 3-port LRC as the primary intervention to treat muscle-invasive or high-risknonmuscle-invasive bladder cancer in elderly patients with an otherwise relatively long life expectancy.