Radical cystectomy is the standard therapy for invasive bladder cancer, with best oncological results compared to any other therapeutic alternative. Even if laparoscopic radical cystectomy (LRC) is a well established surgical procedure, performing the urinary diversion completely intracorporeal, is still a challenge due to technical difficulties and associated complications. The aim of our study is to present the first series of LRC with ureterosigmoidostomy. Since May 2004 were performed 7 LRC (5 males and 2 females) (Gr. A). All cases were T2N0 clinical stage. These patients were compared with a retrospective group of 50 patients who underwent open procedure (Gr. B) in term of: operative time, blood loss, analgesic requirements, and hospital stay. LRC has a longer operative time but with statistically significant lower blood loss, less analgesia, and shorter hospital stay. The resection margins of the surgical specimens were tumor free at pathologic examination. Long-term follow-up is pending. On short-term, the results of laparoscopic radical cystectomy are encouraging. When significant experience in laparoscopic surgery is lacking, surgeons should exercise caution with completely intracorporeal urinary diversion.