Radical cystectomy (RC) is an effective curative treatment for high grade and muscle invasive bladder cancer. Other treatments such as chemoradiation and transurethral resection of bladder tumor as monotherapy are generally not considered as effective as RC. RC is a major surgical procedure associated with significant morbidity and mortality. However, over the last decade significant advances have been made in different aspects of RC, including perioperative care, instrumentation and surgical techniques which has dramatically improved the outcome following RC. Different approaches including open, laparoscopic and robotic approaches are used to perform a RC. Devices such as vascular staplers and ligasure have decreased the blood loss and the need for transfusion. In this article, we review relevant literature and discuss various advances made in an attempt to improve outcome following RC.