AbstractBackground: Proseal LMA (PLMA), is the latest entrant in the family of LMA designed for positive pressure ventilation and protection against aspiration. These features of PLMA are especially useful in laparoscopy surgeries, which are widely preferred these days and can act as an alternative to the Endotracheal tube (ETT). Rigid laryngoscopy during endotracheal intubation (the gold standard for safe glottic seal) causes hemodynamic responses which add to the stress of pneumoperitoneum in laparoscopic surgeries, unlike Proseal LMA which is a supraglottic device and less invasive. Aim: To compare the efficacy and safety of the Proseal Laryngeal Mask Airway with Portex endotracheal intubation in gynecological laparoscopic surgeries under general anesthesia. Setting and Design: A prospective, randomized study was conducted on 60 females, ASA-I & ASA-II patients undergoing laparoscopic gynecological surgery under general anesthesia. Ethical clearance and written consent were obtained before the study. Patients were randomly divided into two groups-PLMA (P) and Endotracheal tube (E) depending on the device used to secure the airway. Ease, attempt of of insertion, hemodynamic parameters, and postoperative complications were studied. Results: The insertion rate was 100% in both groups. Vital parameters like heart rate, systolic bp, diastolic bp and mean arterial pressure were relatively lower with Proseal LMA at 1 min, 3 min, and 5 min and after removal as compared to ETT. The difference was statistically significant. There was no significant difference in End-tidal CO2, SpO2, during baseline, insertion, and removal of the device, before and after pneumoperitoneum, and also in airway pressure during insertion, before and after pneumoperitoneum. Perioperative complications were higher with the endotracheal tube. Conclusion: The Proseal LMA offers a safe and effective alternative for airway management in patients undergoing gynecological laparoscopic procedures under general anesthesia.