Background and objective: The Laryngeal Mask Airway-Supreme is a single-use supraglottic airway device that offers gastric access. The present study compares the safety and efficacy of LMA Supreme with Endotracheal tube (ETT) in adult patients undergoing laparoscopic procedures. Methods: In this prospective study eighty patients of either sex, ASA grade I & II, were randomly assigned to LMA-Supreme and ETT for airway management and intraoperative ventilation. After induction of general anesthesia, devices were inserted, correct placement was verified, airway leak was noted, and a gastric tube was inserted. Insertion success rates and time, ventilatory capability, efficacy of seal, risk of gastric distension and hemodynamic responses were investigated. Results: The insertion of LMA-S was comparatively easier and required lesser time for insertion than ETT.Ventilation parameters and airway pressure during peritoneal insufflations, for LMA-S and ETT were comparable.LMA-S and ETT show similar efficacy during laparoscopic surgery with controlled ventilation. No gastric distension or signs of regurgitation were detected in both groups. The hemodynamic responses to insertion and removal were greater for the ETT than LMA-S.Complications or pharyngo-laryngeal morbidity was less with LMA-S as compared to ETT. Conclusions: The LMA-S is a safe, efficacious and easy-to-use, supraglottic airway device during general anaesthesia for normal as well as laparoscopic procedure. It provides a functional airway seal with minimum adverse events.