Background: The advent of laparoscopic surgery has revolutionized the field of surgery, offering a minimally invasive alternative to traditional open procedures. Despite its benefits, laparoscopic surgery presents unique anesthetic challenges, particularly in airway management and maintaining adequate ventilation due to the creation of pneumoperitoneum. This study compares the efficacy, safety, and patient outcomes associated with the ProSeal Laryngeal Mask Airway (PLMA) and the Endotracheal Tube (ETT) in laparoscopic surgeries. Method and material: A prospective randomized comparative study was conducted in tertiary care hospital and attached medial college for a period of 1 year (January 2023 to December 2023) included a total of 100 patients, aged 20-60 years with ASA Grading 1 and 2 and BMI between 20-25 kg/m², were randomly assigned to Group P (PLMA) or Group E (ETT) using a closed envelope method. Each group comprised 50 patients. Parameters evaluated included the ease of insertion and positioning, Assessing the hemodynamic stability, incidence of adverse events and postoperative complications. Results: The mean age of patients was 45.20 ± 15.50 years in Group B and 44.88 ± 15.30 years in Group L, Sex distribution was 52% male and 48% female in Group B, and 48% male and 52% female in Group L, with no significant difference ASA grading showed 56% Grade I and 44% Grade II in Group B, and 52% Grade I and 48% Grade II in Group L, with no significant difference. For PLMA, the insertion success rate was 86% on the first attempt and 14% on the second, with no failures. For ETT, the rates were 84% on the first attempt, 14% on the second, and 2% on the third, with no failures. The mean time for successful placement was similar between groups (15.82 s for PLMA vs. 17.05 s for ETT, p = 0.193), but PLMA had a significantly shorter time for NGT passage (9.80 s vs. 11.60 s, p = 0.003). PLMA group showed stable mean heart rate (HR), whereas the ETT group had significant increases at insertion (86.20 ± 8.14 bpm to 98.40 ± 13.90 bpm, p < 0.05), 1 minute (103.83 ± 11.70 bpm, p < 0.05), 3 minutes (101.90 ± 13.77 bpm, p < 0.05), and 5 minutes (94.47 ± 20.00 bpm, p < 0.05). Similar trends were observed for systolic blood pressure (SBP) and mean arterial pressure (MAP) with significant increases in the ETT group at 1, 3, and 5 minutes, and during removal (p <0.05). No significant differences in SpO2 or EtCO2 were found between groups. Intraoperatively, PLMA had a higher incidence of leaks (4% vs. 0%) and gastric insufflation (10% vs. 0%) compared to ETT (p < 0.05). No regurgitation or aspiration was observed in either group. Postoperatively, sore throat was significantly more common in the ETT group (20% vs. 6%, p < 0.05). Minor trauma and other complications were not significantly different between groups. Neither group experienced laryngospasm, bronchospasm, regurgitation, or pulmonary aspiration. Conclusion: Our study demonstrates that Supraglottic Airway Devices (SADs) are a viable alternative to Endotracheal Tubes (ETTs) for airway management in laparoscopic surgeries under General Anesthesia. SADs offer easier insertion, maintain hemodynamic stability, and reduce postoperative complications, making them a promising choice for enhancing patient comfort and ensuring smoother surgical outcomes.