Background: The supracostal route for percutaneous nephrolithotomy (PCNL) is often underutilized due to concerns about safety and potential thoracic complications. This study was aimed to evaluate the safety and efficacy of supracostal puncture for PCNL procedure. Methodology: This is a prospective observational study conducted in the Department of Urology, GGH Kurnool, Andhra Pradesh, India, from January 2020 to December 2022. All supracostal punctures were performed above the 12th and 11th rib spaces by urologists, guided by a c-arm, with the patient in the prone position. The mean operative time, stone-free rate, mean hospital stay, and complications were evaluated. Data was presented as frequency (%). Results: A total of 150 patients underwent PCNL, of whom 39 patients had supracostal access Single supracostal tract access was used in 39(89.7%) cases, and 4(10.3%) patients required a second infracostal tract. Overall 84.6% of the patients were rendered stone free or had clinically insignificant residual calculi with PCNL alone and this increased to 100% with ancillary procedures. In patients with multiple calculi, they were completely cleared in 50% of patients with PCNL and 100% with ancillary procedures. The overall complication rate was 10.2% which included Bleeding in 4 patients out of which two patients required transfusion and pneumothorax in 1 patient(2.5%) which was managed with intercostal chest drain. No haemothorax, hydrothorax, or bowel injury developed. Mean post-operative stay was 3.5 days. Conclusion: Supracostal puncture is a safe and effective method which gives a high stone free rates with acceptable and easily manageable complications.