Background and Objectives: While general anesthesia (GA) remains the standard anesthetic modality for performing laparoscopic cholecystectomy (LC), it may not be optimal for all patient populations. This prospective, randomized controlled study was designed to evaluate and compare the hemodynamic profiles associated with GA and thoracic segmental spinal anesthesia (TSSA) during LC. Materials and Methods: A total of 124 adult participants scheduled for elective LC were randomly allocated into two groups: Group A (TSSA) and Group B (GA), with 62 individuals in each arm. Group B underwent standard GA, including endotracheal intubation and mechanical ventilation. Group A received TSSA, wherein 1.5 mL of 0.75% ropivacaine combined with 6 mcg of dexmedetomidine was administered intrathecal between thoracic vertebrae T7 and T12. The primary endpoint was assessment of intraoperative hemodynamic variation. The secondary outcomes included comparison of adverse events during and following the procedure, and ease of doing surgery. Data entry was performed using Microsoft Excel and analyzed with SPSS version 25. Results: Analysis included all randomized subjects. In Group A, a transient decrease in heart rate and blood pressure was noted at the 5-minute mark, followed by sustained hemodynamic stability. In contrast, Group B exhibited more pronounced increases in intraoperative cardiovascular parameters, particularly following pneumoperitoneum. No neurological adverse events were observed in the TSSA cohort. Reports of abdominal pain in the early postoperative phase and sore throat were more prevalent in the GA group. Conclusion: TSSA demonstrates superior intraoperative cardiovascular stability and fewer postoperative complications when compared with GA, positioning it as a viable and effective anesthetic alternative for laparoscopic cholecystectomy.