We tested the hypothesis that the ProSeal laryngeal mask airway is superior to laryngoscope-guided tracheal intubation for gynaecological laparoscopy. One-hundred and eighty consecutive patients (ASA grade 1-2, aged 18-80 y) were divided into two equal-sized groups for airway management with the ProSeal laryngeal mask airway or tracheal tube. Induction was with fentanyl/propofol, maintenance with sevoflurane and muscle relaxation with atracurium. The following primary variables were tested: time to achieve an effective airway, ventilatory capability, peak airway pressure before and after pneumoperitoneum, duration of surgery and pneumoperitoneum and haemodynamic responses. Data about gastric size, airway trauma and sore throat were collected. The number of attempts for successful insertion were similar but effective airway time was shorter for the ProSeal laryngeal mask airway (20 +/- 2s vs 37 +/- 3 s, P < 0.001). All devices were successfully inserted within three attempts. There was no episode of failed ventilation or hypoxia. The haemodynamic stress responses to insertion and removal were greater for the tracheal tube than the ProSeal laryngeal mask airway. The duration of surgery, duration of pneumoperitoneum and intra-abdominal pressures were similar Gastric size was similar at the start and end of surgery. There were no differences in the frequency of complications or sore throat. We conclude that the ProSeal laryngeal mask airway is a similarly effective airway device to conventional laryngoscope-guided tracheal intubation for gynaecological laparoscopy, but is more rapidly inserted and associated with an attenuated haemodynamic response to insertion and removal.