The aim of this study was to evaluate the safety and efficacy of the supracostal access for percutaneous nephrolithotomy (PCNL) and need for postoperative chest X-ray. Between July 2017 to June 2019, 450 patients underwent PCNL, of whom 157 (35%) had supracostal access. All procedures were performed in a single sitting under general anesthesia. The data were analysed for indications, stone clearance rates and the complications associated with supracostal puncture. The indications for a supracostal access were staghorn stones (50%), pelvis stones (10%), calyceal stones in high-lying kidney (16%) and upper ureter/ureteric stones (16%). All tracts were made in the 11th intercostal space. Single tract access was used in 124 cases (79%), but 33 (21%) required a second tract. Additional punctures were required mainly for staghorn stones. Overall, 96.34% of the patients were rendered stone free or had clinically insignificant residual stones with PCNL monotherapy. Significant bleeding requiring blood transfusion occurred in 8 (5.26%) patients. 10 patients developed chest pain and 1.2% developed hydrothorax which were managed conservatively. Except those patients who had complication, all other patient recovered uneventfully. Postoperative hospital stay ranged from 2 to 9 days. In conclusion, supracostal access gives high clearance rate with acceptable complications and should not be avoided for fear of chest complications. Also no routine follow up chest X ray is required.