Objectives: The traditional subcostal access for Percutaneous renal surgery was preferred to avoid injury to the lung and the pleura. However in some patients as those with upper caliceal stones, impacted upper ureteral stones, stag stones and in access to the ureteropelvic junction the supracostal approach provides the most direct access to achieve satisfactory result and the subcostal approach may fail to provide the optimal access. our objective is to prospectively evaluate the safety and efficacy of the supracostal approach in percutaneous renal surgery. Methods: Between august 2004 and august 2005 twenty patients (twenty one renal units underwent percutaneous renal surgery via the supra costal approach as the only or additional access. The indications were staghorn stones, upper calyceal stones, upper ureteric stones, high lying kidneys and secondary PUJO.Results: The results show that the supracostal access was the only access in 72% of the procedures. Additional puncture was required mainly for staghorn stones in 28% of casesOur overall stone free rate is 88.9% and significant chest complications occurred in two (9.5%) patients which required insertion of a chest tube.Conclusion: supra 12th rib approach provides relatively safe access and supra 11th rib should only be done by surgeons with expertise in obtaining access and when this access is the only access to the lesion and chest X ray immediately post operative is mandatory in all patients treated with this approach for early detection of any complications.