Background and Aims Totally implantable venous access port (TIVAP) are widely used for chemotherapy, blood transfusion, and nutritional support in patients with malignancies. Among them, upper arm port (UAP) are increasingly recommended in clinical practice due to their advantages in avoiding thoracic complications and providing more concealed incisions. Currently, two main implantation techniques are used for UAP: the tunnel needle-transverse incision technique and the puncture point-transverse incision technique. This study aims to compare the clinical outcomes of these two techniques in patients with hematological malignancies, focusing on safety and cosmetic appearance, to provide evidence for clinical decision-making.Methods A retrospective analysis was conducted on 412 patients with hematological malignancies who underwent UAP implantation at Xiangya Hospital of Central South University between December 2021 and December 2024. Based on the implantation method, patients were divided into the tunnel needle-transverse incision group (n=200) and the puncture point-transverse incision group (n=212). Intraoperative variables (operative time, intraoperative pain score, catheter kinking at the pocket, intraoperative blood loss) and postoperative indicators (incidence of complications and incision aesthetic satisfaction) were compared between the two groups.Results There were no significant differences in baseline characteristics between the two groups (all P>0.05), indicating comparability. The puncture point-transverse incision group showed superior performance in operative time [(32.99±4.91) min vs. (41.42±5.35) min], catheter kinking rate (1.4% vs. 8.5%), and incision aesthetic satisfaction (7.99±0.58 vs. 6.26±0.86) compared with the tunnel needle-transverse incision group (all P<0.05). Although the puncture point group had slightly more intraoperative bleeding [(4.52±1.02) mL vs. (4.16±0.83) mL], the difference, while statistically significant, was of limited clinical relevance. No significant differences were observed between the two groups in intraoperative pain scores or incidence of postoperative complications (both P>0.05).Conclusion The puncture point-transverse incision technique offers significant advantages in terms of operative efficiency, reduced catheter kinking, and improved incision aesthetics, without compromising safety. It represents a promising alternative to the traditional tunnel needle-transverse incision method and has strong potential for broader clinical adoption.The puncture point-transverse incision technique offers advantages such as shorter operative time, lower catheter kinking rate, and higher incision aesthetic satisfaction. It is a promising alternative to the traditional tunnel needle-transverse incision technique and has good potential for clinical application and promotion.