A meta-analysis by Klaiber et al. (2021) addresses the question of whether, during the implantation of a port system, the V. cephalica should be surgically exposed (“cutdown”) or the catheter should be implanted via puncture of the V. subclavia. Based on six randomized studies involving 1,831 patients, the authors concluded that the open technique is significantly superior to the puncture technique in terms of reducing the risk of pneumothorax (odds ratio, OR 0.308; 95% confidence interval, CI 0.122 to 0.776). There were no differences between the two methods with respect to morbidity and mortality. However, the primary failure rate was higher with the open approach (OR 2.364, 95% CI 1.051 to 5.315). Since pneumothorax is a serious complication, the authors advocate the open approach as the first-line method for the implantation of access ports.