Background Cochlear implant surgery is widely practiced. Minimal incision cochlear implant surgery has been developed with the aims of reducing the impact of surgery on the patient and improving cosmesis while maintaining the low morbidity of conventional wider access approaches. This study aimed to assess the surgical technique and complication rate of minimal incision cochlear implantation (MICI) for children and adults. Methods Data for this study were obtained via a retrospective analysis. Totally 378 patients were included in the study. All patients received minimal incision cochlear implantation, using the skin protector during the process of the operation. The surgical complications of MICI were recorded in a spreadsheet format. The incidence of major and minor complication were analyzed, and appropriate treatment was provided. Results A total of 40 (10.5%) complications were noted in the study. There were 0 life-threatening, 9 major, and 31 minor complications. Of the nine major complications, five were device failures, one developed infection and extrusion, and three required receiver-stimulator repositioning. Conclusions MICI is as safe as standard cochlear implantation (SCI) and affords with it other benefits. Eliminating the scalp flap avoids devascularization and minimizes the opportunity of flap infection or necrosis. Complications not related to the flap are similar to SCI.