In fact, it is not easy nor quick to use a scalpel… however your doctor is probably much more comfortable using one with a dermal elevator to incise and make the pocket. The needle approach, once mastered, is literally a speedy 5 seconds from start to finish. The scalpel method could take several minutes, and will require sutures after to close.
Several things 
The biggest difficulty people seem to have is the bevel. If you keep the bevel up, the point will be down and it will collect quite a lot of skin inside the needle as it goes in. Once you’re past the back of the bevel however, the point will be down and away from the underside of the dermis, so risk of protruding back out through the skin is low as you insert the needle. If you keep the bevel down, then inserting into the skin is much easier, but the point will be up right under the dermal layer, so it is absolutely critical you keep the skin in front of the point pulled up as the needle is inserted, or it will poke right back out again.
We are exploring a rotation approach wherein the bevel is inserted facing down, but once fully under the skin, the needle is then rotated as it is inserted so the bevel ends up facing up with the point down. This approach combines the best of both worlds, but requires finesse and a keen understanding of spacial dynamics and procedural correctness to do properly.
Other risks include opening or completely severing a major blood vessel, infusion, and other nasty things… so, as always, definitely work with a professional to perform any installations.
Attached, for informational purposes only, is our professional guide for needle based flex installations.
VivoKey Flex Device Installation Procedure Guide.pdf (517.4 KB)