Introduction Peritoneal dialysis (PD) guidelines recommend a 14‐day break‐in period after catheter placement, yet this period could be shortened with new insertion techniques. Methods We conducted a prospective cohort study to compare percutaneous vs. surgical catheter insertion in a newly established PD program. The break‐in period was intentionally shortened to <24 h to start PD almost immediately. Results We included 223 subjects who underwent percutaneous (34%) or surgical (66%) catheter placement. Compared to the surgical group, the percutaneous group had a higher proportion of early dialysis initiation within 24 h (97% vs. 8%, p < 0.001), similar successful initiation rates (87% vs. 92%, p = 0.34), and shorter lengths of stay (12 9–18 vs. 18 14–22 days, p < 0.001). Percutaneous insertion increased the likelihood of successful PD initiation within 24 h (OR 74, 95% CI 31–182), without increasing major complications. Conclusion Percutaneous placement could represent a cost‐effective and efficient technique to shorten break‐in periods.