Abstract: A surgical instrument for penetrating bodily tissue including an imaging element providing the capability for simultaneous visualization during penetration is disclosed. A transparent portion of the imaging element extends from the distal end of an elongated, substantially hollow shaft. The imaging element is shaped to enlarge an opening as the instrument is advanced into bodily tissue, and an endoscope can be inserted through the shaft adjacent the imaging element to visualize the penetration of tissue as the instrument is advanced. The imaging element may be substantially hollow, and have an annular interior region inside the shaft distal end. The endoscope can then be positioned to rest on the annular region to prevent glare from the reflection of light traveling from the endoscope to the window surface. The imaging element may also have a blade for facilitating the advance of the instrument through tissue.