A medical device for puncturing tissue at a tissue site is disclosed. The medical device comprises an elongate member having a proximal section (206), a distal section (202) and a rail section (204) between the proximal and distal sections； and an active tip at a distal end of the distal section, the active tip operable to deliver energy to create a puncture through the tissue. The rail section is configured to both act as a rail for supporting installation of one or more tubular members thereupon as well as to be maneuverable for enabling access to the tissue site. Also, a system for puncturing tissue at a tissue site is disclosed. The system comprises such a medical device and an electrosurgical generator for coupling to the at least one medical device for delivering energy to puncture the tissue at the tissue site.
