referring now to fig1 through 4 , there are shown various views of one embodiment of an access needle constructed according to the teachings of the present invention , said access needle being represented generally by reference numeral 11 . access needle 11 includes a cannula 13 , a needle 15 , a stopper 17 and a spreader 19 . cannula 13 , which is preferably made of a biocompatible , rigid metal , such as stainless steel , is an elongated , unitary , tubular member shaped to include a proximal portion 21 and a distal portion 23 . proximal portion 21 , in turn , is shaped to include a generally semi - annular proximal section 27 and a generally annular distal section 29 , proximal section 27 and distal section 29 jointly defining a longitudinally - extending lumen 30 . proximal section 27 terminates proximally at a proximal end 31 . distal section 29 terminates proximally at a proximal end 33 and terminates distally at a distal end 35 . a transverse slot 37 providing access to lumen 30 is provided in distal section 29 of proximal portion 21 , slot 37 extending distally from proximal end 33 for a short distance before distal end 35 . as will be discussed further below , when needle 15 is in its distal position , a portion of needle 15 is removably received in slot 37 . distal portion 23 of cannula 13 is shaped to include a generally annular proximal section 41 and a funnel - shaped distal section 43 , proximal section 41 and distal section 43 jointly defining a longitudinally - extending lumen 44 aligned with lumen 30 . proximal section 41 , which extends distally from distal end 35 of proximal section 21 , is coaxially aligned with proximal section 21 but has a reduced outer diameter for reasons to be discussed below . a pair of oppositely - facing side windows 45 - 1 and 45 - 2 are provided in proximal section 41 , side windows 45 - 1 and 45 - 2 permitting the wings of stopper 17 to be removably inserted therethrough in the manner to be discussed further below . ( preferably , the proximal surfaces 46 - 1 and 46 - 2 , respectively , and the distal surfaces 47 - 1 and 47 - 2 , respectively , of windows 45 - 1 and 45 - 2 are angled as shown to facilitate the insertion and removal of the wings of stopper 17 through windows 45 - 1 and 45 - 2 .) a recessed area 48 is provided along the inside surface of proximal section 41 , recessed area 48 extending from the proximal end of proximal section 41 to a short distance before windows 45 . as will be discussed further below , recessed area 48 is sized and shaped to receive the proximal portion of spreader 19 in such a fashion that spreader 19 does not move translationally within cannula 13 . needle 15 comprises a needle stem 51 and a needle handle 53 . needle stem 51 , which is slidably and rotatably mounted within cannula 13 , is an elongated , unitary , tubular member preferably made of a biocompatible , rigid metal , such as stainless steel . needle stem 51 is shaped to include a proximal end 55 , a distal end in the form of a sharp , beveled tip 57 and a longitudinally - extending lumen 59 . an annular recess 61 is provided on the outer surface of needle stem 51 , recess 61 being sized and shaped to receive stopper 17 in such a fashion that needle stem 51 and stopper 17 are coupled together for translational movement within cannula 13 while permitting needle stem 51 to rotate relative to stopper 17 . needle handle 53 , which is an elongated , unitary , solid member , extends radially outwardly from needle stem 51 a short distance from proximal end 55 . needle handle 53 is preferably made of a biocompatible , rigid metal , such as stainless steel , and may be fixed to needle stem 51 by welding or the like . needle handle 53 is appropriately dimensioned so that it may be received within slot 37 of cannula 13 or , alternatively , may be positioned on top of proximal end 33 of cannula 13 . in this manner , when one wishes to place needle stem 51 in its distal position , handle 53 is aligned with and then drawn distally through slot 37 . alternatively , when one wishes to place needle stem 51 in its proximal position , handle 53 is removed from slot 37 and needle stem 51 is rotated until handle 53 may be placed upon proximal end 33 of cannula 13 . ( it should be appreciated that needle 15 could be modified to include a pair of needle handles , instead of a single needle handle 53 ; however , cannula 13 would need to be modified accordingly to accommodate both needle handles .) in the present embodiment , needle 15 is dimensioned relative to cannula 13 so that , regardless of whether needle 15 is placed in its distal position or in its proximal position , tip 57 extends distally beyond cannula 13 ( tip 57 extending further distally when needle 15 is in its distal position than when needle 15 is in its proximal position ). however , it should be understood that needle 15 could be dimensioned relative to cannula 13 so that , when needle 15 is in its distal position , tip 57 extends distally beyond cannula 13 but when needle 15 is in its proximal position , tip 57 is withdrawn into cannula 13 . stopper 17 , which is also shown separately in fig5 , is a unitary , generally u - shaped clip made of spring steel , nitinol ( a nickel / titanium alloy ) or the like . stopper 17 is shaped to include a pair of resilient , outwardly - biasing wings 71 - 1 and 71 - 2 interconnected by a base portion 73 . ( it should be understood that , whereas stopper 17 has a pair of wings 71 - 1 and 71 - 2 , stopper 17 could be modified to include any number of wings ). as will be explained further below , wings 71 - 1 and 71 - 2 are appropriately dimensioned to be extendable through windows 45 - 1 and 45 - 2 , respectively , in such a way as to engage an interior surface of a patient , thereby anchoring the distal ends of needle 15 and cannula 13 within the patient . a transverse opening 75 is provided in base portion 73 of stopper 17 , opening 75 being sized so that , after inserting stopper 17 over needle 15 , base portion 73 is securely retained within recess 61 of needle 15 . in this manner , stopper 17 is fixed translationally , but not rotationally , relative to needle 15 . spreader 19 , which is also shown separately in fig6 , is a unitary , tubular member preferably made of rubber or the like . spreader 19 is shaped to include a generally annular proximal portion 81 and a downwardly - tapered distal portion 83 . proximal portion 81 is appropriately dimensioned to be retained by an interference fit within recessed area 48 of cannula 13 . distal portion 83 of spreader 19 is appropriately dimensioned so that , when wings 71 - 1 and 71 - 2 of stopper 17 are moved proximally into alignment with windows 45 - 1 and 45 - 2 , respectively , distal portion 83 engages and spreads wings 71 - 1 and 71 - 2 outwardly beyond their relaxed positions . as in the embodiment shown , distal portion 83 may be provided with a plurality of longitudinally - extending slots 85 to endow distal portion 83 with a certain degree of compressibility for when distal portion 83 is pressed against stopper 17 . to prepare access needle 11 for insertion into a body lumen of a patient ( such as into the stomach of a patient , as in fig7 ( a ), through the abdominal wall a and the stomach wall s of the patient ), one first positions needle handle 53 as distally far as possible within slot 37 . in so doing , needle 15 is moved distally relative to cannula 13 , causing stopper 17 to be moved distally relative to windows 45 - 1 and 45 - 2 and to be compressed within cannula 13 . access needle 11 , while in the aforementioned state , is then inserted into the patient . referring now to fig7 ( b ), when one wishes to anchor access needle 11 within the body lumen of the patient , one moves needle 15 proximally relative to cannula 13 until needle handle 53 is removed from slot 37 and then rotates needle stem 51 approximately 180 degrees to rest needle handle 53 upon proximal end 33 of cannula 13 . in so doing , wings 71 - 1 and 71 - 2 of stopper 17 are moved into engagement with spreader 19 , spreader 19 causing wings 71 - 1 and 71 - 2 to be spread outwardly through windows 45 - 1 and 45 - 2 , respectively . as can be seen , wings 71 - 1 and 71 - 2 engage an interior surface of the patient in an area surrounding the incision site , thereby impeding the withdrawal of access needle 11 from the patient . preferably , the distance between distal end 35 and the free ends of wings 71 - 1 and 71 - 2 approximates the thickness of the patient &# 39 ; s body traversed by access needle 11 , thereby causing the body portion between distal end 35 and wings 71 - 1 and 71 - 2 to become entrapped therebetween . to remove a thus - anchored access needle 11 from a patient , one merely rotates needle stem 51 relative to cannula 13 so that needle handle 53 is aligned with slot 37 and then distally advances needle 15 relative to cannula 13 so that needle handle 53 is moved as distally far as possible through slot 57 ( see fig7 ( a )). in so doing , stopper 17 is retracted sufficiently that wings 71 - 1 and 71 - 2 no longer extend through windows 45 - 1 and 45 - 2 , respectively . as can be appreciated , one benefit associated with access needle 11 , as compared to existing access needles , is that only a single individual is needed to insert access needle 11 into a patient and then to anchor access needle 11 within the patient . where , as noted above , access needle 11 is implanted in the stomach of a patient as part of the early steps of a peg procedure ( or is implanted in the jejunum of a patient as part of the early steps of a pej procedure ), once access needle 11 has been implanted in the manner discussed above , a guidewire or a suture may be passed into the stomach ( or jejunum ) through lumen 59 of needle 15 . consequently , as can be appreciated , another benefit of access needle 11 is that needle 15 need not be removed from cannula 13 in order for a guidewire or suture to be inserted into the patient . it should be noted , however , that access needle 11 may be used for purposes other than for use in peg and pej procedures and that objects other than a guidewire or a suture may be delivered to a patient through lumen 59 of needle 15 . in another embodiment of the invention ( not shown ), access needle 11 is modified so that , instead of using needle handle 53 , slot 37 and proximal end 33 to position needle 15 at its proximal and distal positions , a ratchet - type mechanism is employed , such a ratchet - type mechanism being capable of additionally positioning needle 15 at one or more intermediate positions between said proximal and distal positions . in still another embodiment of the invention ( not shown ), access needle 11 may be modified by replacing stopper 17 with a balloon or expandable bladder that would be expanded by the operator with a syringe filled with air or water . the upper end of the needle would be wrapped with the air / water lines that lead to the bladder . prior to inflation , the bladder would be compressed between the needle and cannula . upon inflation , the bladder would expand out through openings in the cannula around the perimeter of the puncture to prevent the assembly from backing out . to remove the needle or cannula , the balloon would be deflated by the same means as inflation . the needle would be removed prior to the cannula since the pulling up on the needle would force any remaining bladder material up through the cannula and not disturb the incision site . the embodiments of the present invention described above are intended to be merely exemplary and those skilled in the art shall be able to make numerous variations and modifications to it without departing from the spirit of the present invention . for example , it is to be understood that anchoring mechanisms , other than those disclosed , could be used and that anchoring mechanisms could be deployed with other types of actuators , such as a screw system . all such variations and modifications are intended to be within the scope of the present invention as defined in the appended claims .
an access needle well - suited for percutaneous implantation in a body lumen , such as the stomach or the jejunum . in one embodiment , the access needle comprises a cannula , a needle , a retractable stopper and a spreader . the cannula is a tubular member having a proximal end , a distal end , a lumen and a pair of side windows providing access to the lumen . the needle is slidably mounted within the cannula lumen and comprises a needle stem and a needle handle , the needle stem having a proximal end , a distal end and a longitudinal lumen , the needle handle extending outwardly from the needle stem proximate to the proximal end thereof . the stopper is coupled to the needle stem for translational movement , the stopper comprising a pair of outwardly - biasing wings removably insertable through the side windows for engaging an interior surface of a patient . the spreader is mounted within the cannula and spreads the wings outwardly as the wings are inserted out the side windows .