title: The effectiveness of rigid pericardial endoscopy for minimally invasive minor surgeries: cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation.
abstract: BACKGROUND
  The efficacy and safety of rigid pericardial endoscopy as the promising minimally invasive approach to the pericardial space was evaluated. Techniques for cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation were developed.
  
  
  METHODS
  Two swine and 5 canines were studied to evaluate the safety and efficacy of rigid pericardial endoscopy. After a double pericardiocentesis, a transurethral rigid endoscope was inserted into the pericardial space. The technique to obtain a clear visual field was examined, and acute complications such as hemodynamic changes and the effects on intra-pericardial pressure were evaluated. Using custom-made needles, pacemaker leads, and forceps, the applications for cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation were also evaluated.
  
  
  RESULTS
  The use of air, the detention of a stiff guide wire in the pericardial space, and the stretching of the pericardium with the rigid endoscope were all useful to obtain a clear visual field. A side-lying position also aided observation of the posterior side of the heart. As a cell transplantation methodology, we developed an ultrasonography-guided needle, which allows for the safe visualization of transplantation without major complications. Pacemaker leads were safely and properly implanted, which provides a better outcome for cardiac resynchronizing therapy. Furthermore, the success of clear visualization of the pulmonary veins enabled us to perform epicardial ablation.
  
  
  CONCLUSIONS
  Rigid pericardial endoscopy holds promise as a safe method for minimally invasive cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation by allowing clear visualization of the pericardial space.
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. kimura@z7.keio.jp
authors.forename: Takehiro
authors.initials: T
authors.lastname: Kimura
authors.forename: Shunichiro
authors.initials: S
authors.lastname: Miyoshi
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.forename: Kotaro
authors.initials: K
authors.lastname: Fukumoto
authors.forename: Kojiro
authors.initials: K
authors.lastname: Tanimoto
authors.forename: Kyoko
authors.initials: K
authors.lastname: Soejima
authors.forename: Seiji
authors.initials: S
authors.lastname: Takatsuki
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fukuda
mesh_terms: D055011:Ablation Techniques; D000818:Animals; D001794:Blood Pressure; D058406:Cardiac Resynchronization Therapy; D006348:Cardiac Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D017690:Cell Transplantation / Q000295:instrumentation / Q000379:methods*; D004285:Dogs; D004452:Echocardiography; D004724:Endoscopy / Q000295:instrumentation* / Q000379:methods; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D008962:Models, Theoretical; D010138:Pacemaker, Artificial; D010496:Pericardium / Q000601:surgery*; D025321:Surgery, Computer-Assisted; D013552:Swine