Direct vision in minimally invasive epicardial procedures: preliminary tests of prototype instrumentation

Abstract

This study investigated the use of direct visualization to enhance minimally invasive epicardial procedures. A commercially available miniature camera was placed in a prototype subxiphoid introducer needle and bench top, in vitro and in vivo tests of system performance were made during simulated and actual attempts at pericardial access and cardio-endoscopy. This system had an unshielded field of view of 100° and a resolution of 220 × 224 pixels. When a sleeve used to maintain depth of field was slid past the distal tip of the camera probe, the field of view would decrease by ≈15° per millimetre of sleeve extension, but without loss of image quality. While tests during in vivo subxiphoid access in a porcine model revealed that the pericardial membrane was difficult to localize, the results also showed excellent resolution of the coronary arteries on the epicardial surface. These findings and potential improvements are discussed in detail.

• Endoscopy
• epicardial access
• in vivo models
• pericardium
• subxiphoid approach

Acknowledgements

The authors thank our colleagues Pamela Bunes, Kathryne Carr, Colin Rolph, Cinnamon Larson and Srijoy Mahapatra for their interest in and assistance with our work. The authors also thank the administration and staff of Synchrony Labs for all the arrangements, approvals and activities needed to carry out the in vivo study. In addition, we thank Mr Lior Lurie of Medigus Ltd., Omer, Israel for several helpful technical discussions and assistance with procurement, operation and testing of the Micro ScoutCam™ apparatus.

Declaration of interest

Co-authors Theran and Gillies hold equity positions in EpiEP, Inc. Co-author Gillies may receive royalties from his institution on licenses of the relevant intellectual properties by it to EpiEP, Inc.