Diaphragm entry for posterior surgical access

1. A Method of accessing posterior surfaces of a body organ in a patient via a minimally invasive procedure, the method comprising:

accessing a diaphragm through a first incision in an abdomen of the patient;

creating an opening in the diaphragm;

advancing an access device through the diaphragm into the thoracic cavity, where the access device comprises at least one working channel where a distal end of the access device is advanced into the thoracic cavity, spaced beyond the diaphragm and between adjacent organs in the thoracic cavity; and

separating the adjacent organs using the distal end of the access device such that the distal end of the access device forms a temporary cavity between the adjacent organs to create a space in the thoracic cavity exterior to a pericardium surrounding a heart.

2. The method of claim 1 , where the access device is inserted into the body to the thoracic cavity in a generally straight profile.

3. The method of claim 1 , further comprising coupling a visualization system to the working channel.

4. The method of claim 1 , further comprising inserting a scope-type device into the working channel to provide visual access to the posterior surface of the body organ.

5. The method of claim 4 , where the scope-type device comprises a 0 degree, 30 degree, or 60 degree scope.

6. The method of claim 1 , further comprising inserting at least one surgical instrument through the working channel into the temporary cavity.

7. The method of claim 6 , where the at least one surgical instrument comprises a plurality of surgical instruments.

8. The method of claim 1 , where the working channel comprises an oval cross-section.

9. The method of claim 1 , further comprising performing a surgical procedure on or near the body organ.

10. The method of claim 9 , further comprising creating at least a second incision in the patient to provide anterior visualization of the surgical procedure and where the access device provides posterior visualization of the surgical procedure.

11. The method of claim 1 , where the access device further comprises an aspiration lumen.

12. The method of claim 1 , further comprising creating a lesion on the posterior surface of the heart.

13. The method of claim 12 , where creating the lesion on the posterior surface of the heart comprises creating the lesion between a superior vena cava and a pulmonary vein.

14. The method of claim 12 , where creating the lesion on the posterior surface of the heart comprises creating the lesion across the right pulmonary veins.

15. The method of claim 12 , where creating the lesion on the posterior surface of the heart comprises creating the lesion across the left pulmonary veins.

16. The method of claim 12 , where creating the lesion on the posterior surface of the heart comprises creating the lesion across an atrial surface between pulmonary veins.

17. The method of claim 1 , further comprising creating a lesion on the posterior surface of the heart adjacent to a pulmonary vein without dissecting the pulmonary vein from cardiac tissue.

18. The method of claim 1 , where the body organ comprises a valve on a posterior surface of a heart, and where the access device is placed adjacent to a posterior valve annulus.

19. The method of claim 1 , where the body organ comprises an aorta.

20. The method of claim 1 , where the body organ comprises a pulmonary artery.

21. The method of claim 1 , where the access device comprises an expandable member on an exterior of the device; and

forming a temporary cavity by actuating the expandable member to separate adjacent tissue structures from the organ in the thoracic cavity.

22. The method of claim 21 , where the expandable member comprises at least one balloon member.

23. The method of claim 21 , where the expandable member on the access device conforms to the adjacent tissue structures while separating to stabilize the tissue structures.

24. The method of claim 21 , where the body organ comprises the heart, and where the access device is placed in the thoracic cavity between the heart and spine.

25. The method of claim 24 , where forming the temporary cavity comprises actuating the expandable member to separate the heart from an esophagus to expose a posterior surface of the heart.

26. The method of claim 25 , where the access device provides direct visualization and access to the posterior surface of the heart.

27. The method of claim 25 , further comprising creating a lesion on a side of a pulmonary vein without dissecting the pulmonary vein from a posterior surface of the heart.

28. The method of claim 27 , where creating the lesion on the side of the pulmonary vein comprises creating the lesion on each side of the pulmonary vein.

29. The method of claim 21 , were the body organ comprises the esophagus, and where the access device is placed behind the esophagus.

30. The method of claim 29 , where forming a temporary cavity comprises actuating the expandable member to separate the esophagus from esophageal vessels.

31. The method of claim 21 , where the expandable member expands in a non-uniform radial direction from the device to create the temporary cavity.

32. The method of claim 1 , where the access device further comprises a slotted opening at the distal end, and where the slotted opening permits access to a larger portion of the organ within the temporary cavity.