Abstract: Methods and devices for pericardial access are described. One embodiment of a device includes a distal portion with a visualization element, along with a retractable access element. The distal portion is inserted into and navigates through the body to locate the pericardium with the aid of the visualization element. The access element is then extended and used to create an access site in the pericardium, again with the aid of the visualization element. The methods and devices may also be used to access other internal cavities, other soft tissues and organs, and the mediastinal space.