Multi lumen access device

A surgical access device includes a housing, a tubular member extending from the housing, a valve disposed on the housing, and a tip member at a distal end of the tubular member. The housing includes a seal and the tubular member includes a plurality of lumens extending therethrough. The valve is fluidly coupled with a first lumen of the plurality of lumens and the tip member includes a first port that is aligned and fluidly coupled with the first lumen of the plurality of lumens. The first port is configured to direct a fluid towards a predetermined location.

TECHNICAL FIELD

The present disclosure relates to a surgical access device. More particularly, the present disclosure relates to a surgical access device having multiple lumens.

BACKGROUND OF RELATED ART

Minimally invasive surgery has become increasingly popular in recent years. Minimally invasive surgery eliminates the need to cut a large incision in a patient, thereby reducing discomfort, recovery time, and many of the deleterious side effects associated with traditional open surgery. Minimally invasive viewing instruments (e.g., laparoscopes and endoscopes) are optical instruments to facilitate the viewing of internal tissues and/or organs.

Laparoscopic surgery involves the placement of a laparoscope in a small incision in the abdominal wall of a patient to view the surgical site. Endoscopic surgery involves the placement of an endoscope in a naturally occurring orifice (e.g., mouth, nose, anus, urethra, or vagina) to view the surgical site. Other minimally invasive surgical procedures include video assisted thoracic surgery and cardiovascular surgery conducted through small incisions between the ribs. These procedures also utilize scopes to view the surgical site.

A typical minimally invasive viewing instrument (e.g., a laparoscope or an endoscope) includes a housing, an elongated shaft extending from one end of the housing, and a lens that is provided in the distal end of the shaft. A camera viewfinder extends from the other end of the housing. A camera is connected to the housing and transmits images of the surgical field viewed through the lens to a monitor on which the images are displayed. During a surgical procedure, the distal end portion of the shaft is extended into the patient, while the proximal end portion of the shaft, the housing, and the camera viewfinder remain outside the patient. In this manner, the laparoscope/endoscope is positioned and adjusted to view particular anatomical structures in the surgical field on the monitor.

During insertion of an endoscope or a laparoscope into the body and during the surgical procedure, debris (e.g., organic matter and moisture) may be deposited on the lens of the endoscope. The buildup of debris and condensation on the lens impairs visualization of the surgical site, and often necessitates cleaning of the lens. This may require the surgeon to remove, clean, and re-insert the endoscope one or more times during a surgical procedure to maintain a clear image of the surgical site. Cleaning of the instruments often necessitates removal of the instruments from the surgical site, thereby increasing the time required to perform the surgical procedure.

Systems for cleaning viewing devices such as endoscopes and laparoscopes are known in the art. Examples of known systems and techniques are described in U.S. Patent Application Publication No. 2009/0234193 to Weisenburgh, II et al., U.S. Pat. No. 8,047,215 to Sasaki, and U.S. Pat. No. 8,888,689 to Poll et al.

SUMMARY

According to one embodiment of the present disclosure, a surgical access device includes a housing including a seal, a tubular member extending from the housing, the tubular member including a plurality of lumens extending therethrough, a valve disposed on the housing and fluidly coupled with a first lumen of the plurality of lumens, and a tip member disposed at a distal end of the tubular member, the tip member including a first port that is aligned and fluidly coupled with the first lumen of the plurality of lumens, the first port configured to direct a fluid towards a predetermined location.

The surgical access device may include the tubular member with an inner tube and an outer tube defining an annular chamber therebetween. The annular chamber may be fluidly coupled to the valve and the first lumen of the plurality of lumens is disposed within the annular chamber.

The surgical access device may include the annular chamber having the second lumen of the plurality of lumens extending therethrough. The second lumen of the plurality of lumens may be fluidly coupled to a second port located in the tip member. The second port may be configured to direct a fluid towards the predetermined location.

The surgical access device of may include the inner tubular member defining a third lumen of the plurality of lumens extending therethrough.

The surgical access device may include the first and second lumens of the plurality of lumens being radially spaced apart.

The surgical access device may include the predetermined location lying along a central longitudinal axis of the tubular member.

The surgical access device may include the valve fluidly coupling a source of fluid to the first and second lumens of the plurality of lumens.

The surgical access device may include the first port being offset from the second port by 180°.

The surgical access device may include each of the first and second ports having a spray pattern that covers 180° of the predetermined location.

The surgical access device may include the first port and the second port being radially offset in a range between about 60° and about 120°.

The surgical access device may include the channel being configured to receive a viewing instrument therethrough.

The surgical access device may be insertable through an opening in tissue.

According to an embodiment of the present disclosure, a method for cleaning a viewing instrument includes moving a lens of a viewing instrument towards a target area defined in a channel of a tubular member, the tubular member including an inner tube disposed in an outer tube defining an annular chamber therebetween, and dispensing a cleaning fluid from a first port towards the target area, the first port located on a tip member, the tip member located at a distal end of the tubular member, the first port fluidly coupled to a first lumen of a plurality of lumens that is disposed in the annular chamber, the first lumen of the plurality of lumens fluidly coupled to a valve for controlling flow of the cleaning fluid.

The method may include dispensing the cleaning fluid from a second port towards the target area. The second port may be located on the tip member and fluidly coupled to a second lumen of the plurality of lumens that is disposed in the annular chamber. The second lumen of the plurality of lumens may be fluidly coupled to the valve for controlling flow of the cleaning fluid.

The method may include moving the optical portion into a third lumen of the plurality of lumens defined by the inner tube.

The method may further include positioning the tubular member through tissue of a patient. The tubular member may extend from a housing with a seal member.

The method may further include repositioning the lens of the viewing instrument along a longitudinal axis of the tubular member such that the lens moves into and out of the predetermined region.

The method may further include viewing an image on a monitor coupled to the viewing instrument during repositioning of the lens.

According to an embodiment of the present disclosure a surgical access device includes a housing with a seal, a tubular member extends from the housing with lumens extending therethrough, a valve disposed on the housing that is fluidly coupled with the lumens, and a tip member disposed at a distal end of the tubular member, the tip member including a first port aligned and fluidly coupled with one of the lumens, the first port including a cavity having a tapered configuration extending between a proximal region and a distal region, the proximal region having a first width and the distal region having a second width less than the first width.

The surgical access device may include a second port with a pocket extending between proximal and distal regions thereof, the pocket having a uniform width.

The surgical access device may have a velocity of a fluid exiting the first port greater than a velocity of a fluid exiting the second port.

The surgical access device may include a first duct of the first port that has a length equal to a length of a second duct of the second port.

The surgical access device may have an increased velocity of a fluid passing from the proximal region of the first port to the distal region of the first port as a result of the tapered configuration of the cavity.

The surgical access device may include the tubular member having an inner tube and an outer tube that define an annular chamber therebetween. The annular chamber may be fluidly coupled to the valve. The lumens may be disposed within the annular chamber and radially spaced apart.

The surgical access device may include the first port being offset from the second port by 180°.

The surgical access device may include the first port and the second port being radially offset in a range between about 60° and about 120°.

The surgical access device may include a third port, the third port having a cavity with a tapered configuration comparable to the tapered configuration of the first port.

The surgical access device may include a channel extending through the tubular member, the channel configured to receive a viewing instrument therethrough.

The surgical access device may include a central longitudinal axis defined through the tubular member, the first port is spaced a first distance from the central longitudinal axis of the tubular member and the third port is spaced a third distance from the central longitudinal axis of the tubular member. The first distance may be different from the third distance.

The surgical access device may include a portion of the distal region of the first port being angled towards the central longitudinal axis of the tubular member such that fluid flow through the first port is directed towards the central longitudinal axis of the tubular member.

The surgical access device may include a supply of insufflation fluid coupled to a first inlet of a multi-way valve and a supply of cleaning fluid coupled to a second inlet of the multi-way valve. An outlet of the multi-way valve may be fluidly coupled to an inlet of the valve disposed on the housing of the surgical access device.

The surgical access device may include the supply of cleaning fluid having a bulb. Actuating the bulb may deliver a quantity of cleaning fluid to the second inlet of the multi-way valve.

The surgical access device may include the multi-way valve having a button that is transitionable between a first position that couples the second inlet port to the outlet port and a second position that couples the first inlet port to the outlet port.

DETAILED DESCRIPTION

Embodiments of the presently disclosed surgical access device are described in detail with reference to the drawings, wherein like reference numerals designate corresponding elements in each of the several views. As used herein, the term “distal” refers to that portion of the instrument, or component thereof which is farther from the user while the term “proximal” refers to that portion of the instrument or component thereof which is closer to the user.

Various embodiments of a surgical access device are described herein. With initial reference toFIGS. 1 and 2, a surgical access device100is illustrated. The components of the surgical access device100may be formed from suitable biocompatible materials such as medical grade metals (e.g., stainless steel), polymeric materials (e.g., polycarbonate), or combinations thereof. The surgical access device100includes a housing160. A collar170is insertable through the housing160and a tubular member120extends from a distal end of the collar170. A tip member140is located at a distal end of the tubular member120. A seal assembly180is releasably coupled to a proximal end of the housing160. An example of a suitable seal assembly usable with the presently disclosed surgical access device100is described in U.S. Pat. No. 10,022,149, issued on Jul. 17, 2018, the entire contents of which are hereby incorporated by reference. It is contemplated that the tubular member120may include a plurality of spaced annular ribs along a portion of a length of the tubular member to improve retention of the surgical access device100in an opening through body tissue. An example of a cannula with annular ribs is disclosed in U.S. Pat. No. 8,740,925, issued on Jun. 3, 2014, the entire contents of which are hereby incorporated by reference. Additionally, the surgical access device100may include a fixation device such as a balloon, an umbrella, a foam collar, etc. An example of a surgical access device with a foam collar and an anchoring balloon is disclosed in U.S. Pat. No. 7,963,975, issued on Jun. 21, 2011, the entire contents of which are hereby incorporated by reference. The surgical access device100may include a combination of ribs, balloons, foam collars, or other known structures for securing an access device in body tissue.

The housing160has open proximal and distal ends defining a cavity166therein. The proximal opening has a larger diameter than the distal opening. A duck bill or zero-closure seal162is positioned in the cavity166of the housing160(FIG. 7). The zero-closure seal162is formed from a suitable resilient material (e.g., silicone) and is configured to prevent fluids from exiting proximally through the housing160in the absence of a surgical instrument (e.g., an endoscope) inserted therethrough. The zero-closure seal162is sandwiched between the housing160and a proximally positioned cap164. The cap164is attached to the housing160to retain the zero-closure seal162in position and provide a fluid-tight boundary for the housing160. The cap164may be attached to the housing160using ultrasonic or RF welding, adhesives, or any other suitable technique for the materials involved. The housing160further includes a port168having an opening169therethrough with a valve150positioned therein. The valve150has a lever152that is rotatable about an axis of the valve150allowing the user to open and close the valve150. The lever152is rotatable between an open position of the valve150and a closed position of the valve150. The lever152may be positioned in one of a plurality of intermediate positions allowing the user to adjust the flow rate of a fluid through the valve150. With additional reference toFIGS. 4, 7, and 10, the valve150is fluidly coupled to an annular conduit174in the collar170. In particular, the valve150is positioned in the opening169of port168and is aligned with an orifice172of the collar170. This alignment allows fluid to flow through the valve150, the orifice172, and into the annular conduit174. In turn, the annular conduit174is open at the proximal end of the collar170for fluidly coupling with lumens126a-fin the tubular member120(FIGS. 7 and 10) as will be described in detail hereinbelow.

Referring now toFIGS. 1-4, 7, and 11, the tubular member120extends distally from the collar170and is formed of a suitable biocompatible material. The tubular member120is attached to the collar170using known techniques such as RF welding, ultrasonic welding, adhesives, etc. The tubular member120may be partially or completely transparent, translucent, or opaque. A passage or channel118extends between open proximal and distal ends of the tubular member120. As illustrated, the tubular member120has substantially uniform inner and outer diameters. It is contemplated that either the inner diameter or the outer diameter may vary along a length of the tubular member120such that the tubular member120is tapered with one of the proximal or distal ends having different diameters from the other of the proximal or distal ends. It is further contemplated that the outer diameter of the tubular member120may be tapered such that the distal end has a smaller outer diameter than the proximal end while the inner diameter of the tubular member120does not vary along the length of the tubular member120.

Further, the tubular member120has lumens126a-fdefined between an inner wall122of the tubular member120and an outer wall124of the tubular member120. Each lumen126extends longitudinally along a length of the tubular member120. The inner and outer walls122,124have substantially the same length, but are axially staggered such that a recess132is defined in the distal region of the tubular member120(FIG. 5) and an extension134is defined in the proximal region of the tubular member120(FIG. 4). The number of lumens126disposed between the inner and outer walls122,124of the tubular member120may vary. In embodiments, there may be as few as one or two lumens126and in other embodiments, there may be as many as six lumens126as illustrated inFIG. 3. However, this does not preclude a greater number of lumens126being defined between the inner and outer walls122,124of the tubular member120.

Each lumen126is fluidly coupled to the annular conduit174of the collar170such that fluid may be supplied to the lumens from a source of fluid FS (FIG. 1) that is coupled to the valve150using tubing T. The outlet156of the valve150is fluidly coupled to the annular conduit174via the orifice172. The fluid may be a cleaning fluid including, but not limited to, an insufflation fluid (e.g., CO2), sterile saline, a surfactant solution, etc. The fluid flow may be through the valve150towards the lumens126a-for through the valve150towards the source of fluid FS as determined by the differential pressure between the lumens126a-fand an inlet154of the valve150.

The tip member140is located at the distal end of the tubular member120. With additional reference toFIGS. 5, 6, and 12, the tip member140includes a number of ports142a-fequal to the number of lumens126a-fof the tubular member120. Each port142includes a duct144that is fluidly coupled to a corresponding lumen126of the tubular member120. Each duct144extends longitudinally through the tip member140and fluidly couples one of the lumens126with an outlet146of the port142. Each outlet146is configured to direct fluid to a predetermined or target region in the tip member140such that the output from each port142is directed to the same predetermined region resulting in an increase in the volume of fluid in the predetermined region. One or more of the outlets146may be configured to generate turbulent fluid flow. As shown inFIG. 8, a surface of the duct144of each port142is angled with respect to a longitudinal axis of the tubular member120which functions to direct the fluid from the duct144to the outlet146of the port142towards the predetermined region. The tip member140has a proximally extending portion147with an outer diameter is less than an outer diameter of a body145of tip member140and the proximally extending portion147is receivable in the recess132of the tubular member120(FIGS. 5 and 6). A distal portion of the tip member140is angled such that one location extends further distally than another location (FIG. 5). The tip member140is attached to the tubular member120using known techniques such as RF welding, ultrasonic welding, adhesives, etc. It is envisioned that one lumen126may be fluidly coupled to a plurality of ports142. In one non-limiting example, the tubular member120may include three lumens126a-cthat are fluidly coupled to six ports142a-fwhere each lumen126is coupled to two ports142. Other combinations of lumens126and ports142are also possible.

In the illustrated embodiment with six ports, each port142is radially offset by 60° from the adjacent ports142. In instances where greater or fewer than six ports are disposed in the tip member140, the amount of radial offset of each port142from an adjacent port142may be defined by dividing 360° by the number of ports142in the distal tip (e.g., four ports would be radially offset by 90° and three ports would be radially offset by 120°). It is contemplated that the radial offset between ports142may not be uniform to create a different spray pattern of fluid (e.g., four ports that are radially offset by 30°).

An alternate embodiment of a tip member is illustrated inFIGS. 6A-6Fand identified as tip member240. Tip member240may be substituted for tip member140and positioned at the distal end of the tubular member120. Tip member240has a proximally extending portion247with an outer diameter is less than an outer diameter of a body245of tip member240and the proximally extending portion247is receivable in the recess132of the tubular member120(FIG. 5). A distal portion of the tip member240is angled such that one location extends further distally than another location (FIG. 6D). The tip member240is attached to the tubular member120using known techniques such as RF welding, ultrasonic welding, adhesives, etc. Similar to tip member140, tip member240includes a number of ports242a-fequal to the number of lumens126a-fof the tubular member120. In the illustrated embodiment, there are six ports and six lumens. In other embodiments, the number of ports and lumens may be lesser or greater than six. Further still, other embodiments may include multiple ports fluidly coupled to a single lumen. In one non-limiting example, each lumen may be coupled to two or more ports. Further, it is contemplated that one lumen may be fluidly coupled to two ports, a second lumen may be fluidly coupled to a single port, and a third lumen may be fluidly coupled to three ports. Various combinations are also within the scope of the present disclosure. Each port242includes a duct244that is fluidly coupled to a corresponding lumen126of the tubular member120. Each duct244extends longitudinally through the tip member240and fluidly couples one of the lumens126with an outlet246of the port242. Each outlet246is configured to direct fluid to a predetermined or target region in the tip member240such that the output from each port242is directed to the same predetermined region resulting in an increase in the volume of fluid in the predetermined region. One or more of the outlets246may be configured to generate turbulent fluid flow. As illustrated inFIGS. 6E and 6F, the duct244of each port includes a floor241that extends along and parallel with a longitudinal axis “X” (FIG. 3) of the tubular member120and a face243that tapers towards a radial center of the tip member240. The face243defines an angle with respect to a central longitudinal axis “Y” (FIG. 6G) of the tip member240. This arrangement directs the fluid (i.e., insufflation or cleaning) from the duct244to the outlet246of the port242and towards a predetermined region of the tip member240. When attached to the tubular member120, the central longitudinal axis “Y” of the tip member240is aligned with the central longitudinal axis “X” of the tubular member120. This is substantially similar to the configuration of each of ports142a-fas seen inFIGS. 6 and 8.

In the illustrated embodiment with six ports, each port242is radially offset by 60° from the adjacent ports242. In instances where greater or fewer than six ports are disposed in the tip member240, the amount of radial offset of each port242from an adjacent port242may be defined by dividing 360° by the number of ports242in the distal tip (e.g., four ports would be radially offset by 90° and three ports would be radially offset by 120°). It is contemplated that the radial offset between ports242may not be uniform to create a different spray pattern of fluid (e.g., four ports that are radially offset by 30°).

Referring now toFIGS. 6B-6D, in addition to the floor241and the face243, each port242further includes opposing sidewalls249that are angled with respect to a central longitudinal axis of the port242such that a distance between opposing sidewalls249in a proximal region of the port242is greater than a distance between opposing sidewalls249in a distal region of the port242. The tapered arrangement of opposing sidewalls249accelerates the fluid passing through the port242. When the area is reduced as the opposing sidewalls249taper towards each other, the pressure decreases resulting in an increase in fluid velocity. Increasing the velocity of the insufflation fluid or cleaning fluid aids in removing debris on a viewing element or lens of a minimally invasive viewing instrument when the viewing element is positioned in the stream of the insufflation or cleaning fluid. Additionally, the increased velocity helps minimize accumulation of debris on the viewing element when the viewing element is positioned in the stream of the insufflation or cleaning fluid.

With reference now toFIGS. 6G and 6H, the ports142,242may not be in the same plane. In particular, one port142,242may be closer to the outer wall122while an adjacent port142,242may be closer to the inner wall124such that the ports142,242are not on the same plane. It is also contemplated that this staggered arrangement may be repeated for all the ports142,242where one or more ports are on one plane while other ports142,242are on different planes (e.g., three ports located on three different planes). Other combinations of non-planar ports are also envisioned. Further, the ports142,242may be arranged in a helical pattern and the ports142,242may be angled with respect to the longitudinal axis of the surgical access device100to provide a desired spray pattern. Additionally, the ports142,242may be staggered longitudinally.

The fluid flow in the predetermined region is usable to remove debris from an outer surface of a lens of a minimally invasive viewing instrument or an endoscope200(FIG. 13). The endoscope200has a housing220with a shaft210extending therefrom. A viewing element or lens212is located at the distal end of the shaft210. A monitor M is coupled to the housing220of the endoscope200using cable C. The monitor M allows the clinician to see what is within the field of view of the lens212of the endoscope200. This allows the clinician to observe the surgical site. During a surgical procedure, the endoscope200extends through the surgical access device100such that the lens212is in position in the surgical site providing the clinician with a view of the surgical site on the monitor M. When the lens212of the endoscope200is to be cleaned, the clinician moves the lens212of the endoscope200from the surgical site into the chamber118of the tubular member120such that an outer surface of the lens212is in the predetermined region such that the fluid directed into the predetermined region by the outlets146a-fof the ports142a-fimpinges upon the outer surface of the lens212to gently dislodge particulate debris without damaging the outer surface of the lens212. Additionally or alternatively, the clinician may move the endoscope200distally and proximally into and out of the predetermined region to assist removing debris from the lens212. During the movement of the endoscope200, the clinician may check the monitor to locate the position of the lens212relative to the predetermined region. This allows the clinician to more accurately position the lens212of the endoscope200for cleaning and also determine when the lens212of the endoscope is sufficiently cleaned. This may be performed with or without a change in the flow rate of fluid into the predetermined region to assist in cleaning debris from the lens212. This cleans the outer surface of the lens212such that the clinician has an unobstructed view through the lens212of the endoscope200. This arrangement allows the clinician to clean the lens212of the endoscope200without removing the endoscope200from the surgical site. As cleaning the lens212of the endoscope200may occur dozens of times during a surgical procedure, being able to clean the lens212without removing the endoscope200from the access device will streamline the surgical procedure allowing the clinician to perform the surgical procedure more efficiently and in less time as compared to removing the endoscope200multiple times during a procedure to clean it. Additionally, allowing the endoscope200to remain in the access device for cleaning reduces the risk of damaging the zero closure seal during repeated removals and insertions of the endoscope200for cleaning.

As assembled for use, fluid travels from the source of fluid FS through tubing to the inlet of the valve150. Repositioning the lever152of the valve150controls the rate of fluid flow through the valve150from zero flow (i.e., valve150is fully shut) to full flow (i.e., valve150is fully open). With the valve150either partially or fully open, the fluid flows through the body of the valve150and exits the outlet156of the valve150where it enters the annular conduit174of the collar170. The annular conduit174is fluidly coupled to the lumens126a-fdefined between the inner and outer walls122,124of the tubular member120such that fluid exiting the outlet156of the valve150is directed by the annular conduit174to the lumens126a-fand ultimately to the outlets146a-fof the ports142a-f. Although fluid flow is described as traveling from the source of fluid FS to the outlets146a-fof the ports142a-f, it is contemplated that fluid may flow from the outlets146a-fof the ports142a-ftowards the valve150and an associated vacuum source or fluid source FS with a lower pressure than the pressure at the outlets146a-fof the ports142a-f.

FIGS. 14A-Cillustrate various flow paths for fluid between the fluid source FS and the ports142a-f,242a-fof their respective tip members142,242(FIGS. 6, 6A). As illustrated inFIG. 14A, the fluid source FS is a source of insufflation fluid (e.g., CO2) with a fluid output that is coupled to the port168(FIG. 2) via the valve150. A source (e.g., a squeeze bulb) of a cleaning fluid (e.g., saline) CS is coupled to the fluid source FS through a check valve180. As the source of cleaning fluid CS is in-line (i.e., serial connection) with the fluid source FS, the check valve180allows the cleaning fluid to be injected into the flow path for the insufflation fluid while preventing the insufflation fluid from entering the source of cleaning fluid CS. The input to the valve150is insufflation fluid, insufflation fluid mixed with the cleaning fluid, or cleaning fluid. Once the particular fluid or fluids enter the port168(FIG. 2) via valve150, the fluid or fluids are communicated to the ports142a-f,242a-fvia lumens126a-f(FIG. 4). In another embodiment shown inFIG. 14B, the fluid source FS and the source of cleaning fluid CS are disposed in a parallel configuration. As in the embodiment ofFIG. 14A, the output of the source of cleaning fluid CS includes check valve180to prevent insufflation fluid from entering the source of cleaning fluid CS. Similar to the embodiment ofFIG. 14A, the output of either the fluid source FS or the source of cleaning fluid CS is coupled to the port168(FIG. 2) via the valve150. Akin to the embodiment ofFIG. 14A, this arrangement allows insufflation fluid, a mixture of insufflation fluid and cleaning fluid, or cleaning fluid to be delivered to the port168(FIG. 2) via the valve150. As before, the particular fluid or fluids enter the port168(FIG. 2) via valve150and are then communicated to the ports142a-f,242a-fvia lumens126a-f(FIG. 4). In a further embodiment shown inFIG. 14C, the fluid source FS and the source of cleaning fluid CS are independently coupled to a valve150′. Valve150′ is a three-way valve with separate input connections for the insufflation fluid and the cleaning fluid. As in the previous embodiments, the connection between the source of cleaning fluid CS and the valve150′ includes check valve180that allows the source of cleaning fluid CS to supply cleaning fluid while preventing insufflation fluid from entering the source of cleaning fluid CS. The valve150′ allows the user to select between supplying insufflation fluid, supplying cleaning fluid, or supplying a mixture of insufflation and cleaning fluids. As in the previous embodiments, the particular fluid or fluids are delivered to the port168(FIG. 2) via the valve150′ and are then communicated to the ports142a-f,242a-fvia lumens126a-f(FIG. 4). Either the fluid source FS or the source of cleaning fluid CS may include a heater and pump for heating the cleaning fluid (e.g., saline). The heater may be a blood warmer or an on-demand heater.