Abstract:
A medical apparatus for dispensing a biologically active liquid includes a trocar-cannula complex configured to be inserted through selected tissue of a patient and including a cannula and an elongated trocar having a closed converging tip at a distal end thereof and a fluid delivery channel. The cannula includes a working channel through which medical instruments may be advanced. A fluid delivery device may be removably coupled to the cannula. The fluid delivery device includes an inner portion adapted to receive the biologically active liquid, an outer surface adapted to contact the tissue of the patient, and at least one pathway from the inner portion to the outer surface for delivering the biologically active liquid from the inner portion to the outer surface when the outer surface is in contact with the tissue.

Description:
[0001]     The present application is a continuation-in-part of U.S. patent application Ser. No. 10/786,647, filed on Feb. 25, 2004 (pending), which is a continuation of PCT Serial No. PCT/US02/29356 filed on Sep. 17, 2002 (expired) which claims the priority of U.S. Provisional Patent Application Ser. No. 60/325,806, filed on Sep. 28, 2001 (now abandoned) and U.S. Ser. No. 60/341,032, filed on Dec. 12, 2001 (now abandoned), and which is a continuation-in-part of U.S. Ser. No. 09/934,399, filed on Aug. 21, 2001 (now U.S. Pat. No. 6,695,815) which is a continuation of U.S. Ser. No. 09/511,100 filed on Feb. 23, 2000 (now U.S. Pat. No. 6,302,873). The present application is also related to U.S. Provisional Application Ser. No. 60/552,048, filed on Mar. 10, 2004 (pending). The disclosures of each of these prior related applications are hereby fully incorporated by reference herein. 
     
    
     FIELD OF THE INVENTION  
       [0002]     This invention generally relates to trocar assemblies and related accessories and, more specifically, to devices used to irrigate a port site during minimally invasive surgery.  
       BACKGROUND OF THE INVENTION  
       [0003]     Minimally invasive surgery is a popular alternative to more traditional surgery. This is due to the fact that minimally invasive surgery generally results in less pain and shorter hospital stays for the patient. Also, the cost of performing a surgical procedure through minimally invasive techniques can be substantially less than more traditional surgical approaches.  
         [0004]     Minimally invasive surgical techniques require access into the body of a patient through a small working channel of an apparatus known as a trocar-cannula complex or assembly. A relatively small access incision is made in the patient at the appropriate location to receive the trocar-cannula complex. When the trocar-cannula complex is combined with long, narrow instruments, the resulting assembly allows a surgeon to work inside the body through the small access incision or port site. This approach has resulted in the aforementioned clinical advantages and extensive health care cost savings.  
         [0005]     Traditionally, the trocar-cannula complex has been configured with three parts. The first part is the top portion and is referred to in the medical industry as the hub. The hub defines the entrance to the trocar-cannula complex and also includes various seals and air insufflation components. The second part is the trocar, which is a long, narrow blade or closed, converging tip extendable through a cannula to allow smooth penetration into the body of the patient through the tissue layers. The third portion is an outer cannula which is a tubular member of the complex adapted to pass into the body cavity. The outer cannula provides an interface between the patient&#39;s tissue at the access incision or port site and the trocar assembly.  
         [0006]     Minimally invasive surgery has grown in popularity in recent years and many new types of trocar-cannula products have been proposed and introduced to address different surgical needs and procedures. The various trocar-cannula complexes include reusable and disposable cannulas and trocars, as well as hybrid varieties that comprise combinations of reusable and disposable components of the trocar-cannula complexes. A complex which is a combination of reusable and disposable components is known as a resposable device. Such devices continue to improve surgical outcomes and economics.  
         [0007]     Animal studies on cancer treatments involving the performance of minimally invasive surgery point to a growing body of evidence which supports the concept of delivering an irrigant to the port site before, during or after the surgical procedure. In order for surgeons to continue with a minimally invasive procedure, such as a laparoscopic, arthroscopic, or thoracoscopic case, the cannula must stay in the port site of the patient. Thus, the irrigants were delivered by a syringe and needle and included substances such as betadine, saline and lidocaine. These studies showed that irrigating the port site with such substances immediately after the surgical procedure beneficially resulted in a lower incidence of infection or less pain, depending on the irrigant. However, the technique also resulted in increased operative time and increased exposure of the surgical staff to needle sticks. In addition, the potential for contaminants to spread to the port site during the surgery has been well documented. Irrigation performed only at the end of the surgical procedure unfortunately cannot reduce patient exposure to contaminants during the procedure.  
         [0008]     The above-incorporated patents and patent applications disclose various manners of delivering irrigants to a port site.  
         [0009]     There is a need for even more effective and efficient delivery of fluids to an access point or port in the body of a patient before, during, and/or after the performance of minimally invasive surgery. Such delivery of fluid(s) could assist in patient treatment, such as through the delivery of cancer treatment medication or other medication, as well as reduction of port site contamination and infection, and reduction of post-operative pain. Other uses of the invention may be made in connection with delivering any desired fluid to a patient.  
       SUMMARY OF THE INVENTION  
       [0010]     The present invention generally relates to a medical apparatus for dispensing a biologically active fluid or liquid on the outside of a cannula. The apparatus includes a fluid delivery device which is configured to be removable coupled to the cannula and includes an inner portion adapted to receive the biologically active liquid and an outer surface adapted to contact any selected tissue of the patient. At least one pathway extends from the inner portion to the outer surface for delivering the biologically active liquid to the outer surface when the outer surface is in contact with the tissue.  
         [0011]     Various embodiments are disclosed in which, for example, the inner portion of the fluid delivery device may further comprise a sponge material, a void space, multiple discrete void spaces, etc., all of which serve to convey the liquid to the outer surface of the device at an appropriate time, either immediately upon insertion of the trocar-cannula complex into the port site of the patient, or at some desired time or times after insertion of the trocar-cannula complex. As additional examples, the plurality of discrete void spaces may further comprise a plurality of fluid delivery channels extending generally along the length of the cannula. For example, these channels may be parallel to the length of the cannula or may spiral along the length of the cannula, or be formed in any other configuration. The fluid delivery device may be removably engaged with the cannula in many different manners, such as through frictional engagement or any other type of mechanical engagement or adhesive engagement.  
         [0012]     An actuator may be coupled to the fluid delivery device and configured to force the biologically active liquid along the pathway to the outer surface into contact with the tissue of the patient. The actuator, for example, may comprise a pump mechanism of many different types. For example, the actuator may comprise a syringe, or another type of movable piston-type pump, or screw-type pump. In another embodiment, the pump mechanism comprises one or more flexible members similar to primer mechanisms which may be depressed by the user to displace fluid from the inner portion along the pathway to the tissue of the patient. The fluid delivery device may include more than one actuator and more than one type of actuator. For example, a preselected amount of the liquid may be initially contained in the fluid delivery device and delivered to the patient via one pump mechanism and, if necessary, a second pump mechanism such as a syringe may deliver an additional amount of the same liquid or a different liquid, for example, if the first stored amount of liquid is depleted during the surgical procedure.  
         [0013]     In accordance with another aspect of the invention, a fluid path selection device may be operatively coupled with the fluid delivery device for selectively allowing the biologically active liquid to be dispensed along different portions of the length of the fluid delivery device. For example, in one position fluid may be dispensed into one or more channels which release the liquid along a first  1 cm length portion of the fluid delivery device, and in a second position the fluid is released along a second 1 cm length portion of the fluid delivery device. Alternatively, or in addition, the fluid path selection device may be adjusted to deliver fluid along preselected shorter or longer extents of the fluid delivery device. This type of adjustability in the fluid exits allows, for example, for fluid to be accurately delivered to an appropriate location depending on the tissue requirements of the patient. Typically, this will mean delivering the fluid to the tissue between the skin of the patient and an underlying body cavity or space in which a procedure is undertaken.  
         [0014]     A method of performing a minimally invasive surgical procedure in accordance with the invention generally involves affixing the removable fluid delivery device to the cannula portion of a trocar-cannula complex, and introducing the trocar-cannula complex and the fluid delivery device through a port site of a patient during, for example, laparoscopic, arthroscopic, or thoracoscopic cases. Fluid is then delivered from a fluid passage in the fluid delivery device to the outside surface thereof and into contact with the tissue of the patient within the port site. Various biologically active liquids may be delivered in this manner, including irrigants, pain medication, tissue adhesives, or any other liquid substance which is desired at the port site.  
         [0015]     It will be understood that various advantages and additional features of the invention will become more readily apparent to those of ordinary skill upon review of the following detailed description of the preferred embodiments taken in conjunction with the accompanying drawings. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0016]      FIG. 1  is a disassembled perspective view of a fluid delivery device constructed in accordance with a first embodiment of the invention.  
         [0017]      FIG. 2A  is a partially sectioned perspective view of a trocar-cannula complex or assembly including the fluid delivery device of  FIG. 1 .  
         [0018]      FIG. 2B  is a perspective view, again partially cross sectioned and shown inserted into a patient&#39;s tissue.  
         [0019]      FIG. 3A  is a longitudinal cross sectional view of a fluid delivery device constructed in accordance with another embodiment of the invention.  
         [0020]      FIG. 3B  is a cross sectional view similar to  FIG. 3A , but illustrating the assembly of a trocar-cannula complex with the fluid delivery device.  
         [0021]      FIG. 3C  is a cross sectional view similar to  FIG. 3B , but illustrating the insertion of the fully assembled device into the tissue of a patient.  
         [0022]      FIG. 4  is a longitudinal cross sectional view of another fluid delivery device constructed in accordance with the invention.  
         [0023]      FIG. 4A  is a cross sectional view taken along line  4 A- 4 A of  FIG. 4 .  
         [0024]      FIG. 5  is a partially fragmented perspective view illustrating another embodiment of a fluid delivery device in accordance with the invention.  
         [0025]      FIG. 6  is a partially fragmented perspective view illustrating another embodiment of a fluid delivery device in accordance with the invention.  
         [0026]      FIGS. 7A and 7B  are partially cross sectioned views showing a fluid delivery device of the invention being assembled with a trocar-cannula complex.  
         [0027]      FIG. 8  is a partially cross sectioned view of a trocar-cannula complex assembled with a fluid delivery device according to another embodiment of the invention.  
         [0028]      FIG. 8A  is an enlarged view of the distal end of the trocar-cannula complex shown in  FIG. 8 .  
         [0029]      FIG. 9  is a perspective view of the fluid delivery device shown in  FIGS. 8 and 8 A.  
         [0030]      FIG. 10  is a perspective view of a fluid delivery device constructed in accordance with another embodiment of the invention.  
         [0031]      FIG. 11  is a cross sectional view illustrating the fluid delivery device of  FIG. 10  assembled with a trocar-cannula complex.  
         [0032]      FIG. 11A  is an enlarged view of the proximal portion of the fluid delivery device shown in  FIG. 11 .  
         [0033]      FIG. 12A  is a cross sectional view taken along line  12 A- 12 A of  FIG. 11 .  
         [0034]      FIG. 12B  is a cross sectional view similar to  FIG. 12A , but illustrating an adjusted position for delivering fluid along a different path in the fluid delivery device.  
         [0035]      FIG. 13  is a transverse cross sectional view of an alternative fluid delivery device illustrating another manner of manufacture.  
         [0036]      FIG. 14  is a perspective view of a fluid delivery device constructed according to another embodiment of the invention.  
         [0037]      FIG. 15  is a cross sectional view similar to  FIG. 11A , but illustrating one type of pump mechanism for forcing liquid through the fluid delivery device.  
         [0038]      FIG. 16A  is a cross sectional view of a fluid delivery device constructed in accordance with another embodiment of the invention having a screw pump mechanism.  
         [0039]      FIG. 16B  is a cross sectional view similar to  FIG. 16A , but illustrating the screw pump mechanism in a depressed position for forcing liquid out of the fluid delivery device.  
         [0040]      FIG. 17A  is a cross sectional view of a fluid delivery device in accordance with another embodiment of the invention, and including a piston pump mechanism.  
         [0041]      FIG. 17B  is a cross sectional view similar to  FIG. 17A , but illustrating the piston pump mechanism in a depressed position.  
         [0042]      FIG. 18  is a cross sectional view of a fluid delivery device in accordance with another embodiment of the invention, and illustrating a pump mechanism in the form of a flexible member adapted to be depressed by a user to displace fluid from the fluid delivery device.  
         [0043]      FIG. 19A  is a disassembled perspective view of a disposable fluid container adapted to be coupled with a fluid delivery device of the present invention.  
         [0044]      FIG. 19B  is a disassembled cross sectional view illustrating the assembly of the container shown in  FIG. 19A  with a fluid delivery device of the invention.  
         [0045]      FIG. 19C  is a cross sectional view similar to  FIG. 19B , but illustrating the assembled condition of the container and fluid delivery device. 
     
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS  
       [0046]      FIG. 1  illustrates a fluid delivery device  10  constructed in accordance with one embodiment of the invention before application to a trocar-cannula complex  12  as shown in  FIGS. 2A and 2B . The device  10  of  FIG. 1  may be formed from a sponge-type material and is shown having a thickness greater than that which would most likely be used in practice, but this is for illustrative purposes of clearly showing the layers of the device  10  in  FIGS. 2A and 2B . This device  10  may have an adhesive backing  14  which may be exposed by peeling away a paper layer  16  and may also include a retaining member  20  which is slipped over the distal end of the device as shown in  FIGS. 2A and 2B  for helping to maintain the distal end in place, especially during insertion into the port site of a patient. As further shown in these figures, the device  10  includes a fluid delivery line  22  and a standard luer connector  24 , for example, for attaching a syringe  26  The syringe  26  may be used to deliver the biologically active fluid or liquid into a space or inner portion  30  of the device which may be filled with a sponge-like absorbent material  32  encased by inner and outer skins  36 ,  38 . The outer skin  38  may include perforations  40  for allowing the fluid to travel along a fluid path within the sponge  32  and onto the outer surface of the device  10  through the perforations  40 . Although the perforations  40  are shown along substantially the entire length of the device  10 , these may instead be selectively formed along a specific portion of the length of the device  10 .  
         [0047]     As further shown in  FIGS. 2A and 2B , the trocar-cannula complex  12  may include a conventional trocar  42  and hub assembly  44 . A cannula  46  includes a base portion  46 a coupled with the hub assembly  44 . The hub assembly  44  may further include an insufflation valve  47  and a gas inlet  48  for receiving a pressurized gas, such as CO 2  as is conventionally used in laparoscopic procedures. As shown in  FIG. 2B , when the apparatus  10 ,  12  is inserted in to the port site, fluid may be delivered through the perforations  40  and into the tissue of the patient, for example, through a squeezing action on the sponge material  32  after the sponge material  32  has been saturated with the desired fluid.  
         [0048]      FIGS. 3A-3C  illustrate another embodiment of the invention in cross section. More specifically, a trocar-cannula complex  50  includes a trocar  52  and cannula  54 . The trocar-cannula complex  50  is inserted into a fluid delivery device  60  in a removable fashion and, for example, is retained on the outer surface  54   a  of the cannula  54  with a friction fit. The fluid delivery device  60  comprises a housing  62  having an inner wall  64  and an outer wall  66  with an essentially cylindrical, annular space  68  therebetween that receives a sponge material or other fluid absorbent material  70 . A chamber or void space  72  is formed at the proximal end of the device  60  and is in fluid communication with a suitable coupling  74 . The coupling  74  may be secured to a fluid delivery line or directly to a fluid actuator, such as a syringe or other type of pump mechanism (not shown). The fluid  80  will be delivered to the chamber  72  as schematically shown in  FIG. 3C  whereupon it will soak into and saturate the sponge or fluid absorbent material  70 . The trocar-cannula complex  50  with the attached fluid delivery device  60  is preferably not inserted until full saturation of the sponge material  70  has taken place. At that point, the trocar-cannula complex  50  and fluid delivery device  60  are inserted and, as shown in  FIG. 3C , at least the outer wall or skin  66  is flexible such that the sponge material  70  is compressed by the patient&#39;s tissue during insertion and the biologically active liquid is forced out of perforations  82  in the outer wall  66  into the tissue of the patient as indicated by the arrows in  FIG. 3C . As with several, if not all, embodiments illustrated herein, the thickness of the fluid delivery device is exaggerated for illustrative purposes related to clearly showing certain details. Also, it may be desirable to taper the distal end of the fluid delivery device, if necessary, to aid in its insertion through a port site.  
         [0049]      FIGS. 4, 4A  and  5  illustrate another embodiment of a fluid delivery device  90  respectively in longitudinal cross section, and transverse cross section. This device  90  is similar to the device described with respect to  FIGS. 3A-3C , with the exceptions being that no sponge or fluid absorbent material is utilized, and the two layers or walls  92 ,  94  of the fluid delivery device  90  are not separated by a cylindrical, annular void space but instead are separated by channels  96  extending along the length of the device  90  and communicating with respective perforations  98  in the outer layer  94 . In this embodiment, the channels  96  are shown as being formed on the outer surface of the inner layer  92 , however, it will be understood that the channels  96  may be formed on the inner surface of the outer layer  94 , or on both the inner and outer layers  92 ,  94 . In this embodiment as well, the outer layer  94  may not need to be flexible as the fluid is forced out of the perforations  98  as opposed to being squeezed out of the perforations during insertion. The forceful ejection of fluid may take place by the pressure developed, for example, by the pump mechanism such as a syringe (not shown) being used to introduce the fluid.  
         [0050]      FIG. 6  is a perspective view similar to  FIG. 5 , but illustrating another embodiment in which a skeletal structure  100  of elongate tubes  102  is used in place of channels on the outside of an inner layer of the fluid delivery device. In this embodiment, the fluid delivery device  104  may have inner and outer layers with the skeletal structure  100  of perforated tubes  102  sandwiched between the inner and outer layers. Only an outer layer  106  is shown. The perforations  108  of the tubes  102  may align with perforations  110  in the outer layer  106 , or the outer layer  106  may be, for example, formed from a more generally perforate structure to allow transfer of the fluid to the outer surface thereof and into the tissue of the patient.  
         [0051]      FIGS. 7A and 7B  illustrate partially sectioned side views of an embodiment which is similar to the embodiment discussed above with respect to  FIGS. 2A and 2B .  FIGS. 7A and 7B  illustrate various dimensional relationships appropriate for allowing easy insertion, but adequate retention of the fluid delivery device on the outside of the cannula  120  of a trocar-cannula complex. In this regard, the diameter D 1  of the internal bore  122  at the proximal end of the fluid delivery device  124  is greater than the inner diameter D 2  at the distal end thereof. In addition, D 1  is greater than the outer diameter D 3  of cannula  120  and D 2  is less than D 3 . Therefore, the cannula  120  will be easily inserted at the proximal end of the fluid delivery device  124 , yet securely retained by friction at the distal end as illustrated in  FIG. 7B .  
         [0052]      FIGS. 8, 8A  and  9  illustrate yet another embodiment of the invention in the form of a fluid delivery device  130  which, like the previously discussed embodiments, is universally attachable to any existing trocar-cannula complex  132 , such as that shown in  FIG. 8 , and which includes an upper generally cup-shaped reservoir  134  for receiving the biologically active liquid from an inlet  136  coupled with, for example, a fluid delivery line  138  and a suitable connector  140  for a pump mechanism, such as a standard syringe (not shown). The biologically active liquid will enter the upper cup-shaped reservoir  134  in an inner portion  142  of the fluid delivery device  130  and travel by gravity, or forceful pressure, or both, to the distal end of the device  130  between inner and outer layers  144 ,  146 , as best shown in  FIG. 8A . In this embodiment, the outer layer  146  includes perforations  148  which are covered by a removable tape  150  so that the surgeon may selectively expose the perforations  148  as illustrated in  FIG. 9  for accurate delivery of the fluid into the tissue of the patient as indicated by the arrows in  FIG. 8A . For example, for some thinner patients, perforations  148  at a more distal end of the device  130  may be exposed, while for heavier patients, perforations  148  closer to the proximal end of the device  130  may be additionally or alternatively exposed. This allows delivery of the fluid as schematically illustrated in  FIG. 8A  to the desired tissue in an accurate manner.  
         [0053]      FIGS. 10, 11 ,  11  A and  12 A- 12 B illustrate another embodiment of the invention in the form of a fluid delivery device  160  which again may be universally and removably coupled to any trocar-cannula complex. As shown best in  FIG. 10 , the fluid delivery device  160  includes internal channels  162  which may be formed in various manners, including but not limited to, the manners discussed previously. These channels  162  are formed with perforations  164  in an outer layer which extend along different lengths of the device  160 . In the embodiment shown, three different lengths of channels  162  are illustrated, but it will be understood that a greater or fewer number of selections may be provided in the device  160 . In addition, in the illustrative embodiment each of the different length channels  162  becomes shorter in a direction extending toward the proximal end of the device  160 . It will also be appreciated that the different channels  162  may instead have perforations along any desired incremental length of the fluid delivery device. For example, as shown  FIG. 10 , one channel  162  or subset of channels  162  may have perforations  164   a  at only the distal end, a second channel  162  or subset of channels  162  may have perforations  164   b  only at an intermediate portion of the length, and a third channel  162  or subset of channels  162  may have perforations  164   c  only at a proximal portion of the length. Upper component  172  may be rotated or dialed relative to lower component  174  to select indicia such as “1”, “2”, or “3”, as shown, depending on which set of perforations  164   a,    164   b,  or  164   c  the surgeon desires to dispense fluid through in accordance with the invention. Additional, corresponding indicia (not shown) may be placed on the outer surface of the device so that, for example, the number “1”, “2”, or “3” will be visible to the surgeon just above the patient&#39;s skin at the port site thereby indicated the appropriate number on the dial to select for accurate fluid delivery.  
         [0054]     As shown in  FIGS. 11 and 11 A, fluid is introduced into an inlet  168 , such as in a manner previously described, and is delivered into a proximal chamber or void space  170  which is in fluid communication, selectively, with the respective channels  162  contained along the length of the device  160 . The upper or proximal portion of the device  160  is formed in at least two components  172 ,  174  which are movable and, preferably, rotatable with respect to each other to selectively align fluid delivery passages  178 ,  180  between the chamber  170  and the selected subset of channels, based on the desired delivery location for the fluid along the length of the device  160 . An O-ring  182  or other appropriate seal may be used between the two rotatable components  172 ,  174  of the fluid delivery device  160 . By further review of  FIGS. 12A and 12B , it will be appreciated that rotating the upper component  172  relative to the lower component  174  will align the fluid delivery passages  178  in the upper component  172  with a selected group of fluid delivery passages  180  in the lower component  174  which then communicate with a corresponding group of fluid delivery channels  162  and perforations  164  along the desired length of the fluid delivery device  160 . This allows the surgeon to easily select the location along the length of the fluid delivery device  160  to dispense the biologically active liquid into the tissue (not shown).  
         [0055]      FIG. 13  illustrates a transverse cross section of a fluid delivery device  140  formed in another alternative manner. That is, an outer layer  192  is secured, such as through ultrasonic welding, to an inner layer  194  in such a manner that a plurality of longitudinally extending channels  196  are formed between the weld locations  198 . The channels  196 , as previously described include perforations  200  along the same or different selected length portions of the fluid delivery device  190 .  
         [0056]      FIG. 14  is a perspective view illustrating another alternative fluid delivery device  210  which is the same as that shown in  FIG. 10 , except that the channels  212  are formed in a spiral or helical fashion along the length of the fluid delivery device  210 . It will be understood that other configurations of fluid delivery channels may be used as well.  
         [0057]      FIG. 15  illustrates a cross sectional view similar to  FIG. 11A , but illustrating an alternative fluid delivery device  220 . Device  220  includes a connector  221 , for example, adapted to be connected to a syringe (not shown) for filling the void space or chamber  222  through an inlet. This connector may then be sealed by way of a cap  224 . After insertion of the trocar-cannula complex  230  and the connected fluid delivery device  220  into a port site of a patient, the biologically active liquid is forced into the patient&#39;s tissue by another integrated pump mechanism  232  which may be similar to a priming pump mechanism and includes a piston member  234  which pressurizes the inner chamber  222  and the selectively, fluidly coupled channels  236  to thereby force the liquid from the perforations  238 . If the liquid is depleted from the chamber  222  and the surgeon desires to introduce additional liquid, a syringe may be used to again fill the chamber  222  through the connector  221 . All other aspects of this embodiment may be similar or the same as discussed with respect to the embodiment of  FIG. 11A .  
         [0058]      FIGS. 16A and 16B  illustrate side cross sectional views of yet another embodiment of a fluid delivery device  240  which is similar to those embodiments discussed above, except that a screw pump mechanism  242  is illustrated for drawing liquid into the device  240 , or expelling liquid from the device, or both. As shown in  FIG. 16A , a screw pump-type mechanism  242  is located in a proximal chamber  244  and includes, for example, an O-ring  246  for sealing purposes. The screw mechanism  242  may be rotated in a proximal direction to initially draw fluid into an inner portion  248 , such as channels or an annular space, formed in the fluid delivery device  240 , as well as into the proximal chamber  244  during an initial liquid filling phase and prior to insertion of the device  240  with a trocar-cannula complex (not shown) into a patient. Once the fluid delivery device  240  is filled with the desired liquid in this manner, or another manner, the screw mechanism  242  may be rotated in a distal direction as shown in  FIG. 16B  (and after insertion into the patient) to force the liquid into the tissue of the patient.  
         [0059]      FIGS. 17A and 17B  are illustrations of another fluid delivery device  250  constructed in accordance with an embodiment similar to that shown in  FIGS. 16A and 16B , but illustrating a more standard piston-type pump mechanism  252  as opposed to a screw pump-type mechanism. In this embodiment, the piston pump  252  may be axially withdrawn in a proximal manner as shown in  FIG. 17A  to fill the inner portion  254 , such as an annular void space or series of channels, as well as a proximal chamber  256 . The piston pump  252  may then be axially depressed in a distal direction as shown in  FIG. 17B  to force the desired biologically active liquid into the desired tissue of a patient, such as in one of the manners described herein.  
         [0060]      FIG. 18  illustrates a longitudinal cross sectional view similar to the embodiments of  FIGS. 16A, 16B ,  17 A and  17 B, but illustrating yet another pumping mechanism  260  for forcing biologically active liquid from a selected portion of a fluid delivery device  262 . In this embodiment, the proximal chamber portion  264  of the device  262  includes a connector  266  for coupling with a suitable filling mechanism such as a syringe (not shown) for filling the interior chamber or void space  264  with the desired biologically active liquid. This chamber  264  communicates with an inner portion, such as a series of channels, or an annular void space  268  (with or without a fluid absorbent material, not shown) for delivery of the liquid to the tissue of the patient. For forcing the liquid from perforations  270  in the outer layer of the device two bulbous flexible membranes  274 ,  276  are provided and may be depressed by a user. This forces liquid from the upper chamber or void space  264  through delivery passages  280  and into the inner portion  268 , such as the void space or channels, and out of the perforations  270 . This is illustrated by the arrows and by illustrating the depressed configuration of the membranes or flexible members  274 ,  276  in dash-dot lines.  
         [0061]      FIGS. 19A-19C  illustrate yet another embodiment of a fluid delivery device  290  constructed in accordance with the invention. This device  290  may be formed, for example, as discussed in connection with the embodiment of  FIGS. 11, 11A ,  12 A and  12 B. The difference in the embodiment of  FIGS. 19A-19C  is that a prefilled proximal component  292  of the fluid delivery device  290  is provided so that the device  290  is readily usable by the surgeon. That is, device  290  can require less preparation time by the surgery team. In this regard, a removable seal  294 , as illustrated in  FIGS. 19A and 19B  is provided to initially contain the biologically active liquid in the proximal chamber or void space  296  of the proximal component  292 . The seal  294  is removed as shown in  FIG. 19B  with the device  290  inverted (i.e., the fluid delivery passages  298  are directed upwardly as shown) and the distal component  300  of the device  290  is snapped into place and retained, for example, by an O-ring  302 , and/or any other suitable connector/seal assembly. The assembled device  290  is shown in  FIG. 19C . An integrated pump mechanism (not shown), such as previously described with respect to  FIG. 15 , FIGS.  16 A-B, FIGS.  17 A-B, or  FIG. 18 , may be used to force the liquid through the device  290  and out of the selected perforations  304 . It will further be understood that the proximal component  292  illustrated in  FIGS. 19B and 19C  may rotate with respect to the attached distal component  300  for selection of the desired fluid delivery location as described with respect to the embodiment of  FIGS. 11, 11A ,  12 A and  12 B.  
         [0062]     Many different types of irrigation fluids may be introduced through the fluid delivery devices of this invention. These include, but are not limited to, saline solutions, lidocaine-containing fluids, betadine-containing fluids, cancer treatment fluids, or any other fluid or pharmaceutically acceptable formulation necessary or desired for a particular medical procedure. In addition, fluids other than irrigation fluids or treatment fluids may be delivered through the devices of this invention. As one additional example, bioadhesives may be delivered to an incision site or any other necessary tissue repair site to provide for quicker and more effective administration of the adhesive to the desired site.  
         [0063]     These fluids are pharmaceutically acceptable formulations that contain biologically active agents that the surgeon can infuse to the port site and intervening tissue layers. Examples of active agents include, but are not limited to various types of anesthetics, therapeutic peptides, polypeptides, macromolecules such as proteins (e.g., monoclonal antibodies), oligonucleotides (e.g., antisensenucleotides), lipid components, lipid formulations, liposome substances, immunoglobins, immunomodulators, steroids, antiangiogenic agents, cancer chemotherapeutic agents, anti-infectives (antibiotics, antiviral, etc.), cytotoxins, anticoagulants, fibrinolytic agents, anti-inflammatory agents and combinations thereof.  
         [0064]     The pharmaceutically acceptable formulations as known to one skilled in the art may contain the biologically active agents in a freely soluble form for immediate effect at the tissue site or in a controlled or sustained release matrix for a long-term effect such as hours or days, or a combination of both.  
         [0065]     The controlled or sustained released matrix may be biologically degradable and prepared using procedures as known to one skilled in the art. The form of the matrix may be selected, for example, from microporous films, microspheres, nanospheres, micelles, liposomes, powders, microparticles, and hydrogels. These matrices may be a component of the pharmaceutically acceptable formulation that is delivered to the port. They then diffuse into the surrounding tissue and become embedded or implanted in the tissue. Thus, they impart a sustained effect of the active agent due to its controlled release from the matrix as it degrades.  
         [0066]     Biologically degradable matrices may be formed by procedures known to one skilled in the art. For example, such components may be various types of lipids that form micelles and liposomes, polymers and copolymers of polyorthoesters, polyethylene glycol, ketene acetals, polyols and others. Examples of the various biodegradable polymers, various biologically active agents that become entrapped or encapsulated in the formed matrices as previously described, injectable fluid dosage forms, and semi-solid pharmaceutical compositions are described in U.S. Pat. No. 6,524,606; U.S. Pat. No. 6,667,371; U.S. Pat. No. 6,613,355; U.S. Pat. No. 5,968,543; U.S. Pat. No. 5,939,453; U.S. Pat. No. 4,957,998; U.S. Pat. No. 4,946,931; U.S. Pat. No. 4,855,132; U.S. Pat. No. 4,764,364; U.S. Pat. No. 4,304,767; and U.S. Published Applications 2002/0037300, 2003/0130472, 2002/0168336, 2002/0176844, and 2003/0212148, the disclosures of which are incorporated herein in their entirety. Other dosage forms and biologically active agents in pharmaceutically acceptable formulations may be used as well.  
         [0067]     Many different types of trocars and cannulas may be utilized within the scope of this invention. These trocars and cannulas may be inserted through a port site of a patient together or separately, for example, by using a needle introducer for an expandable cannula and subsequently introducing the cannula of the trocar-cannula complex. The cannula is configured to receive laparoscopic and arthroscopic instruments, and other instruments used during minimally invasive surgery.  
         [0068]     The use of the invention eliminates or at least reduces the handling of needles during the surgical procedure and the trocar-cannula assembly or complex allows accurate delivery to the port site. The active agent is delivered to the port site fast and simple. Both short and long acting active agents may be delivered to ameliorate various biological responses such as the pain cascade in a physiological fashion. The assembly also allows the surgeon to choose what to infuse or irrigate for any particular case and may be infused at any time during the procedure and as many times as is necessary such as after the initial introduction of the assembly through the port site, during the surgical procedure, or at the end of the procedure.  
         [0069]     While the present invention has been illustrated by a description of a preferred embodiment and while this embodiment has been described in some detail, it is not the intention of the Applicant to restrict or in any way limit the scope of the appended claims to such detail. Additional advantages and modifications will readily appear to those skilled in the art. The various features of the invention may be used alone or in numerous combinations depending on the needs and preferences of the user. This has been a description of the present invention, along with the preferred methods of practicing the present invention as currently known. However, the invention itself should only be defined by the appended claims, wherein I claim: