Patent Publication Number: US-8986199-B2

Title: Apparatus and methods for cleaning the lens of an endoscope

Description:
BACKGROUND 
     i. Field of the Invention 
     The present application relates to methods and devices for use in medical procedures, including without limitation, minimally invasive surgical, therapeutic, and diagnostic procedures and, more particularly, to devices for cleaning the lenses of an endoscopic camera while positioned internally in a body cavity. 
     ii. Description of the Related Art 
     In minimally invasive medical procedures, such as laparoscopic surgery, a surgeon may place one or more small ports into a patient&#39;s abdomen to gain access to the abdominal cavity of the patient. Surgical and diagnostic instruments are delivered transcutaneously into the patient&#39;s body via one or more ports, through for example, a trocar or a trocar incision. Other minimally invasive surgical procedures include natural orifice transluminal endoscopic surgery (NOTES™) wherein surgical instruments and viewing devices are introduced into a patient&#39;s body through, for example, the mouth, vagina, nose, or rectum. Another class of such minimally invasive surgery includes magnetically-based systems (MAGS). MAGS devices typically include an internal device or end-effector that provides therapy to the patient (e.g. electro-cautery) or information to the surgeon or clinician (e.g. video camera) and an external magnet used to control the internal device. 
     In any of these procedures, a combination of a video camera or any suitable imaging equipment, and a source of illumination, is often used to guide the procedure. It is likely that at several points during the procedure, the camera lens will become smudged with bodily fluids or material, and a means for clearing the lens is necessary. When an endoscope is delivered ether via a NOTES pathway (flexible overtube) or transcutaneously through a trocar or trocar incision, the ability to remove and clean the lens becomes more difficult. 
     The foregoing discussion is intended only to illustrate various aspects of the related art in the field of the invention at the time, and should not be taken as a disavowal of claim scope. 
     SUMMARY 
     Disclosed herein is an apparatus and methods for cleaning a lens, or one or more lenses, of at least one of, and preferably both of, an endoscopic camera and an illumination source while the endoscope is deployed in a patient during a medical procedure, such as a minimally invasive procedure, or a therapeutic or diagnostic procedure. 
     More particularly, there is described an apparatus for cleaning a lens of at least one of, and preferably both of, a videoscopic camera and an illumination source that is deployable into an internal site of a patient. The apparatus includes a conduit, which in use is attached to the endoscope. The conduit defines a longitudinal axis and has a proximal end and a distal end and is structured for the passage of fluid therethrough. The distal end&#39;of the conduit defines at least one fluid delivery port. The apparatus also includes an alignment system for aligning the delivery port in a desired position relative to a lens of the endoscope and a supply tube attached to the proximal end of the conduit, the tube defining at least one lumen for passage of fluid therethrough. The conduit is preferably rigid and the supply tube may be flexible along at least part of, and preferably all of its length. The conduit may comprise at least one passage formed along the length thereof extending in use from the proximal to the distal end of the endoscope. The at least one passage of the conduit is fluidly connected to the lumen of the supply tube for passage of fluid from the supply tube through the conduit passage to the fluid delivery port. 
     In various embodiments, the conduit may have two, three or more passages for delivery of liquid and/or gaseous cleaning fluids to the delivery ports and the camera and/or illumination source lens, and for suctioning fluid away from the lens or lenses. In various embodiments, the supply tube may have two, three or more lumens for delivery of liquid and/or gaseous cleaning fluids to the one or more conduit passages and for suctioning fluid away. 
     In various embodiments, the endoscope comprises a passage extending to the distal end of the endoscope for receiving the conduit. The passage may be positioned within the endoscope, or may be positioned on the exterior of the endoscope. 
     In various embodiments, the apparatus may comprise a carrier member, such as a sleeve or a tray, sized to at least partially encase and conform to at least a portion of the shape of the body of the endoscope. The carrier member may have at least a partial opening at the distal end thereof to expose at least the lens of the camera and the illumination source and may be fully open or have at least a partial opening at the proximal end thereof for passage of the supply conduit. In such embodiments, the conduit may be formed within, or be a separate component disposed within, the carrier member. 
     In certain embodiments, when the passage is positioned on the exterior of the endoscope, the apparatus may comprise a plurality of elastic prongs or a pair of opposing elastic prongs for releasably attaching the conduit to the endoscope. In the embodiments wherein the conduit is positioned in the passage on the exterior of the endoscope, the alignment system may comprise an engagement head positioned at the distal end of the conduit. The engagement head may extend outwardly from the longitudinal axis of the conduit to engage the endoscope and position the at least one fluid delivery port to a desired position adjacent the lens of one or both of the camera and the illumination source. 
     The conduit may be at least two, three or more passages formed along the length of the carrier member, each of which may be fluidly connected to the one or more corresponding lumen or lumens of the supply tube. A liquid fluid may pass through the lumen of the supply tube through one of the passages in the conduit to the fluid delivery port, and a gaseous fluid may pass through the lumen of the supply tube through another of the passages of the conduit to the fluid delivery port. A vacuum source may be fluidly connected to the proximal end of the supply tube, positioned at a site external to the patient to suction fluid away from one or both of the camera and illumination source lens. 
     In certain embodiments, the alignment system may comprise a protrusion that extends outwardly from the conduit in a direction generally transverse to the longitudinal axis of the conduit. The endoscope in such embodiments includes a recess formed therein for receiving the protrusion. The recess has a first recessed section for maintaining the protrusion in a locked position when received therein, and a second recessed section wherein the protrusion is in an unlocked position when received therein. The alignment system may also include a biasing member for maintaining the protrusion in the locked position. The delivery port is positioned on the conduit such that the delivery port is directed towards one or both of the lenses of the camera and the illumination source when the protrusion is in the locked position. The alignment system may further include a handle for moving the protrusion between the locked and unlocked positions. 
     In various embodiments, the alignment system may include a clamp mounted on the proximal end of the conduit for rotational movement about the longitudinal axis of the conduit between a locked position and an unlocked position. The clamp in such an embodiment may have an engagement surface for locking engagement with the engagement surface on the endoscope structured for locking engagement with the engagement surface of the clamp. The alignment system may also include a spring member for biasing the clamp in the distal direction, and a stop for limiting the movement of the endoscope in the distal direction. The endoscope in such embodiments preferably includes a first recess formed therein for receiving the proximal end of the conduit and a second recess formed circumferentially about a portion of the endoscope transverse to the first recess for receiving the clamp when in the locked position. The engagement surface of the endoscope may be positioned in the second recess. 
     In various embodiments, the endoscope defines a passage therein. The passage may extend, for example, from the first recess to the distal end of the endoscope and may receive the conduit. The stop for limiting the movement of the endoscope in the distal direction may be positioned in the passage. 
     A method for cleaning a lens of one or both of a camera and an illumination source is also provided. The method includes attaching a cleaning apparatus to the endoscope, the cleaning apparatus comprising a rigid conduit defining a longitudinal axis and having a proximal end and a distal end, and being structured for the passage of fluid therethrough. In various embodiments the conduit may be constructed of a compliant material. The distal end of the conduit defines at least one fluid delivery port. The apparatus also includes an alignment system for aligning the fluid delivery port in a desired position relative to a lens of one or both of the camera and the illumination source and a flexible supply tube attached to the proximal end of the conduit. The compliant conduit would allow for an interference fit with the alignment feature. The supply tube comprises at least two lumens for passage of fluid therethrough. The method further includes aligning the fluid delivery port into the desired position facing the lens of one or both of the camera and the illumination source, locking the conduit and the fluid delivery port into the desired position, and directing a cleaning fluid selected from a liquid, a gas or a combination thereof from at least one source of cleaning fluid external to the patient through the supply tube, the conduit and to the at least one delivery port. The method may further include attaching the proximal end of the supply tube to a source of vacuum external to the patient, and drawing fluid away from the lens of one or both of the camera and the illumination source through at least one opening in the delivery port by applying suction from the vacuum source through the supply tube and the conduit. 
    
    
     
       FIGURES 
       Various features of the embodiments described herein are set forth with particularity in the appended claims. The various embodiments, however, both as to organization and methods of operation, together with advantages thereof, may be understood in accordance with the following description taken in conjunction with the accompanying drawings as follows. 
         FIG. 1  shows an exemplary endoscope for internal use during a medical, therapeutic, or surgical procedure with the distal tip of an embodiment of a cleaning conduit extending from the distal face of the endoscope. 
         FIG. 2  shows a section view through the longitudinal axis of the endoscope of  FIG. 1 . 
         FIG. 3  shows a section view of the opposite side of the endoscope of  FIG. 2  through the longitudinal axis of the cleaning conduit. 
         FIG. 4  is a perspective cut away view of the proximal end of an embodiment of an internal endoscope showing a double lumen supply line leading to a cleaning conduit. 
         FIG. 5  is a cut away view of an embodiment of a transition from a double lumen to a single lumen supply line. 
         FIG. 6  is a perspective view of an embodiment of a locking and alignment member at a junction between the cleaning conduit and the supply line. 
         FIG. 7  shows the locking and alignment member of  FIG. 6  positioned in the endoscope of  FIG. 1 . 
         FIG. 8  is a view of the distal tip of the cleaning conduit of  FIG. 1  showing an opening for delivery of fluid in the direction of the lens of the endoscope of  FIG. 1 . 
         FIG. 9  is a perspective view of the distal tip of the cleaning conduit of  FIG. 8  removed from the endoscope. 
         FIG. 10  is a perspective view of an embodiment of a cleaning conduit showing an alternative locking and alignment member and an alternative distal tip. 
         FIG. 11  is a section view of the locking and alignment member of  FIG. 10  at the proximal end of the cleaning conduit. 
         FIG. 12  is a section view of the distal end of the endoscope and the distal tip of the cleaning conduit of  FIG. 10 . 
         FIG. 13  is a view of the proximal end of the cleaning conduit and locking and alignment member of  FIG. 10  positioned in an internal endoscope in an unlocked position. 
         FIG. 14  is a perspective view of an embodiment of a magnetic internal endoscope showing the locking and alignment member of  FIG. 10  in a locked positioned. 
         FIG. 15  shows a section view of the locking and alignment member of  FIG. 14 , in the locked position. 
         FIG. 16  shows a perspective view of the proximal end of the endoscope of  FIG. 14  showing the locking and alignment member in the locked position. 
         FIGS. 17A-C  show an alternative embodiment of the cleaning conduit separate from and positioned in a conduit carrier on an embodiment of an internal endoscope. 
         FIG. 18  shows an embodiment of a conduit carrier in the form of a sleeve for a cleaning conduit mounted on an internal endoscope. 
         FIG. 19  shows a close up view of the engagement member of the sleeve carrier of  FIG. 18 . 
         FIG. 20  shows a perspective view from the proximal end of an alternative embodiment of a conduit carrier for attachment to an internal endoscope. 
         FIG. 21  shows a section view of the conduit carrier of  FIG. 20 , showing a channel. 
         FIG. 22  shows a perspective view from the distal end of the embodiment of the conduit carrier of  FIG. 20 . 
         FIG. 23  is a section view of the conduit carrier of  FIG. 22  showing the engagement with the endoscope. 
         FIG. 24  shows a perspective view of the proximal end of an alternative embodiment of the conduit carrier of  FIG. 20  having a dual lumen. 
         FIG. 25  shows a view of the conduit carrier of  FIG. 24  from the distal end. 
         FIG. 26  is a section view of an alternative embodiment of the conduit carrier of  FIG. 20  or  25  showing three channels for porting fluid. 
         FIG. 27  shows a view of an alternative embodiment of a conduit carrier from the distal end mounted to an internal endoscope. 
         FIG. 28  shows a view of the conduit carrier of  FIG. 27  from the proximal end. 
         FIG. 29  shows a view of the conduit carrier of  FIG. 27  from the distal end. 
         FIG. 30  shows a view of the conduit carrier of  FIG. 27  with a double sided attachment tape adhered to the conduit carrier. 
         FIG. 31  shows an external control unit connected to the supply tube on one end and vacuum and irrigation lines on the other end. 
     
    
    
     Corresponding reference characters indicate corresponding parts throughout the several views. The exemplifications set out herein illustrate various embodiments of the invention, in one form, and such exemplifications are not to be construed as limiting the scope of the invention in any manner. 
     DESCRIPTION 
     Numerous specific details are set forth to provide a thorough understanding of the overall structure, function, manufacture, and use of the embodiments as described in the specification and illustrated in the accompanying drawings. It will be understood by those skilled in the art, however, that the embodiments may be practiced without such specific details. In other instances, well-known operations, components, and elements have not been described in detail so as not to obscure the embodiments described in the specification. Those of ordinary skill in the art will understand that the embodiments described and illustrated herein are non-limiting examples, and thus it can be appreciated that the specific structural and functional details disclosed herein may be representative and do not necessarily limit the scope of the embodiments, the scope of which is defined solely by the appended claims. 
     The articles “a” and “an” are used herein to refer to one or to more than one (i.e., to at least one) of the grammatical object of the article. By way of example, “an element” means one element or more than one element. Reference throughout the specification to “various embodiments,” “some embodiments,” “one embodiment,” or “an embodiment”, or the like, means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment. Thus, appearances of the phrases “in various embodiments,” “in some embodiments,” “in one embodiment,” or “in an embodiment”, or the like, in places throughout the specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. 
     Thus, the particular features, structures, or characteristics illustrated or described in connection with one embodiment may be combined, in whole or in part, with the features structures, or characteristics of one or more other embodiments without limitation. 
     It will be appreciated that the terms “proximal” and “distal” may be used throughout the specification with reference to a clinician manipulating one end of an instrument used to treat a patient. The term “proximal” refers to the portion of the instrument closest to the clinician and the term “distal” refers to the portion located farthest from the clinician. It will be further appreciated that for conciseness and clarity, spatial terms such as “vertical,” “horizontal,” “up,” and “down”, “top” and “bottom” may be used herein with respect to the illustrated embodiments. However, surgical instruments may be used in many orientations and positions, and these terms are not intended to be limiting and absolute. 
     As used herein, the term “patient,” refers to any human or animal on which a medical procedure, such as a surgical, therapeutic, or diagnostic procedure, may be performed. As used herein, the term “internal site” of a patient means a lumen, body cavity or other location in a patient&#39;s body including, without limitation, sites accessible through natural orifices or through incisions. As used herein, the term “transverse” means being situated or lying across something or extending outwardly from something, for example, at an angle to an axis of something. Transverse may include, but is not limited to, being situated perpendicular to the axis of something. As used herein, the term “generally” means usually or mostly, such that “generally transverse” means the thing referenced may mostly be situated across or extending outwardly at an angle from something else. 
     In a MAGS system, an external control unit (not shown) having one or more permanent magnets or electro-magnetic magnets housed therein is positioned on the outer surface of the patient&#39;s body. An endoscope may be carried in an internal magnetic sled (not shown) having its own magnets, which are attracted to the external control unit. Movement of the external control unit moves the internal magnetic and the endoscope carried in the sled. Alternately, the endoscope and magnetic sled may be integrated into a single unit wherein the magnets are housed in a unit that also carries the various lighting, image capture and relay components of the endoscope. 
     Disclosed herein is an apparatus for cleaning a lens, or one or more lenses, such as one or preferably both the camera and illumination lenses of an endoscope while the endoscope is deployed in a patient during a medical procedure, such as a minimally invasive procedure, or a therapeutic or diagnostic procedure. In various embodiments, the endoscope may be a MAGS-based camera equipped with an onboard magnet or source of a magnetic field that will magnetically couple the endoscope to an external manipulation unit for moving the endoscope while the endoscope is deployed in an internal site of a patient. 
     The cleaning apparatus generally includes a conduit having a fluid delivery port, an alignment system, and a generally flexible supply tube to fluidly connect the conduit to one or both of a source of a fluid and a suction device. 
     Referring to  FIG. 1 , an embodiment of an endoscope  10  for use in an internal site of a patient is shown. The endoscope  10  includes a distal face  12 , a proximal end  14 , a top side  22  and a bottom side  24 . The top side  22  would typically be oriented in use, for example, toward the patient&#39;s abdominal wall or other external surface. In a MAGS endoscope, the top side would typically be oriented toward and magnetically coupled to an external magnetic control unit. The bottom side  24  would typically be oriented in use, for example, towards the interior of the patient. 
     At the distal end  12  of the endoscope  10 , illumination source  18  and a lens  20  are shown. At the proximal end  14  of the endoscope, a tether  16  and a supply tube  60  are shown. The tether  16  may contain wires or other power, illumination source and/or communication lines to deliver power to the endoscope and to return images to an external viewer external to the patient. Endoscopes with power, illumination, and communication lines are known in the art. These features therefore, need not be described in detail herein. 
     Also at the distal face  12  of endoscope  10 , the distal tip  42  of a conduit for delivering cleaning fluid to the lens  20  of the camera is shown. Referring to  FIG. 2 , an embodiment of a conduit  40  having a lumen  50  through which fluid flows is shown positioned in channel  28  of the endoscope. When endoscope  10  is a MAGS endoscope, an internal magnet  26  will be housed in the endoscope body.  FIG. 2  also shows the illumination source, such as a Light Emitting Diode (LED)  18   a , a lens  18   b  shaped to focus the light, and sealed covers  18   c  for illumination sources  18 . An electronic CMOS array, CCD array, or circuit board for the camera  20   a  is provided. A copper heat sink  106  absorbs heat given off from electronics boards  108  and  20   a.    
     The distal tip  42  of the cleaning conduit  40  has a delivery port such as an opening or slot  46  shown in  FIG. 3 , through which cleaning fluid may be directed toward lens  20 . In the embodiments herein, slot  46  is on the medial side  48  of distal tip  42  and forms an arc, for example, in the 6:00 o&#39;clock to the 12 o&#39;clock position. 
     In various embodiments, conduit  40  may have the same internal diameter along its full length. The supply line  60  internal diameter may be greater than the internal diameter of the conduit  40  over its length, or may be smaller than the internal diameter of the conduit&#39;s lumen. The relative diameters of lumen  50  and lumen  62  will influence the pressure and/or speed of the fluid coming out of the delivery port, slot  46 . To maintain a steady luminal flow of fluid at a consistent pressure across the lens from the delivery port, lumen  50  and lumen  62  are preferably the same, or substantially the same, in cross-section and the fluid is preferably delivered at a constant, or substantially constant, pressure. The distal face  12  of endoscope  10  is angled relative to the top side  22  and bottom side  24  of endoscope  10 . The distal tip  42  of conduit  40  is also angled. The angle of slot  46  is parallel to the angle of the distal face  12  of endoscope  10 . 
     The cleaning apparatus also includes a supply line  60  fluidly connected to conduit  40  at the proximal end  44  of conduit  40 . Referring to  FIGS. 2-5 , an embodiment of conduit  40  and supply line  60  are shown which are joined at a junction  62  where lumen  50  of conduit  40  meets single lumen  62  of supply line  60 . 
     In the embodiment shown in  FIGS. 4 and 5 , the lumen  62  of supply line  60  includes a transitional section  54  wherein single lumen  62  transitions into a double lumen  56 . Double lumen  56  and camera tether  16  are dimensioned to allow them to pass through the space  104  remaining between a tool  102  and the internal channel wall of a trocar  100  (or through the space between the exterior of a trocar and an incision in the patient) to the exterior of the patient. Double lumen  56  is fluidly connected to an external source of fluid for cleaning lens  20 . In any of the embodiments discussed herein, the cleaning fluid may be a liquid, such as water or saline, or a gas such as sterile air or CO 2 . The cleaning fluid must be sterile and biocompatible. 
     The two sets of supply tubing, single lumen  60  and double lumen  56 , may be joined at a three way intersection in transitional section  64  by an adhesive, any suitable engaging members, or a combination of adhesive and engagement members. Alternatively, they may be molded as a single unit with two different sections. The proximal end of supply line  60  is fluidly connected to a source of a cleaning fluid (not shown). An inline trumpet valve  310  shown in  FIG. 31  may be used to allow the clinician to control the fluid flow from the source of cleaning fluid through the supply line  60 . Valve  310  is preferably located at a site external to the patient, sufficiently close to the clinician to allow quick delivery of cleaning fluid (liquid or gas) and suction through irrigation line  320  and vacuum line  330 , respectively, through the trumpet valve  310  to supply line  60  and conduit  40  to clean a dirty or obstructed lens  20  as needed. A vacuum control button  340  and an irrigation control button  350  are provided on trumpet valve  310  for use by the clinician control the flow of cleaning fluid or the application of suction by pushing the appropriate button. A clip  312  is provided to releasably connect the trumpet valve control unit to a surgical drape. 
     In addition to the fluid delivery, the proximal end of supply line  60  may be connected to a vacuum source, such as a pump (not shown) to provide suction through conduit  40  to draw fluid away from lens  20 . 
     In the dual lumen embodiments, one lumen may be used for delivering a liquid cleaning agent to the lens  20  and the second lumen may be used to deliver a gas to the lens  20 . Alternatively, one lumen may be used for delivering a fluid (liquid or gas) and the other lumen may be used to suction fluid away from lens  20 . In certain embodiments, there may be at least three lumens; two lumens for delivery of fluid to the lens and at least one lumen for drawing fluid away from the lens, for example, by suction. Independent channeling to separate the suctioning and fluid delivery eliminates vision blocking debris that may form while the lens is being cleaned. 
     The cleaning apparatus includes an alignment system  70  for aligning the delivery port in a desired position relative to the lens  20  of endoscope  10 . In various embodiments of the cleaning apparatus, the alignment system  70  may include one or more members to bias conduit  40  in a desired position. In the embodiment shown in  FIGS. 2 ,  3 ,  6 , and  7 , the alignment system  70  includes a spring  72 , a ring or sleeve  74  defining a bore  78 . A pin  76  is positioned on the exterior surface of ring  74 . Ring  74  is fixedly attached to conduit  40  so that movement of ring  74  moves conduit  40  in like manner. 
     As shown in  FIG. 7 , endoscope  10  includes a recess  30  and J-groove  32 . J-groove  32  receives pin  76  of ring  74 . J-groove  32  includes a longer groove  36  and a shorter groove  34  joined by a lateral groove  35 . In the embodiment shown, spring  72  is positioned in recess  30  over conduit  40  between the distal end of ring  74  and the proximal end of an annular shoulder  64  surrounding the opening to channel  28 . The spring loaded alignment system resembles a bayonet system where a small twist of the ring  74  locks the slot  46  of conduit  40  in the correct orientation, facing the lens  20 . In a locked position, the spring  72  biases pin  76  in the shorter groove  34  to lock pin  76  in to the position that positions slot  46  towards lens  20  (see  FIGS. 8-9 ). To release the pin  76 , ring  74  is pushed distally enough to move pin  74  from groove  34  to lateral groove  35  to longer groove  36 , thereby releasing the compression on spring  72  as pin  76  moves proximally to the end of longer groove  36  to assume the unlocked position. Because conduit  40  is attached to ring  74 , conduit  40  moves with ring  74  as it moves longitudinally in the distal or proximal direction, and as it rotates as pin  76  moves between the longer and shorter grooves  36  and  34 , respectively, of J-groove  32 . 
     A handle  58  may be positioned in certain embodiments at the proximal end of ring  74  to facilitate rotating ring  74  to move pin  76  between the locked and unlocked positions. To maintain a streamlined outer contour for endoscope  10  to facilitate passage through a trocar or a trocar incision, the recess  30  in endoscope  10  may also include a recessed area to seat handle  58  so that it does not extend outwardly from the endoscope body. 
     An alternative embodiment of an alignment system is shown in  FIGS. 10-16 . In this embodiment, a clamp  80  is pivotally attached about pivot axis  82  to the proximal end of conduit  40 , by sleeve member  92  sliding over conduit  40 . Clamp  80  may include an engagement portion, for example, a latch portion  86 , and a clamp handle  84 . Clamp handle  84  may be made of an elastomeric material structured to define a compressible leaf spring surround an opening  90 . Sleeve  92  includes a truncated conical section  94  at the proximal end of sleeve  92  to connect conduit  40  and sleeve member  92  to the supply line  60 . 
     The outer diameter of a distal end portion  98  of conduit  40  in the embodiment shown in  FIGS. 10-16 , is smaller than the outer diameter of the remaining portion of conduit  40 . A shoulder  110  marking the transition to distal end portion  98  of conduit  40  abuts mating shoulder  112  in channel  28  of endoscope  10  which marks the transition in channel  28  to a distal end channel  38  having a smaller external diameter than that of the remainder of channel  28 . The internal diameter of the embodiment of conduit  40  shown is constant along its length, including the internal diameter of distal end portion  98 . Shoulders  110  and  112  interact to act as a stop to prevent further movement of conduit  40  distally thereby aligning the delivery port, slot  46 , with the distal face  12  of endoscope  10 . 
     The axial orientation of the alignment system is maintained at the proximal end of conduit  40  by clamp  80 .  FIG. 13  illustrates the clamp in the open position. The proximal end of conduit  40  with sleeve  92  and clamp  80  attached is positioned in longitudinal recess  116  of endoscope  10 . A radial recess  118  in endoscope  10  transverse to the axis of longitudinal recess  116  mates with clamp  80  when clamp  80  is latched into a closed position, as shown in  FIGS. 14-16 . Clamp engagement portion  86 , which may be a thickened end portion of clamp  80 , is positioned in notch  120  of endoscope  10  when clamp  80  is in the closed position and gripping edge  88  of engagement portion  86  is pressed against mating edge  122  of notch  120  to hold clamp  80  in the closed position. The leaf spring portion  96  of handle  84  is pressed into opening  90  by the proximal edge of radial engagement surface  118  to bias conduit  40  distally so that shoulder  110  is against shoulder  112  of channel  28 . 
     In various embodiments of the cleaning apparatus, the conduit  40  need not be housed in the endoscope  10 . Instead, conduit  40  may be secured to endoscope  10  by a sled-like or sleeve-like carrier  130 . The carriers  130  may conform to a portion of the external shape of endoscope  10 , or may form a sleeve encircling all, or at least a portion of endoscope  10 . 
     Referring to  FIGS. 17   a - c , a carrier  130  is shown attached by any suitable means to the bottom  24  of endoscope  10 . The carrier  130  includes a groove  132  for receiving a conduit  40 ′ between opposing receiver sections  134  that run along the length of the bottom  24  of endoscope  10 . The groove  132  may be tooled into the bottom  24  of the endoscope  10  or may be in a separate carrier  130  attached to the bottom of the endoscope, extending outwardly from it. In the latter embodiment, the endoscope body may, for example, have a groove or recess in the proximal and/or distal ends, and preferably may have multiple grooves spaced along the length of the endoscope body to receive tabs or protrusions from carrier  130  to secure the carrier to the endoscope body. The carrier  130  preferably fits tightly to the endoscope body and snaps into the grooves or recesses to maintain a streamlined profile and to aggressively secure the cleaning conduit to the endoscope. Other means of connecting the carrier to the endoscope body are described herein. In such embodiments, the distal tip  140  of conduit  40 ′ is curved upwardly. The delivery port is positioned on the upwardly curved tip and is defined by an opening  142  directed in use towards the camera and/or illumination source lens  20 . 
       FIGS. 18-19  illustrate a circumferential embodiment of a carrier sleeve  150  for attaching the cleaning apparatus to a endoscope  10 . In the embodiment shown, the carrier sleeve  150  is made, at least in part, of a pliable or flexible material to facilitate sliding the sleeve  150  over the endoscope  10  body. Sleeve  150  is generally cylindrical in shape and includes a distal panel  154  that is configured to cover the lower portion of the distal face  12  of endoscope  10 . Panel  154  includes a cut out section, such as U-shaped cut out  156  shown in  FIG. 18 , to expose lens  20  and position fluid delivery ports  158  and  160  on each side of lens  20  when the sleeve  150  is on endoscope  10  to provide a bidirectional flow of cleaning fluid to lens  20 . 
     A conduit may be formed in sleeve  150  along its length. The conduit (not shown) has one or more lumens, such as a single lumen that branches into separate paths leading to ports  158  and  160 . The conduit extends from the proximal to the distal end of sleeve  150  to deliver cleaning fluid to delivery ports  158  and  160  or to draw fluid away from lens  20  by suction, as described above. The proximal end of the conduit is fluidly connected to supply line  60 , as described in any of the embodiments described above. 
     Sleeve  150  additionally may be secured to endoscope  10  by engagement tab  152  as shown in  FIG. 19 . Extension  162  of tab  152  snaps into engagement with shoulder  164  on neck  166  of endoscope  10  at the proximal end  14  of endoscope  10 . The shoulder  164  acts as a stop to prevent extension  162  and sleeve  150  from moving farther distally. The engagement of extension  162  and shoulder  164  serves to position panel  154  against distal face  12  and thereby align delivery ports  158 , 160  with lens  20  to ensure the flow of fluid against lens  20 . 
     In certain embodiments, the conduit carrier  130  may not fully encircle endoscope  10 , but may instead only partially cover the endoscope  10 .  FIGS. 20-26  illustrate a conduit carrier  130  having a semi circular cross-section structured to encase the bottom  245  and a portion of the sides of endoscope  10 . Referring to  FIGS. 20-26 , a carrier sleeve  170  having a distal panel  174  and a proximal panel  184  is shown. Distal panel  174  may include a cut out portion  176  to expose lens  20  of endoscope  10  and to position first and fluid delivery ports  178  and  180  adjacent lens  20  for bidirectional delivery of cleaning fluid to lens  20 . Alternatively, as shown in  FIG. 26 , there may be more than two delivery ports, such as three or four or multiple spaced ports to effect a spray of cleaning fluid from multiple directions aimed towards lens  20 . Any of the embodiments of the cleaning apparatus described herein may have multiple fluid delivery and/or suction ports to effect unidirectional or multi-directional flow, or spray cleaning fluid with or without suction from one or more positions around lenses  20 . 
     Sleeve  170 , sleeve  150 , or any of the conduit carriers  130  may be made of a rigid or pliable material, preferably a somewhat rigid but elastomeric material, that allows sleeve  170  to snap onto and conform closely to the shape of the bottom portion of endoscope  10 . 
     Referring to  FIGS. 21 and 23 , sleeve  170  may be secured to endoscope  10  by engagement tabs  188  that extend preferably along the length of each side of sleeve  170  to mate with complementary engagement grooves  190  that extend in a complementary manner along the length of each side of endoscope  10 . The engagement tabs  188  with grooves  190  align distal panel  174  and cut out  176  in a desired position relative to lens  20 . Proximal panel  184  prevents sleeve  170  from being advanced too far distally, thereby accurately positioning ports  178 ,  180  to direct the flow of cleaning fluid to lens  20 . 
       FIGS. 24-25  illustrate an embodiment of sleeve  170  having a dual lumen supply line  182 . One lumen, for example  182 , may be for delivery of a cleaning fluid to delivery port  178  and another lumen, for example  192 , may be for suction to draw fluid away from lens  20  through port  180 . Lumens  182 ,  192  may be fluidly connected to supply line  60  as described above.  FIG. 26  illustrates an embodiment of sleeve  170  having a three lumen conduit  194  extending along the length of the carrier sleeve between the proximal and the distal ends of the sleeve. One lumen, for example  194   a , may be used for suction and the other two lumens, for example  194   b  and  c , may be used to deliver cleaning fluid to multiple ports  178 ,  180  to lens  20 . 
     As described above, the lumens  194  of the conduit in sleeve  170 , sleeve  150  or any of the embodiments of the conduit carrier sleeves  130 , are fluidly connected to supply line  60  by any suitable means, including any of the embodiments of supply line  60  described previously herein, supply line  60  is connected at its proximal end to a source of cleaning fluid (liquid or gaseous) and/or a source of vacuum to provide cleaning fluid or suction or both, as desired, to lens  20  of endoscope  10 . 
     The lumens of conduit carriers  130  may themselves function as the conduit for delivery of the cleaning fluid or suction to the delivery ports or may function as channels for receiving separate conduits in each lumen, appropriately ported to one or more delivery ports. 
     In an alternative embodiment of a conduit carrier, a carrier tray  210  that adheres to the bottom  24  of endoscope  10  may be used to attach the cleaning apparatus to endoscope  10 . As shown in  FIGS. 27-29 , tray  210  conforms to the shape of the bottom  24  of endoscope  10 , for example, curved. Those skilled in the art will appreciate that other shapes are possible. Tray  210 , as shown, includes a distal panel  214  having a lens cut out portion  216  and a proximal panel  218 . One, two, three or more delivery ports  224  may be provided along the edge of cut out portion  216  to direct cleaning fluid or suction or both to lens  20 . A conduit having one, two, or three lumens extends from line  220  through the body of tray  210  to delivery ports  224  in the manner described previously for carrier sleeves  150  and  170 , for example. 
     Tray  210  may be completely rigid. Tray  210  may be made of a magnetic alloy, such as a ferrous alloy, so that the magnets carried in endoscope  10  when it is a MAGS endoscope, attract and hold tray  210  to endoscope  10 . Panels  214  and  218  abut distal and proximal faces  12 ,  14  of endoscope  10 . The magnetic hold in addition to the positioning provided by distal and proximal panels  214  and  218 , respectively, serve to align the cut out portion  216  and delivery port or ports  224  with lens  20 . 
     An alternative means of attaching a conduit carrier to endoscope  10  is shown in  FIG. 30 . A double sided tape  230  made of a biocompatible adhesive material may be placed on the interior surface of the carrier, such as tray  210  as shown, to tape one side of the tape  230  to the carrier. The other side of the double sided tape  230  adheres to the endoscope bottom  24 . The double sided tape  230 , while shown with tray  210 , may be used with any of the conduit carrier embodiments described herein. 
     The conduit carrier may be held to the endoscope  10  with a chemical or an adhesive having the following properties: i) water/salt-based fluid impervious, ii) strong enough to hold the conduit in place for the length of the medical procedure, iii) able to be released by any suitable means after the endoscope has been retrieved from the patient, that does not damage the endoscope, for example, by dissolving the adhesive with a chemical, with heat, or by separating the endoscope from the attachment means by physical force. 
     The embodiments of the devices described herein may be introduced inside a patient using minimally invasive or open surgical techniques. In some instances it may be advantageous to introduce the devices inside the patient using a combination of minimally invasive and open surgical techniques. Minimally invasive techniques may provide more accurate and effective access to the treatment region for diagnostic and treatment procedures. To reach internal treatment regions within the patient, the devices described herein may be inserted through natural openings of the body such as the mouth, anus, and/or vagina, for example. Some portions of the devices may be introduced to the tissue treatment region percutaneously or through small, keyhole incisions. 
     Endoscopic minimally invasive therapeutic or diagnostic surgical medical procedures are used to evaluate and treat internal organs by inserting a small tube into the body. The endoscope may have a rigid or a flexible tube. A flexible endoscope may be introduced either through a natural body opening (e.g., mouth, anus, and/or vagina) or via a trocar through a relatively small, keyhole incision (usually 0.5-2.5-2 cm). The endoscope can be used to observe surface conditions of internal organs, including abnormal or diseased tissue such as lesions and other surface conditions and capture images for visual inspection and photography. The endoscope may be adapted and configured with working channels for introducing medical instruments to the treatment region for taking biopsies, retrieving foreign objects, and/or performing surgical procedures. 
     The cleaning apparatus described herein is preferably a disposable device, intended for a single use. Preferably, the various embodiments of the devices described herein will be processed before surgery. First, a new cleaning apparatus and a new or used instrument, such as endoscope  10  and trocars are obtained and if necessary cleaned. The instruments can then be sterilized. In one sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic or TYVEK® bag. The container and instrument are then placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high-energy electrons. The radiation kills bacteria on the instrument and in the container. The sterilized instrument can then be stored in the sterile container. The sealed container keeps the instrument sterile until it is opened in the medical facility. Other sterilization techniques can be done by any number of ways known to those skilled in the art including beta or gamma radiation, ethylene oxide, and/or steam. Alternately, the device may be of a single-use disposable nature, and would be delivered sterilized and disposed of after a procedure. 
     Although the various embodiments of the devices have been described herein in connection with certain disclosed embodiments, many modifications and variations to those embodiments may be implemented. For example, different types of end effectors may be employed. Also, where materials are disclosed for certain components, other materials may be used. The foregoing description and following claims are intended to cover all such modification and variations. 
     Any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated materials does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material. 
     It should be understood that any numerical range recited herein is intended to include all sub-ranges subsumed therein. For example, a range of “1 to 10” is intended to include all sub-ranges between (and including) the recited minimum value of 1 and the recited maximum value of 10, that is, having a minimum value equal to or greater than 1 and a maximum value of equal to or less than 10.