CA2739833A1 - Apparatus for controlling flow in a bodily organ - Google Patents
Apparatus for controlling flow in a bodily organ Download PDFInfo
- Publication number
- CA2739833A1 CA2739833A1 CA2739833A CA2739833A CA2739833A1 CA 2739833 A1 CA2739833 A1 CA 2739833A1 CA 2739833 A CA2739833 A CA 2739833A CA 2739833 A CA2739833 A CA 2739833A CA 2739833 A1 CA2739833 A1 CA 2739833A1
- Authority
- CA
- Canada
- Prior art keywords
- wall portion
- constriction
- control
- stimulation
- control device
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
Links
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
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- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/0004—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse
- A61F2/0031—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse for constricting the lumen; Support slings for the urethra
- A61F2/0036—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse for constricting the lumen; Support slings for the urethra implantable
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- A—HUMAN NECESSITIES
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- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/0004—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse
- A61F2/0031—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse for constricting the lumen; Support slings for the urethra
- A61F2/0036—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse for constricting the lumen; Support slings for the urethra implantable
- A61F2/004—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse for constricting the lumen; Support slings for the urethra implantable inflatable
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- A61N1/02—Details
- A61N1/04—Electrodes
- A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
- A61N1/0507—Electrodes for the digestive system
- A61N1/0509—Stomach and intestinal electrodes
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- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
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- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/36007—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation of urogenital or gastrointestinal organs, e.g. for incontinence control
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- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/372—Arrangements in connection with the implantation of stimulators
- A61N1/37211—Means for communicating with stimulators
- A61N1/37235—Aspects of the external programmer
- A61N1/37247—User interfaces, e.g. input or presentation means
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
- A61F2002/045—Stomach, intestines
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2250/0001—Means for transferring electromagnetic energy to implants
- A61F2250/0002—Means for transferring electromagnetic energy to implants for data transfer
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2250/0004—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable
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- A61F7/00—Heating or cooling appliances for medical or therapeutic treatment of the human body
- A61F7/02—Compresses or poultices for effecting heating or cooling
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
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- A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
- A61N1/36514—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure
- A61N1/36564—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by blood pressure
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- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
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- A61N1/362—Heart stimulators
- A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
- A61N1/36514—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure
- A61N1/36578—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
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- A61N1/40—Applying electric fields by inductive or capacitive coupling ; Applying radio-frequency signals
- A61N1/403—Applying electric fields by inductive or capacitive coupling ; Applying radio-frequency signals for thermotherapy, e.g. hyperthermia
Abstract
An apparatus for controlling a flow of fluid and/or other bodily matter in a lumen formed by a tissue wall of a patient's organ comprises an implantable constriction device for gently constricting (i.e. without substantially hampering the blood circulation in the tissue wall) at least one portion of the tissue wall to influence the flow in the lumen, and a stimulation device for stimulating the wall portion of the tissue wall. A control device controls the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion constricted by the constriction device to further influence the flow in the lumen. The apparatus can be used for restricting or stopping the flow in the lumen, or for actively moving the fluid in the lumen, with a low risk of injuring the organ.
Description
TITLE OF THE INVENTION
APPARATUS FOR CONTROLLING FLOW IN A BODILY ORGAN
FIELD OF THE INVENTION
[0001] The present invention relates to controlling the flow of fluids and/or other bodily matter in bodily organs, and in particular, to an apparatus for controlling the flow of fluids and/or other bodily matter in lumens formed by tissue walls of bodily organs, such as (but not limited to) the esophagus, stomach, intestines, urine bladder, urethra, and blood vessels.
BACKGROUND OF THE INVENTION
APPARATUS FOR CONTROLLING FLOW IN A BODILY ORGAN
FIELD OF THE INVENTION
[0001] The present invention relates to controlling the flow of fluids and/or other bodily matter in bodily organs, and in particular, to an apparatus for controlling the flow of fluids and/or other bodily matter in lumens formed by tissue walls of bodily organs, such as (but not limited to) the esophagus, stomach, intestines, urine bladder, urethra, and blood vessels.
BACKGROUND OF THE INVENTION
[0002]There are diseases that prevent a patient from maintaining normal control of the flow of fluids and/or other bodily matter in a lumen of a bodily organ.
(The term "patient" generally includes human beings, but may also include animals.) For example, a patient suffering from urinary incontinence, which is a common disease that is very embarrassing to a patient, typically occurs where the patient has lost full control of urine -flow in the urethra because of a malfunctioning of the urethral sphincter. Anal incontinence often occurs because of a malfunctioning of the anal sphincter, which causes an uncontrolled drainage of fecal matter through the anus.
Impotence is typically due to an inability to sufficently reduce blood flow from the penis so that an errection can be achieved. Reflux disease is typically due to a malfunctioning of the cardia, which causes stomach acids to be regurgitated into the esophagus when the stomach wall moves during digestion.
(The term "patient" generally includes human beings, but may also include animals.) For example, a patient suffering from urinary incontinence, which is a common disease that is very embarrassing to a patient, typically occurs where the patient has lost full control of urine -flow in the urethra because of a malfunctioning of the urethral sphincter. Anal incontinence often occurs because of a malfunctioning of the anal sphincter, which causes an uncontrolled drainage of fecal matter through the anus.
Impotence is typically due to an inability to sufficently reduce blood flow from the penis so that an errection can be achieved. Reflux disease is typically due to a malfunctioning of the cardia, which causes stomach acids to be regurgitated into the esophagus when the stomach wall moves during digestion.
[0003]One prior solution to the problem of malfunctioning sphincters has been to implant an artificial sphincter that replaces a malfunctioning sphincter. A
variety of artificial sphincters have been used in the past. These artificial sphincters have included cuffs, clamping elements or inflatable bands that are applied externally around the bodily organ that is connected to the malfunctioning sphincter.
variety of artificial sphincters have been used in the past. These artificial sphincters have included cuffs, clamping elements or inflatable bands that are applied externally around the bodily organ that is connected to the malfunctioning sphincter.
[0004] For example, U.S. Patent No. 3,750,194 discloses a hydraulic cuff applied around the urethra of a patient suffering from urinary incontinence Hydraulic fluid SUBSTITUTE SHEET (RULE 26) flowing to the hydraulic cuff causes the cuff to squeeze the urethra and restrict fluid flow through it.
[0005] U.S. Patent No. 6,074,341 discloses a mechanical device in the form of a loop member that is applied around a bodily organ to replace the organ's missing or damaged sphincter. The loop member includes a wire which is used to constrict the organ in question to close the lumen therein.
[0006] A disadvantage common to all prior artificial sphinters is that hard fibrosis may form around the artificial sphincter over time and may cause malfunction of the artificial sphincter. Thus, the formed fibrosis may sooner or later become a hard fibrotic layer which may make it difficult for the artificial sphincter to work.
[0007] Another more serious disadvantage is that the element that constricts, clamps or restricts a bodily organ may injure the tissue wall of the organ. Thus, a consequence of the element's constricting action on the organ is that the element might erode into the organ over time, and in a worst case, penetrate the constricted wall portion of the organ. In addition, blood circulation in the constricted tissue wall portion of the organ is eventually hampered by the pressure exerted by the element, so that poor blood circulation, or worse, no blood circulation results in deterioration of the constricted tissue.
[0008] One solution to prevent tissue deterioration due to poor blood circulation could be to apply two or more separately operating constricting elements along respective tissue wall portions of the organ and operate the elements sequentially, whereby each tissue wall portion would have time to recover, i.e., restore normal blood circulation while one of the other tissue wall portions is constricted.
However, an apparatus devised in accordance with this solution would have several disadvantages. First, the apparatus would require a large amount of space, making it impractical to implant. Second, the operation of the apparatus in moving the constricting elements between constricting and non-constricting positions day and night would require a large power supply. Such a large power supply would necessitate the implantation of a very large, high capacity battery and/or a sophisticated system for continuous wireless transmission of energy from outside the patient's body for frequent charging of an implanted rechargeable battery.
Thus, because of its large size and high power consumption, the apparatus would be impractical or even unrealistic. Third, a sophisticated control system would be necessary to control the moving elements. Finally, such a complicated apparatus of SUBSTITUTE SHEET (RULE 26)
However, an apparatus devised in accordance with this solution would have several disadvantages. First, the apparatus would require a large amount of space, making it impractical to implant. Second, the operation of the apparatus in moving the constricting elements between constricting and non-constricting positions day and night would require a large power supply. Such a large power supply would necessitate the implantation of a very large, high capacity battery and/or a sophisticated system for continuous wireless transmission of energy from outside the patient's body for frequent charging of an implanted rechargeable battery.
Thus, because of its large size and high power consumption, the apparatus would be impractical or even unrealistic. Third, a sophisticated control system would be necessary to control the moving elements. Finally, such a complicated apparatus of SUBSTITUTE SHEET (RULE 26)
9 PCT/SE2008/000568 the type described above would significantly add to the costs of treating a malfunctioning sphincter.
[0009]Another solution to the problem of malfunctioning sphincters that has been previously used has been the electric stimulation of the sphincter, to restore its normal function, i.e., the contraction and closing of its associated lumen.
This solution would work where the normal sphincteric function is somewhat reduced and has not completely ceased. European patent application 1004330 Al discloses an example of such a solution, in which electric pulses are delivered to the lower esophageal sphincter of a patient suffering from reflux disease to minimize reflux.
However, the esophageal sphincter has to be continuously stimulated with electric pulses to keep it closed, except when the patient eats, which may result in a decreased stimulation effect over time. An even more serious drawback to this solution is that the continuous stimulation over time might cause tissue deterioration due to poor blood circulation.
[0009]Another solution to the problem of malfunctioning sphincters that has been previously used has been the electric stimulation of the sphincter, to restore its normal function, i.e., the contraction and closing of its associated lumen.
This solution would work where the normal sphincteric function is somewhat reduced and has not completely ceased. European patent application 1004330 Al discloses an example of such a solution, in which electric pulses are delivered to the lower esophageal sphincter of a patient suffering from reflux disease to minimize reflux.
However, the esophageal sphincter has to be continuously stimulated with electric pulses to keep it closed, except when the patient eats, which may result in a decreased stimulation effect over time. An even more serious drawback to this solution is that the continuous stimulation over time might cause tissue deterioration due to poor blood circulation.
[0010]The use of electric stimula to restore the sphincteric function of a malfunctioning sphincter is only possible if the sphincter responds sufficiently to the stimula, i.e., closes the lumen in question. In cases where the sphincteric function of a sphincter has completely ceased, or the sphincter has been removed from the patient's body, electric stimulation cannot be employed.
[0011]Electric stimulation of bodily organs other than sphincters can only insignificantly affect the flow in the organ in question. For example, where the organ is the small intestine of an anal incontinent patient, electric stimulation of the small intestine affects fecal flow, but could not possibly fully close the fecal passageway, at least not by employing the necessary low stimulation intensities that are harmless to the human body.
BRIEF SUMMARY OF THE INVENTION
BRIEF SUMMARY OF THE INVENTION
[0012]The object of the present invention is to provide an apparatus for controlling the flow of fluids and/or other bodily matter in lumens formed by tissue walls of bodily organs, so as to at least substantially or even completely eliminate the injured tissue wall problems that have resulted from implanted prior art devices that constrict such bodily organs.
SUBSTITUTE SHEET (RULE 26)
SUBSTITUTE SHEET (RULE 26)
[0013]In accordance with this object of the present invention, there is provided an apparatus for controlling the flow of fluids and/or other bodily matter in a lumen that is formed by the tissue wall of a bodily organ, the apparatus comprising an implantable constriction device for gently constricting a portion of the tissue wall to influence the flow in the lumen, a stimulation device for stimulating the wall portion of the tissue wall, and a control device for controlling the stimulation device to stimulate the wall portion as the constriction device constricts the wall portion to cause contraction of the wall portion to further influence the flow in the lumen.
[00141The present invention provides an advantageous combination of constriction and stimulation devices, which results in a two-stage influence on the flow of fluids and/or other bodily matter in the lumen of a bodily organ. Thus, the constriction device may gently constrict the tissue wall by applying a relatively weak force against the wall portion, and the stimulation device may stimulate the constricted wall portion to achieve the desired final influence on the flow in the lumen. The phrase "gently constricting a portion of the tissue wall" is to be understood as constricting the wall portion without substantially hampering the blood circulation in the tissue wall.
100151Preferably, the stimulation device is adapted to stimulate different areas of the wall portion as the constriction device constricts the wall portion, and the control device controls the stimulation device to intermittently and individually stimulate the areas of the wall portion. This intermittent and individual stimulation of different areas of the wall portion of the organ allows tissue of the wall portion to maintain substantially normal blood circulation during the operation of the apparatus of the invention.
[0016]The combination of the constriction and stimulation devices enables application of the apparatus of the invention at any place on any kind of bodily organs, in particular, but not limited to, tubular bodily organs, which is a significant advance in the art, as compared with prior stimulation devices that are confined to electric stimulation of malfunctioning sphincters.
[0017]In most applications using the present invention, there will be daily adjustments of the implanted constriction device. Therefore, in a preferred embodiment of the invention, the constriction device is adjustable to enable adjustment of the constriction of the wall portion as desired, wherein the, control device controls the constriction device to adjust the constriction of the wall portion.
The control device may control the constriction and stimulation devices independently SUBSTITUTE SHEET (RULE 26) of each other, and simultaneously. Optionally, the control device may control the stimulation device to stimulate, or to not stimulate the wall portion while the control device controls the constriction device to change the constriction of the wall portion.
[0018] Initially, the constriction device may be calibrated by using the control device to control the stimulation device to stimulate the wall portion, while controlling the constriction device to adjust the constriction of the wall portion until the desired restriction of the flow in the lumen is obtained.
Flow restriction (00191The apparatus of the present invention is well suited for restricting the flow of fluids and/or other bodily matter in the lumen of a bodily organ. Thus, in a principal embodiment of the invention, the constriction device is adapted to constrict the wall portion to at least restrict the flow in the lumen, and the control device controls the stimulation device to cause contraction of the constricted wall portion, so that the flow in the lumen is at least further restricted. Specifically, the constriction device is adapted to constrict the wall portion to a constricted state in which the blood circulation in the constricted wall portion is substantially unrestricted and the flow in the lumen is at least restricted, and the control device controls the stimulation device to cause contraction of the wall portion, so that the flow in the lumen is at least further restricted when the wall portion is kept by the constriction device in the constricted state.
[0020]The constriction and stimulation devices may be controlled to constrict and stimulate, respectively, to an extent that depends on the flow restriction that is desired to be achieved in a specific application of the apparatus of the invention.
Thus, in accordance with a first flow restriction option, the control device controls the constriction device to constrict the wall portion, such that flow in the lumen is restricted but not stopped, and controls the stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that flow in the lumen is further restricted but not stopped. More precisely, the control device may control the stimulation device in a first mode to stimulate the constricted wall portion to further restrict but not stop the flow in the lumen and to:
a) control the stimulation device in a second mode to cease the stimulation of the wall portion to increase the flow in the lumen; or SUBSTITUTE SHEET (RULE 26) b) control the stimulation and constriction devices in the second mode to cease the stimulation of the wall portion and release the wall portion to restore the flow in the lumen.
[0021]1n accordance with a second flow restriction option, the control device controls the constriction device to constrict the wall portion, such that flow in the lumen is restricted but not stopped, and controls the stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that flow in the lumen is stopped. More precisely, the control device may control the stimulation device in a first mode to stimulate the constricted wall portion to further restrict but not stop the flow in the lumen and to:
a) control the stimulation device in a second mode to cease the .
stimulation of the wall portion to allow flow in the lumen; or b) control the stimulation and constriction devices in the second mode to cease the stimulation of the wall portion and release the wall portion to restore the flow in the lumen.
[0022]in accordance with a third flow restriction option, the control device controls the constriction device to constrict the wall portion, such that the flow in the lumen is substantially stopped, and controls the stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the lumen is completely stopped. More precisely, the control device may control the stimulation device in a first mode to stimulate the constricted wall portion to completely stop the flow in the lumen and to:
a) control the stimulation device in a second mode to cease the stimulation of the wall portion to allow flow in the lumen; or b) control the stimulation and constriction devices in the second mode to cease the stimulation of the wall portion and release the wall portion to restore the flow in the lumen.
[0023]For example, the third flow restriction option may be applied where the present invention is used for controlling fecal flow of an anal incontinent patient.
Thus, the restriction and stimulation devices may be implanted on any part of the incontinent patient's large or small intestines to serve as an artificial anal sphincter.
Between defecations, the control device controls the constriction device to gently flatten a portion of the intestines to at least almost completely stop the fecal flow in the intestines, and controls the stimulation device to stimulate the flattened portion to SUBSTITUTE SHEET (RULE 26) insure that the fecal flow is completely stopped. Since the control device controls the stimulation device to intermittently and individually stimulate the areas of the wall portion, as stated above in paragraph 0015, the risk of the implanted constriction device injuring the intestines over time is significantly reduced or even eliminated, and it is insured that the effect of the stimulation is maintained over time.
When the patient wants to defecate, the control device controls the constriction and stimulation devices to release the portion of the intestines and cease the stimulation, whereby fecal matter may pass the portion of the intestines. However, it should be noted that in some other applications of the present invention, for example where the invention is used for controlling urine flow of a urinary incontinent patient, it may suffice to just cease the stimulation to achieve fluid flow through the organ in question.
[0024]Where the stimulation device stimulates the constricted wall portion to contract, such that the flow in the lumen is stopped, the control device suitably controls the stimulation device to simultaneously and cyclically stimulate a first length of the constricted wall portion and a second length of the constricted wall portion, which is located downstream of the first length, wherein the control device controls the stimulation device to progressively stimulate the first length in the upstream direction of the lumen and to progressively stimulate the second length in the downstream direction of the lumen.
[0025]The control device may control the stimulation device to change the stimulation of the wall portion in response to a sensed physical parameter of the patient or functional parameter of the apparatus. For example, the control device may control the stimulation device to increase the intensity of the stimulation of the wall portion in response to a sensed pressure increase in the lumen, such that the flow in the lumen remains stopped. Any sensor for sensing a physical parameter of the patient, such as a pressure in the patient's body that relates to the pressure in the lumen may be provided, wherein the control device controls the stimulation device in response to signals from the sensor. Such a sensor may for example sense the pressure in the patient's abdomen, the pressure against the implanted constriction device or the pressure on the tissue wall of the bodily organ.
[0026] For example, a pressure sensor may be applied where the present invention is used for controlling urine flow of a urinary incontinent patient. Thus, the constriction and stimulation devices may be applied on the urinary incontinent patient's urethra or urine bladder to serve as an artificial sphincter, wherein the constriction device SUBSTITUTE SHEET (RULE 26) constricts the urethra or urine bladder, such that the urine flow is substantially stopped, and the stimulation device stimulates the constricted urethra or urine bladder to cause contraction thereof to completely stop the urine flow. The control device controls the stimulation device to increase the stimulation intensity in response to signals from the pressure sensor sensing a sudden increase in the pressure in the patient's bladder or abdominal cavity, whereby the urine flow remains stopped and the patient maintains continence. In this manner, the present invention insures that the patient even is continent when he or she sneezes or coughs, or performs other physical activity that causes a sudden pressure increase in the patient's bladder/urinary tract.
[0027] In accordance with a fourth flow restriction option, the control device controls the constriction device to constrict the wall portion, such that the flow in the lumen is stopped. More precisely, the control device may control the constriction device in a first mode to constrict the constricted wall portion to stop the flow in the lumen and in a second mode to cease the constriction of the wall portion to restore flow in the lumen. In this case, the control device only controls the stimulation device to stimulate the wall portion when needed. A sensor for sensing a physical parameter of the patient's body that relates to the pressure in the lumen may be provided, wherein the control device controls the stimulation device in response to signals from the sensor. Such a physical parameter may be a pressure in the patient's abdomen and the sensor may be a pressure sensor.
[0028]For example, the fourth flow restriction option may be applied where the present invention is used for controlling urine flow of a urinary incontinent patient in a manner similar to the situation described in the foregoing paragraph 0026.
However, in this example stimulation is only applied when necessary to maintain continence, Thus, the control device controls the stimulation device to stimulate the urethra or urine bladder to cause contraction thereof in response to signals from the pressure sensor sensing a sudden increase in the pressure in the patient's bladder or abdominal cavity, when the patient sneezes or coughs, or performs other physical activity. As a result, the urine flow remains stopped and the patient maintains continence.
[0029] In some applications of the invention, the implanted constriction device may be designed to normally keep the patient's wall portion of the organ in the constricted state. In this case, the control device may be used when needed, conveniently by SUBSTITUTE SHEET (RULE 26) the patient, to control the stimulation device to stimulate the constricted tissue wall portion, preferably while adjusting the stimulation intensity, to cause contraction of the wall portion, such that the flow in the lumen is at least further restricted or stopped, and to control the stimulation device to cease the stimulation. More precisely, the control device may:
a) control the stimulation device in a first mode to stimulate the constricted wall portion to further restrict the flow in the lumen, and control the stimulation device in a second mode to cease the stimulation of the wall portion to increase the flow in the lumen; or b) control the stimulation device in a first mode to stimulate the constricted wall portion to stop the flow in the lumen, and control the stimulation device in a second mode to cease the stimulation of the wall portion to allow flow in the lumen.
[0030] Either the first mode or the second mode may be temporary.
[0031]The constriction device may include a plurality of separate constriction elements adapted to constrict any wall portions of a series of wall portions of the organ's tissue wall, respectively. The control device may control the constriction device to activate the constriction elements in random or in accordance with a predetermined sequence. In this case, the stimulation device includes stimulation elements positioned on the constriction elements, wherein the control device controls the stimulation device to activate the stimulation elements to stimulate any wall portions of the series of wall portions constricted by said constriction elements to contract the organ to close the organ's lumen.
[0032]Alternatively, the control device controls the constriction device to activate the constriction elements to constrict all of the wall portions of the series of wall portions, and controls the stimulation device to activate the stimulation elements to stimulate any constricted wall portions in random or in accordance with a predetermined sequence to close the organ's lumen. The design of the constriction device in the form of a plurality of separate constriction elements makes possible to counteract growth of hard fibrosis where the constriction device is implanted.
SUBSTITUTE SHEET (RULE 26) Movement of fluid and/or other bodily matter in lumen [0033]The apparatus of the invention can be used for actively moving the fluid and/or other bodily matter in the lumen of a patient's organ, as described in the embodiments of the invention listed below.
[0034]1) The control device controls the constriction device to close the lumen, either at an upstream end or a downstream end of the wall portion, and then controls the constriction device to constrict the remaining part of the wall portion to move the fluid and/or other bodily matter in the lumen.
[0035] la) In accordance with a first alternative of the above noted embodiment (1), the control device controls the stimulation device to stimulate the wall portion as the constriction device constricts the remaining part of the wall portion.
[0036] 1 b) In accordance with a second alternative, the constriction device is adapted to constrict the wall portion to restrict but not stop the flow in the lumen.
The control device controls the stimulation device to stimulate the wall portion constricted by the constriction device to close the lumen, either at an upstream end or a downstream end of the wall portion, and simultaneously controls the constriction device to increase the constriction of the wall portion to move the fluid and/or other bodily matter in the lumen.
[0037] 2) The constriction device is adapted to constrict the wall portion to restrict or vary the flow in the lumen, and the control device controls the stimulation device to progressively stimulate the constricted wall portion, in the downstream or upstream direction of the lumen, to cause progressive contraction of the wall portion to move the fluid and/or other bodily matter in the lumen.
[0038] 3) The control device controls the constriction device to vary the constriction of the different areas of the wall portion, such that the wall portion is progressively constricted in the downstream or upstream direction of the lumen to move the fluid and/or other bodily matter in the lumen. The constriction device may include at least one elongated constriction element that extends along the wall portion, wherein the control device controls the elongated constriction element to progressively constrict the wall portion in the downstream or upstream direction of the lumen.
[0039] 3a) In accordance with a preferred alternative of the above noted embodiment (3), the control device controls the stimulation device to progressively stimulate the constricted wall portion to cause progressive contraction thereof in harmony with the SUBSTITUTE SHEET (RULE 26) progressive constriction of the wall portion performed by the constriction device.
Where the constriction device includes at least one elongated constriction element the control device controls the elongated constriction element to progressively constrict the wall portion in the downstream or upstream direction of the lumen.
Suitably, the elongated constriction element comprises contact surfaces dimensioned to contact a length of the wall portion, when the constriction device constricts the wall portion, and the stimulation device comprises a plurality of stimulation elements distributed along the contact surfaces, such that the stimulation elements stimulate the different areas of the wall portion along the length of the wall portion, when the control device controls the stimulation device to stimulate the wall portion.
[0040]4) The constriction device is adapted to constrict any one of a series of wall portions of the tissue wall to at least restrict the flow in the lumen. The control device controls the constriction device to successively constrict the wall portions of the series of wall portions to move the fluid and/or other bodily matter in the lumen in a peristaltic manner.
[0041]4a) In accordance with a first alternative of embodiment (4), the constriction device includes a plurality of constriction elements adapted to constrict the wall portions of the tissue wall, respectively. The control device controls the constriction device to activate the constriction elements one after the other, so that the wall portions of the series of wall portions are successively constricted along the organ, whereby the fluid and/or other bodily matter in the lumen is moved.
[0042] 4b) In accordance with a second alternative of embodiment (4), the constriction device includes at least one constriction element that is moveable along the wall of the organ to successively constrict the wall portions of the series of wall portions, wherein the control device controls the constriction device to cyclically move the constriction element along the wall portions of the series of wall portions.
Preferably, the constriction device comprises a plurality of constriction elements, each of which is moveable along the wall of the organ to successively constrict the wall portions of the series of wall portions, wherein the control device controls the constriction device to cyclically move the constriction elements one after the other along the wall portions of the series of wall portions. Specifically, the constriction device includes a rotor carrying the constriction elements, and the control device controls the rotor to rotate, such that each constriction element cyclically constricts SUBSTITUTE SHEET (RULE 26) the wall portions of the series of wall portions. Each constriction element suitably comprises a roller for rolling on the wall of the organ to constrict the latter.
[0043] 4c) In accordance with a preferred alternative of the above noted embodiment (4), the stimulation device stimulates any of the wall portions of the series of wall portions constricted by the constriction device, to close the lumen. Where the constriction device includes at least one constriction element, the stimulation device suitably includes at least one stimulation element positioned on the constriction element for stimulating the wall portion constricted by the constriction element to close the lumen.
[0044] Where the constriction device includes a plurality of constriction elements, the stimulation device suitably includes stimulation elements positioned on the constriction elements for stimulating the wall portions constricted by the constriction elements to close the lumen.
[0046] 5) The constriction device is adapted to constrict any one of a series of wall portions of the tissue wall to restrict the flow in the lumen, wherein the constriction device includes a plurality of constriction elements adapted to constrict the wall portions of the tissue wall, respectively, and the stimulation device includes stimulation elements positioned on the constriction elements for stimulating the wall portions constricted by the constriction elements to close the lumen. The control device controls the constriction device to activate the constriction elements to constrict the wall portions of the series of wall portions without completely closing the organ's lumen, and controls the stimulation device to activate the stimulation elements to stimulate the wall portions one after the other, so that the wall portions of the series of wall portions are successively contracted along the organ to move the fluid and/or other bodily matter in the lumen of the patient's organ.
[0046]6) The constriction device comprises a first constriction element for constricting the wall portion at an upstream end thereof, a second constriction element for constricting the wall portion at a downstream end thereof, and a third constriction element for constricting the wall portion between the upstream and downstream ends thereof. The control device controls the first, second and third constriction elements to constrict and release the wall portion independently of one another. More specifically, the control device controls the first or second constriction element to constrict the wall portion at the upstream or downstream end thereof to close the lumen, and controls the third constriction element to constrict the wall SUBSTITUTE SHEET (RULE 26) portion between the upstream and downstream ends thereof, whereby the fluid and/or other bodily matter contained in the wall portion between the upstream and downstream ends thereof is moved downstream or upstream in the lumen.
Optionally, the control device controls the stimulation device to stimulate the wall portion between the upstream and downstream ends thereof, when the third constriction element constricts the wall portion.
[0047] 6a) In accordance with a first alternative, the control device controls the first constriction element to constrict the wall portion at the upstream end thereof to restrict the flow in the lumen and controls the stimulation device to stimulate the constricted wall portion at the upstream end to close the lumen. With the lumen closed at the upstream end of the constricted wall portion, the control device controls the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, and optionally controls the stimulation device to simultaneously stimulate the wall portion as the latter is constricted by the third constriction element. As a result, the fluid and/or other bodily matter contained in the wall portion between the upstream and downstream ends thereof is moved downstream in the lumen.
[0048] 6b) In accordance with a second alternative, the control device controls the second constriction element to constrict the wall portion at the downstream end thereof to restrict the flow in the lumen and controls the stimulation device to stimulate the constricted wall portion at the downstream end to close the lumen. With the lumen closed at the downstream end of the constricted wall portion, the control device controls the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, and optionally controls the stimulation device to simultaneously stimulate the wall portion as the latter is constricted by the third constriction element. As a result, the fluid and/or other bodily matter contained in the wall portion between the upstream and downstream ends thereof is moved upstream in the lumen.
[0049] In any of the above noted embodiments (1) to (6b), the stimulation device may stimulate the wall portion with electric pulses.
[0050]Where the organ is tubular in shape, such as the small intestines, a particularly long wall portion of the tubular organ may be surgically prepared to extend in zigzag with adjacent walls stitched together by two parallel rows of stitches and with the adjacent walls cut through between the two rows of stitches. As a result, SUBSTITUTE SHEET (RULE 26)
[00141The present invention provides an advantageous combination of constriction and stimulation devices, which results in a two-stage influence on the flow of fluids and/or other bodily matter in the lumen of a bodily organ. Thus, the constriction device may gently constrict the tissue wall by applying a relatively weak force against the wall portion, and the stimulation device may stimulate the constricted wall portion to achieve the desired final influence on the flow in the lumen. The phrase "gently constricting a portion of the tissue wall" is to be understood as constricting the wall portion without substantially hampering the blood circulation in the tissue wall.
100151Preferably, the stimulation device is adapted to stimulate different areas of the wall portion as the constriction device constricts the wall portion, and the control device controls the stimulation device to intermittently and individually stimulate the areas of the wall portion. This intermittent and individual stimulation of different areas of the wall portion of the organ allows tissue of the wall portion to maintain substantially normal blood circulation during the operation of the apparatus of the invention.
[0016]The combination of the constriction and stimulation devices enables application of the apparatus of the invention at any place on any kind of bodily organs, in particular, but not limited to, tubular bodily organs, which is a significant advance in the art, as compared with prior stimulation devices that are confined to electric stimulation of malfunctioning sphincters.
[0017]In most applications using the present invention, there will be daily adjustments of the implanted constriction device. Therefore, in a preferred embodiment of the invention, the constriction device is adjustable to enable adjustment of the constriction of the wall portion as desired, wherein the, control device controls the constriction device to adjust the constriction of the wall portion.
The control device may control the constriction and stimulation devices independently SUBSTITUTE SHEET (RULE 26) of each other, and simultaneously. Optionally, the control device may control the stimulation device to stimulate, or to not stimulate the wall portion while the control device controls the constriction device to change the constriction of the wall portion.
[0018] Initially, the constriction device may be calibrated by using the control device to control the stimulation device to stimulate the wall portion, while controlling the constriction device to adjust the constriction of the wall portion until the desired restriction of the flow in the lumen is obtained.
Flow restriction (00191The apparatus of the present invention is well suited for restricting the flow of fluids and/or other bodily matter in the lumen of a bodily organ. Thus, in a principal embodiment of the invention, the constriction device is adapted to constrict the wall portion to at least restrict the flow in the lumen, and the control device controls the stimulation device to cause contraction of the constricted wall portion, so that the flow in the lumen is at least further restricted. Specifically, the constriction device is adapted to constrict the wall portion to a constricted state in which the blood circulation in the constricted wall portion is substantially unrestricted and the flow in the lumen is at least restricted, and the control device controls the stimulation device to cause contraction of the wall portion, so that the flow in the lumen is at least further restricted when the wall portion is kept by the constriction device in the constricted state.
[0020]The constriction and stimulation devices may be controlled to constrict and stimulate, respectively, to an extent that depends on the flow restriction that is desired to be achieved in a specific application of the apparatus of the invention.
Thus, in accordance with a first flow restriction option, the control device controls the constriction device to constrict the wall portion, such that flow in the lumen is restricted but not stopped, and controls the stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that flow in the lumen is further restricted but not stopped. More precisely, the control device may control the stimulation device in a first mode to stimulate the constricted wall portion to further restrict but not stop the flow in the lumen and to:
a) control the stimulation device in a second mode to cease the stimulation of the wall portion to increase the flow in the lumen; or SUBSTITUTE SHEET (RULE 26) b) control the stimulation and constriction devices in the second mode to cease the stimulation of the wall portion and release the wall portion to restore the flow in the lumen.
[0021]1n accordance with a second flow restriction option, the control device controls the constriction device to constrict the wall portion, such that flow in the lumen is restricted but not stopped, and controls the stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that flow in the lumen is stopped. More precisely, the control device may control the stimulation device in a first mode to stimulate the constricted wall portion to further restrict but not stop the flow in the lumen and to:
a) control the stimulation device in a second mode to cease the .
stimulation of the wall portion to allow flow in the lumen; or b) control the stimulation and constriction devices in the second mode to cease the stimulation of the wall portion and release the wall portion to restore the flow in the lumen.
[0022]in accordance with a third flow restriction option, the control device controls the constriction device to constrict the wall portion, such that the flow in the lumen is substantially stopped, and controls the stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the lumen is completely stopped. More precisely, the control device may control the stimulation device in a first mode to stimulate the constricted wall portion to completely stop the flow in the lumen and to:
a) control the stimulation device in a second mode to cease the stimulation of the wall portion to allow flow in the lumen; or b) control the stimulation and constriction devices in the second mode to cease the stimulation of the wall portion and release the wall portion to restore the flow in the lumen.
[0023]For example, the third flow restriction option may be applied where the present invention is used for controlling fecal flow of an anal incontinent patient.
Thus, the restriction and stimulation devices may be implanted on any part of the incontinent patient's large or small intestines to serve as an artificial anal sphincter.
Between defecations, the control device controls the constriction device to gently flatten a portion of the intestines to at least almost completely stop the fecal flow in the intestines, and controls the stimulation device to stimulate the flattened portion to SUBSTITUTE SHEET (RULE 26) insure that the fecal flow is completely stopped. Since the control device controls the stimulation device to intermittently and individually stimulate the areas of the wall portion, as stated above in paragraph 0015, the risk of the implanted constriction device injuring the intestines over time is significantly reduced or even eliminated, and it is insured that the effect of the stimulation is maintained over time.
When the patient wants to defecate, the control device controls the constriction and stimulation devices to release the portion of the intestines and cease the stimulation, whereby fecal matter may pass the portion of the intestines. However, it should be noted that in some other applications of the present invention, for example where the invention is used for controlling urine flow of a urinary incontinent patient, it may suffice to just cease the stimulation to achieve fluid flow through the organ in question.
[0024]Where the stimulation device stimulates the constricted wall portion to contract, such that the flow in the lumen is stopped, the control device suitably controls the stimulation device to simultaneously and cyclically stimulate a first length of the constricted wall portion and a second length of the constricted wall portion, which is located downstream of the first length, wherein the control device controls the stimulation device to progressively stimulate the first length in the upstream direction of the lumen and to progressively stimulate the second length in the downstream direction of the lumen.
[0025]The control device may control the stimulation device to change the stimulation of the wall portion in response to a sensed physical parameter of the patient or functional parameter of the apparatus. For example, the control device may control the stimulation device to increase the intensity of the stimulation of the wall portion in response to a sensed pressure increase in the lumen, such that the flow in the lumen remains stopped. Any sensor for sensing a physical parameter of the patient, such as a pressure in the patient's body that relates to the pressure in the lumen may be provided, wherein the control device controls the stimulation device in response to signals from the sensor. Such a sensor may for example sense the pressure in the patient's abdomen, the pressure against the implanted constriction device or the pressure on the tissue wall of the bodily organ.
[0026] For example, a pressure sensor may be applied where the present invention is used for controlling urine flow of a urinary incontinent patient. Thus, the constriction and stimulation devices may be applied on the urinary incontinent patient's urethra or urine bladder to serve as an artificial sphincter, wherein the constriction device SUBSTITUTE SHEET (RULE 26) constricts the urethra or urine bladder, such that the urine flow is substantially stopped, and the stimulation device stimulates the constricted urethra or urine bladder to cause contraction thereof to completely stop the urine flow. The control device controls the stimulation device to increase the stimulation intensity in response to signals from the pressure sensor sensing a sudden increase in the pressure in the patient's bladder or abdominal cavity, whereby the urine flow remains stopped and the patient maintains continence. In this manner, the present invention insures that the patient even is continent when he or she sneezes or coughs, or performs other physical activity that causes a sudden pressure increase in the patient's bladder/urinary tract.
[0027] In accordance with a fourth flow restriction option, the control device controls the constriction device to constrict the wall portion, such that the flow in the lumen is stopped. More precisely, the control device may control the constriction device in a first mode to constrict the constricted wall portion to stop the flow in the lumen and in a second mode to cease the constriction of the wall portion to restore flow in the lumen. In this case, the control device only controls the stimulation device to stimulate the wall portion when needed. A sensor for sensing a physical parameter of the patient's body that relates to the pressure in the lumen may be provided, wherein the control device controls the stimulation device in response to signals from the sensor. Such a physical parameter may be a pressure in the patient's abdomen and the sensor may be a pressure sensor.
[0028]For example, the fourth flow restriction option may be applied where the present invention is used for controlling urine flow of a urinary incontinent patient in a manner similar to the situation described in the foregoing paragraph 0026.
However, in this example stimulation is only applied when necessary to maintain continence, Thus, the control device controls the stimulation device to stimulate the urethra or urine bladder to cause contraction thereof in response to signals from the pressure sensor sensing a sudden increase in the pressure in the patient's bladder or abdominal cavity, when the patient sneezes or coughs, or performs other physical activity. As a result, the urine flow remains stopped and the patient maintains continence.
[0029] In some applications of the invention, the implanted constriction device may be designed to normally keep the patient's wall portion of the organ in the constricted state. In this case, the control device may be used when needed, conveniently by SUBSTITUTE SHEET (RULE 26) the patient, to control the stimulation device to stimulate the constricted tissue wall portion, preferably while adjusting the stimulation intensity, to cause contraction of the wall portion, such that the flow in the lumen is at least further restricted or stopped, and to control the stimulation device to cease the stimulation. More precisely, the control device may:
a) control the stimulation device in a first mode to stimulate the constricted wall portion to further restrict the flow in the lumen, and control the stimulation device in a second mode to cease the stimulation of the wall portion to increase the flow in the lumen; or b) control the stimulation device in a first mode to stimulate the constricted wall portion to stop the flow in the lumen, and control the stimulation device in a second mode to cease the stimulation of the wall portion to allow flow in the lumen.
[0030] Either the first mode or the second mode may be temporary.
[0031]The constriction device may include a plurality of separate constriction elements adapted to constrict any wall portions of a series of wall portions of the organ's tissue wall, respectively. The control device may control the constriction device to activate the constriction elements in random or in accordance with a predetermined sequence. In this case, the stimulation device includes stimulation elements positioned on the constriction elements, wherein the control device controls the stimulation device to activate the stimulation elements to stimulate any wall portions of the series of wall portions constricted by said constriction elements to contract the organ to close the organ's lumen.
[0032]Alternatively, the control device controls the constriction device to activate the constriction elements to constrict all of the wall portions of the series of wall portions, and controls the stimulation device to activate the stimulation elements to stimulate any constricted wall portions in random or in accordance with a predetermined sequence to close the organ's lumen. The design of the constriction device in the form of a plurality of separate constriction elements makes possible to counteract growth of hard fibrosis where the constriction device is implanted.
SUBSTITUTE SHEET (RULE 26) Movement of fluid and/or other bodily matter in lumen [0033]The apparatus of the invention can be used for actively moving the fluid and/or other bodily matter in the lumen of a patient's organ, as described in the embodiments of the invention listed below.
[0034]1) The control device controls the constriction device to close the lumen, either at an upstream end or a downstream end of the wall portion, and then controls the constriction device to constrict the remaining part of the wall portion to move the fluid and/or other bodily matter in the lumen.
[0035] la) In accordance with a first alternative of the above noted embodiment (1), the control device controls the stimulation device to stimulate the wall portion as the constriction device constricts the remaining part of the wall portion.
[0036] 1 b) In accordance with a second alternative, the constriction device is adapted to constrict the wall portion to restrict but not stop the flow in the lumen.
The control device controls the stimulation device to stimulate the wall portion constricted by the constriction device to close the lumen, either at an upstream end or a downstream end of the wall portion, and simultaneously controls the constriction device to increase the constriction of the wall portion to move the fluid and/or other bodily matter in the lumen.
[0037] 2) The constriction device is adapted to constrict the wall portion to restrict or vary the flow in the lumen, and the control device controls the stimulation device to progressively stimulate the constricted wall portion, in the downstream or upstream direction of the lumen, to cause progressive contraction of the wall portion to move the fluid and/or other bodily matter in the lumen.
[0038] 3) The control device controls the constriction device to vary the constriction of the different areas of the wall portion, such that the wall portion is progressively constricted in the downstream or upstream direction of the lumen to move the fluid and/or other bodily matter in the lumen. The constriction device may include at least one elongated constriction element that extends along the wall portion, wherein the control device controls the elongated constriction element to progressively constrict the wall portion in the downstream or upstream direction of the lumen.
[0039] 3a) In accordance with a preferred alternative of the above noted embodiment (3), the control device controls the stimulation device to progressively stimulate the constricted wall portion to cause progressive contraction thereof in harmony with the SUBSTITUTE SHEET (RULE 26) progressive constriction of the wall portion performed by the constriction device.
Where the constriction device includes at least one elongated constriction element the control device controls the elongated constriction element to progressively constrict the wall portion in the downstream or upstream direction of the lumen.
Suitably, the elongated constriction element comprises contact surfaces dimensioned to contact a length of the wall portion, when the constriction device constricts the wall portion, and the stimulation device comprises a plurality of stimulation elements distributed along the contact surfaces, such that the stimulation elements stimulate the different areas of the wall portion along the length of the wall portion, when the control device controls the stimulation device to stimulate the wall portion.
[0040]4) The constriction device is adapted to constrict any one of a series of wall portions of the tissue wall to at least restrict the flow in the lumen. The control device controls the constriction device to successively constrict the wall portions of the series of wall portions to move the fluid and/or other bodily matter in the lumen in a peristaltic manner.
[0041]4a) In accordance with a first alternative of embodiment (4), the constriction device includes a plurality of constriction elements adapted to constrict the wall portions of the tissue wall, respectively. The control device controls the constriction device to activate the constriction elements one after the other, so that the wall portions of the series of wall portions are successively constricted along the organ, whereby the fluid and/or other bodily matter in the lumen is moved.
[0042] 4b) In accordance with a second alternative of embodiment (4), the constriction device includes at least one constriction element that is moveable along the wall of the organ to successively constrict the wall portions of the series of wall portions, wherein the control device controls the constriction device to cyclically move the constriction element along the wall portions of the series of wall portions.
Preferably, the constriction device comprises a plurality of constriction elements, each of which is moveable along the wall of the organ to successively constrict the wall portions of the series of wall portions, wherein the control device controls the constriction device to cyclically move the constriction elements one after the other along the wall portions of the series of wall portions. Specifically, the constriction device includes a rotor carrying the constriction elements, and the control device controls the rotor to rotate, such that each constriction element cyclically constricts SUBSTITUTE SHEET (RULE 26) the wall portions of the series of wall portions. Each constriction element suitably comprises a roller for rolling on the wall of the organ to constrict the latter.
[0043] 4c) In accordance with a preferred alternative of the above noted embodiment (4), the stimulation device stimulates any of the wall portions of the series of wall portions constricted by the constriction device, to close the lumen. Where the constriction device includes at least one constriction element, the stimulation device suitably includes at least one stimulation element positioned on the constriction element for stimulating the wall portion constricted by the constriction element to close the lumen.
[0044] Where the constriction device includes a plurality of constriction elements, the stimulation device suitably includes stimulation elements positioned on the constriction elements for stimulating the wall portions constricted by the constriction elements to close the lumen.
[0046] 5) The constriction device is adapted to constrict any one of a series of wall portions of the tissue wall to restrict the flow in the lumen, wherein the constriction device includes a plurality of constriction elements adapted to constrict the wall portions of the tissue wall, respectively, and the stimulation device includes stimulation elements positioned on the constriction elements for stimulating the wall portions constricted by the constriction elements to close the lumen. The control device controls the constriction device to activate the constriction elements to constrict the wall portions of the series of wall portions without completely closing the organ's lumen, and controls the stimulation device to activate the stimulation elements to stimulate the wall portions one after the other, so that the wall portions of the series of wall portions are successively contracted along the organ to move the fluid and/or other bodily matter in the lumen of the patient's organ.
[0046]6) The constriction device comprises a first constriction element for constricting the wall portion at an upstream end thereof, a second constriction element for constricting the wall portion at a downstream end thereof, and a third constriction element for constricting the wall portion between the upstream and downstream ends thereof. The control device controls the first, second and third constriction elements to constrict and release the wall portion independently of one another. More specifically, the control device controls the first or second constriction element to constrict the wall portion at the upstream or downstream end thereof to close the lumen, and controls the third constriction element to constrict the wall SUBSTITUTE SHEET (RULE 26) portion between the upstream and downstream ends thereof, whereby the fluid and/or other bodily matter contained in the wall portion between the upstream and downstream ends thereof is moved downstream or upstream in the lumen.
Optionally, the control device controls the stimulation device to stimulate the wall portion between the upstream and downstream ends thereof, when the third constriction element constricts the wall portion.
[0047] 6a) In accordance with a first alternative, the control device controls the first constriction element to constrict the wall portion at the upstream end thereof to restrict the flow in the lumen and controls the stimulation device to stimulate the constricted wall portion at the upstream end to close the lumen. With the lumen closed at the upstream end of the constricted wall portion, the control device controls the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, and optionally controls the stimulation device to simultaneously stimulate the wall portion as the latter is constricted by the third constriction element. As a result, the fluid and/or other bodily matter contained in the wall portion between the upstream and downstream ends thereof is moved downstream in the lumen.
[0048] 6b) In accordance with a second alternative, the control device controls the second constriction element to constrict the wall portion at the downstream end thereof to restrict the flow in the lumen and controls the stimulation device to stimulate the constricted wall portion at the downstream end to close the lumen. With the lumen closed at the downstream end of the constricted wall portion, the control device controls the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, and optionally controls the stimulation device to simultaneously stimulate the wall portion as the latter is constricted by the third constriction element. As a result, the fluid and/or other bodily matter contained in the wall portion between the upstream and downstream ends thereof is moved upstream in the lumen.
[0049] In any of the above noted embodiments (1) to (6b), the stimulation device may stimulate the wall portion with electric pulses.
[0050]Where the organ is tubular in shape, such as the small intestines, a particularly long wall portion of the tubular organ may be surgically prepared to extend in zigzag with adjacent walls stitched together by two parallel rows of stitches and with the adjacent walls cut through between the two rows of stitches. As a result, SUBSTITUTE SHEET (RULE 26)
14 the lumen of this long wall portion of the organ can be significantly expanded. In this case, the constriction device of the apparatus of the invention is able to move a considerably larger volume of fluid each time it constricts the long wall portion of the organ.
[0051]The various solutions described above under the headline: "Flow restriction" to stop the flow in the lumen of the organ may also be used in any of the above noted embodiments (1 a), (lb), (4a), (5), (6), (6a) and (6b).
Stimulation [0052]When stimulating neural or muscular tissue there is a risk of injuring or deteriorating the tissue over time, if the stimulation is not properly performed. The apparatus of the present invention is designed to reduce or even eliminate that risk.
Thus, in accordance with the present invention, the control device controls the stimulation device to intermittently stimulate different areas of the wall portion of the organ, such that at least two of the areas are stimulated at different points of time that is, the stimulation is shifted from one area to another area over time. In addition, the control device controls the stimulation device, such that an area of the different areas that currently is not stimulated has time to restore substantially normal blood circulation before the stimulation device stimulates the area again.
Furthermore, the control device controls the stimulation device to stimulate each area during successive time periods, wherein each time period is short enough to maintain satisfactory blood circulation in the area until the lapse of the time period.
This gives the advantage that the apparatus of the present invention enables continuous stimulation of the wall portion of the organ to achieve the desired flow control, while essentially maintaining over time the natural physical properties of the organ without risking injuring the organ.
[0053]Also, by physically changing the places of stimulation on the organ over time as described above it is possible to create an advantageous changing stimulation pattern on the organ, in order to achieve a desired flow control.
[0054]The control device may control the stimulation device to stimulate one or more of the areas of the wall portion at a time, for example by sequentially stimulating the different areas. Furthermore, the control device may control the stimulation device to SUBSTITUTE SHEET (RULE 26) cyclically propagate the stimulation of the areas along the wall portion, preferably in accordance with a determined stimulation pattern. To achieve the desired reaction of the tissue wall during the stimulation thereof, the control device may control the stimulation device to, preferably cyclically, vary the intensity of the stimulation of the wall portion.
[0055]In a preferred embodiment of the invention, the control device controls the stimulation device to intermittently stimulate the areas of the wall portion with pulses that preferably form pulse trains. At least a first area and a second area of the areas of the wall portion may be repeatedly stimulated with a first pulse train and a second pulse train, respectively, such that the first and second pulse trains over time are shifted relative to each other. For example, the first area may be stimulated with the first pulse train, while the second area is not stimulated with said second pulse train, and vice versa. Alternatively, the first and second pulse trains may be shifted relative to each other, such that the first and second pulse trains at least partially overlap each other.
[0056]The pulse trains can be configured in many different ways. Thus, the control device may control the stimulation device to vary the amplitudes of the pulses of the pulse trains, the duty cycle of the individual pulses of each pulse train, the width of each pulse of the pulse trains, the length of each pulse train, the repetition frequency of the pulses of the pulse trains, the repetition frequency of the pulse trains, the number of pulses of each pulse train, and/or the off time periods between the pulse trains. Several pulse trains of different configurations may be employed to achieve the desired effect.
[0057] In case the control device controls the stimulation device to vary the off time periods between pulse trains that stimulate the respective area of the wall portion, it is also possible to control each off time period between pulse trains to last long enough to restore substantially normal blood circulation in the area when the latter is not stimulated during the off time periods.
Electric Stimulation [0058]In accordance with a preferred embodiment of the invention, the stimulation device is an electrically powered stimulation device that electrically stimulates the tissue wall portion of the patient's bodily organ, preferably with electric pulses. This SUBSTITUTE SHEET (RULE 26) embodiment is particularly suited for applications in which the wall portion includes muscle fibers that react to electrical stimula. In this embodiment, the control device controls the stimulation device to stimulate the wall portion with electric pulses preferably in the form of electric pulse trains, when the wall portion is in the constricted state, to cause contraction of the wall portion. Of course, the configuration of the electric pulse trains may be similar to the above described pulse trains and the control device may control the stimulation device to electrically stimulate the different areas of the wall of the organ in the same manner as described above.
[0059]The electric stimulation device suitably comprises at least one, preferably a plurality of electrical elements, such as electrodes, for engaging and stimulating the wall portion with electric pulses. Optionally, the electrical elements may be placed in a fixed orientation relative to one another. The control device controls the electric stimulation device to electrically energize the electrical elements, one at a time, or groups of electrical elements at a time. Preferably, the control device controls the electric stimulation device to cyclically energize each element with electric pulses.
Optionally, the control device may control the stimulation device to energize the electrical elements, such that the electrical elements are energized one at a time in sequence, or such that a number or groups of the electrical elements are energized at the same time. Also, groups of electrical elements may be sequentially energized, either randomly or in accordance with a predetermined pattern.
[0060]The electrical elements may form any pattern of electrical elements.
Preferably, the electrical elements form an elongate pattern of electrical elements, wherein the electrical elements are applicable on the patient's wall of the organ, such that the elongate pattern of electrical elements extends lengthwise along the wall of the organ, and the elements abut the respective areas of the wall portion. The elongate pattern of electrical elements may include one or more rows of electrical elements extending lengthwise along the wall of the organ. Each row of electrical elements may form a straight, helical or zig-zag path of electrical elements, or any form of path. The control device may control the stimulation device to successively energize the electrical elements longitudinally along the elongate pattern of electrical elements in a direction opposite to, or in the same direction as that of, the flow in the patient's lumen.
[0061]Optionally, the control device may control the stimulation device to successively energize the electrical elements from a position substantially at the SUBSTITUTE SHEET (RULE 26) center of the constricted wall portion towards both ends of the elongate pattern of electrical elements. Where the lumen of the organ is to be kept closed for a relatively long time, the control device may control the stimulation device to energize the electrical elements, such that energized electrical elements form two waves of energized electrical elements that simultaneously advance from the center of the constricted wall portion in two opposite directions towards both ends of the elongate pattern of electrical elements. Such waves of energized electrical elements can be repeated over and over again without harming the organ and without moving fluid or gas in any direction in the lumen of the organ.
[0062]The control device suitably controls the stimulation device to energize the electrical elements, such that the electrical elements currently energized form at least one group of adjacent energized electrical elements. In accordance with a first alternative, the elements in the group of energized electrical elements form one path of energized electrical elements. The path of energized electrical elements may extend at least in part around the patient's organ. In a second alternative, the elements of the group of energized electrical elements may form two paths of energized electrical elements extending on mutual sides of the patient's organ, preferably substantially transverse to the flow direction in the lumen of the organ. In a third alternative, the elements of the group of energized electrical elements may form more than two paths of energized electrical elements extending on different sides of the patient's organ, preferably substantially transverse to the flow direction in the patient's lumen.
[0063] In accordance with a preferred embodiment of the invention, the electrical elements form a plurality of groups of elements, wherein the groups form a series of groups extending along the patient's organ in the flow direction in the patient's lumen.
The electrical elements of each group of electrical elements may form a path of elements extending at least in part around the patient's organ. In a first alternative, the electrical elements of each group of electrical elements may form more than two paths of elements extending on different sides of the patient's organ, preferably substantially transverse to the flow direction in the patient's lumen. The control device may control the stimulation device to energize the groups of electrical elements in the series of groups in random, or in accordance with a predetermined pattern.
Alternatively, the control device may control the stimulation device to successively energize the groups of electrical elements in the series of groups in a direction SUBSTITUTE SHEET (RULE 26) opposite to, or in the same direction as that of, the flow in the patient's lumen, or in both said directions starting from a position substantially at the center of the constricted wall portion. For example, groups of energized electrical elements may form advancing waves of energized electrical elements, as described above;
that is, the control device may control the stimulation device to energize the groups of electrical elements, such that energized electrical elements form two waves of energized electrical elements that simultaneously advance from the center of the constricted wall portion in two opposite directions towards both ends of the elongate pattern of electrical elements.
[0064]A structure may be provided for holding the electrical elements in a fixed orientation. Although the structure may be separate from the constriction device, it is preferable that the structure is integrated in the constriction device, which is a practical design and facilitates implantation of the constriction and stimulation devices. Where the electrical elements form an elongate pattern of electrical elements, the structure may be applicable on the patient's organ such that the elongate pattern of electrical elements extends along the organ in the same direction as that of the flow in the patient's lumen and the elements abut the respective areas of the wall portion of the organ.
Thermal stimulation [0065]In another embodiment of the invention, the stimulation device thermally stimulates the wall portion of the organ. Thus, the control device may control the stimulation device to cool the wall portion, when the wall portion is constricted, to =
cause contraction of the wall portion. For example, the constriction device may constrict the wall portion to at least restrict the flow in the lumen, and the control device may control the stimulation device to cool the constricted wall portion to cause contraction thereof, such that the flow in the lumen is at least further restricted, or further restricted but not stopped, or stopped. Alternatively, the control device may control the stimulation device to heat the wall portion, when the wall portion is constricted and contracted, to cause expansion of the wall portion. Where the wall portion includes a blood vessel, the control device may control the stimulation device to cool the blood vessel to cause contraction thereof, or heat the blood vessel to cause expansion thereof. Where applicable, thermal stimulation may be practised in SUBSTITUTE SHEET (RULE 26) any of the embodiments of the present invention, and the thermal stimulation may be controlled in response to various sensors, for example strain, motion or pressure sensors.
Sensor Controlled Constriction and/or Stimulation Device [0066]As mentioned above, the apparatus may comprise at least one implantable sensor, wherein the control device controls the constriction device and/or the stimulation device in response to signals from the sensor. Generally, the sensor directly or indirectly senses at least one physical parameter of the patient, or at least one functional parameter of the apparatus, or at least one functional parameter of a medical implant in the patient.
[0067] Many different kinds of sensor for sensing physical parameters may be used.
For example motion sensors for sensing organ motion, i.e. natural contractions, such as stomach or intestinal contractions, pressure sensors for sensing pressure in the organ, strain sensors for sensing strain of the organ, flow sensors for sensing fluid flow in the lumen of the organ, spectro-photometrical sensors, Ph-sensors for sensing acidity or alkalinity of the fluid in the lumen of the organ, oxygen-sensors sensors for sensing the oxygen content of the fluid in the lumen of the organ, or sensors for sensing the distribution of the stimulation on the stimulated organ. Any conceivable sensors for sensing any other kind of useful physical parameter may be used.
[0068]Many different kinds of sensors that sense functional parameters of the apparatus may also be used for the control of the constriction device and/or the stimulation device. For example sensors for sensing electric parameters of implanted electric components of the apparatus, or sensors for sensing the performance of implanted motors of the apparatus.
[0069]The sensor may comprise a pressure sensor for sensing as the physical parameter a pressure in the patient's body that relates to the pressure in the lumen of the patient's bodily organ, wherein the control device controls the constriction device and/or stimulation device to change the constriction of the patient's wall portion in response to the pressure sensor sensing a predetermined value of measured pressure.
SUBSTITUTE SHEET (RULE 26) [00701Alternatively, or in combination with the pressure sensor, a position sensor may be provided for sensing as the physical parameter the orientation of the patient with respect to the horizontal. The position sensor may be a biocompatible version of what is shown in U.S. patents 4 942 668 and 5 900 909. For example, the control device may control the constriction device and/or stimulation device to change the constriction of the patient's wall portion in response to the position sensor sensing that the patient has assumed a substantially horizontal orientation, i.e. that the patient is lying down.
[0071]The above described sensors may be used in any of the embodiments of the invention, where applicable.
[0072]The control device may control the constriction device and/or stimulation device to change the constriction of the patient's wall portion in response to the time of day. For that purpose the control device may include a clock mechanism for controlling the constriction device and/or stimulation device to change the constriction of the patient's wall portion to increase or decrease the influence on the flow in the lumen during different time periods of the day. In case a sensor of any of the above-described types for sensing a physical or functional parameter is provided, either the clock mechanism is used for controlling the constriction device and/or stimulation device provided that the parameter sensed by the sensor does not override the clock mechanism, or the sensor is used for controlling the constriction device and/or stimulation device provided that the clock mechanism does not override the sensor.
Suitably, the control device produces an indication, such as a sound signal or displayed information, in response to signals from the sensor.
[0073]The control device may comprise an implantable internal control unit that directly controls the constriction device and/or stimulation device in response to signals from the sensor. The control device may further comprise a wireless remote control adapted to set control parameters of the internal control unit from outside the patient without mechanically penetrating the patient. At least one of the control parameters, which is settable by the wireless remote control, is the physical or functional parameter. Suitably, the internal control unit includes the above mentioned clock mechanism, wherein the wireless remote control also is adapted to set the clock mechanism.
SUBSTITUTE SHEET (RULE 26) [0074]Alternatively, the control device may comprise an external control unit outside the patient's body for controlling the constriction device and/or stimulation device in response to signals from the sensor.
Adjustable Constriction Device [0075] In several alternative embodiments of the invention, the constriction device is adjustable. In these embodiments, there is an operation device for operating the adjustable constriction device to change the constriction of the patient's tissue wall portion, and the constriction and stimulation devices form a constriction/stimulation unit. Preferably, the constriction and stimulation devices of the constriction/stimulation unit are integrated in a single piece suitable for implantation.
The constriction device of the unit comprises contact surfaces dimensioned to contact a length of a tissue wall portion of a patient's organ, and the stimulation device of the unit comprises a plurality of stimulation elements provided on and distributed along the contact surfaces. When the control device controls the stimulation device to stimulate the wall portion, the stimulation elements stimulate different areas of the wall portion along the length of the wall portion. The stimulation elements preferably comprise electric elements, as described above, for stimulating the wall portion with electric pulses. However, in most applications of the present invention, other kinds of stimulations, such as thermal stimulation, could be suitable to employ.
[0076] The operation device operates the adjustable constriction device of the constriction/stimulation unit in a manner that depends on the design of the constriction device, as will be explained by the following examples of embodiments.
1) The constriction device comprises at least two elongated clamping elements having the contact surfaces and extending along the wall portion on different sides of the organ, and the operation device operates the clamping elements to clamp the wall portion between the clamping elements to constrict the wall portion of the organ.
[0077]2) The constriction device comprises one elongate clamping element having the contact surfaces and extending along the wall portion on one side of the organ, = and the operation device operates the clamping element to clamp the wall portion between the clamping element and the bone or tissue of the patient to constrict the wall portion.
SUBSTITUTE SHEET (RULE 26) [0078]3) The constriction device comprises at least two engagement elements having the contact surfaces and positioned on different sides of the organ, and the operation device rotates the engagement elements, such that the engagement elements engage and constrict the wall portion of the organ.
[007934) The constriction device comprises at least two articulated clamping elements having the contact surfaces and positioned on different sides of the organ, and the operation device moves the clamping elements towards each other to clamp the wall portion of the organ between the clamping elements, to constrict the wall portion.
[0080] 5) The constriction device comprises at least two separate clamping elements having the contact surfaces, at least one of the clamping elements being pivoted, such that it may turn in a plane in which the loop of the constriction member extends, and the operation device turns the pivoted clamping element to change the size of the constriction opening.
[008136) The constriction device comprises at least one elongated constriction member having the contact surfaces, and forming means for forming the constriction member into at least a substantially closed loop around the organ, wherein the loop defines a constriction opening. The operation device operates the constriction member in the loop to change the size of the constriction opening.
[0082] 6a) The elongated constriction member comprises a belt having the contact surfaces, and the operation device operates the belt to change the longitudinal extension of the belt in the loop to change the size of the constriction opening. The forming means may form the constriction member or belt into a loop having at least one predetermined size.
[0083] 6b) The elongated constriction member is operable to change the size of the constriction opening, such that the outer circumferential confinement surface of the constriction device is changed, or, alternatively, is unchanged.
[0084] 6c) The elongated constriction member is elastic and varies in thickness as seen in a cross-section there through, and is operable to turn around the longitudinal extension of the constriction member.
[0085] 6d) The elongated constriction member comprises two substantially or partly semi-circular frame elements having the contact surfaces and hinged together, such that the semi-circular elements are swingable relative to each other from a fully SUBSTITUTE SHEET (RULE 26) open state in which they substantially or partly form a circle to a fully folded state in which they substantially form a semi-circle.
[0086]7) The constriction device is adapted to bend the wall portion of the organ to constrict the latter.
[0087] In the above noted embodiments (1) to (7), it is important that the constriction device is designed to constrict said length of the tissue wall portion of the patient's organ. For this purpose, the constriction device may include two or more of the described constriction elements/members to be applied in a row along said length of the wall portion, wherein said row extends in the direction of flow in the lumen of the organ. Preferably, such constriction elements/members are non-inflatable and mechanically operable or adjustable.
[0088] In the above noted embodiments (1) to (7), the operation device may either mechanically or hydraulically adjust the constriction device of the constriction/stimulation unit. Also, the operation device may comprise an electrically powered operation device for operating the constriction device. For many applications of the present invention, the operation device suitably operates the constriction device, such that the through-flow area of the lumen assumes a size in the constricted state that enables the stimulation device to contract the wall portion such that the flow in the lumen is stopped.
Mechanical operation (0089] Where the operation device mechanically operates the constriction device of the constriction/stimulation unit, it may be non-inflatable. Furthermore, the operation device may comprise a servo system, which may include a gearbox. The term "servo system" encompasses the normal definition of a servo mechanism, i.e., an automatic device that controls large amounts of power by means of very small amounts of power, but may alternatively or additionally encompass the definition of a mechanism that transfers a weak force acting on a moving element having a long stroke into a strong force acting on another moving element having a short stroke.
Preferably, the operation device operates the constriction device in a non-magnetic and/or non-=
manual manner. A motor may be operatively connected to the operation device.
The operation device may be operable to perform at least one reversible function and the motor may be capable of reversing the function.
SUBSTITUTE SHEET (RULE 26) Hydraulic Operation (0090] Where the operation device hydraulically operates the constriction device of the constriction/stimulation unit, it includes hydraulic means for adjusting the constriction device.
[0091]In an embodiment of the invention, the hydraulic means comprises a reservoir and an expandable/contractible cavity in the constriction device, wherein the operation device distributes hydraulic fluid from the reservoir to expand the cavity, and distributes hydraulic fluid from the cavity to the reservoir to contract the cavity.
The cavity may be defined by a balloon of the constriction device that abuts the tissue wall portion of the patients organ, so that the patient's wall portion is constricted upon expansion of the cavity and released upon contraction of the cavity.
[0092]Alternatively, the cavity may be defined by a bellows that displaces a relatively large contraction element of the constriction device, for example a large balloon that abuts the wall portion, so that the patient's wall portion is constricted upon contraction of the bellows and released upon expansion of the bellows. Thus, a relatively small addition of hydraulic fluid to the bellows causes a relatively large increase in the constriction of the wall portion. Such a bellows may also be replaced by a suitably designed piston/cylinder mechanism.
(0093] Where the hydraulic means comprises a cavity in the constriction device, the apparatus of the invention can be designed in accordance with the options listed below.
[0094] 1) The reservoir comprises first and second wall portions, and the operation device displaces the first and second wall portions relative to each other to change the volume of the reservoir, such that fluid is distributed from the reservoir to the cavity, or from the cavity to the reservoir.
'1 a) The first and second wall portions of the reservoir are displaceable relative to each other by at least one of a magnetic device, a hydraulic device or an electric control device.
2) The operation device comprises a pump for pumping fluid between the reservoir and the cavity.
2a) The pump comprises a first activation member for activating the pump to pump fluid from the reservoir to the cavity and a second activation member for activating the pump to pump fluid from the cavity to the reservoir.
SUBSTITUTE SHEET (RULE 26) 2a1) The first and second activation members are operable by manual manipulation thereof.
2a2) At least one of the activation members operates when subjected to an external predetermined pressure.
2a3) At least one of the first and second activating members is operable by magnetic means, hydraulic means, or electric control means.
2b) The apparatus comprises a fluid conduit between the pump and the cavity, wherein the reservoir forms part of the conduit. The conduit and pump are devoid of any non-return valve. The reservoir forms a fluid chamber with a variable volume, and the pump distributes fluid from the chamber to the cavity by a reduction in the volume of the chamber and withdraws fluid from the cavity by an expansion of the volume of the chamber. The apparatus further comprises a motor for driving the pump, wherein the pump comprises a movable wall of the reservoir for changing the volume of the chamber.
[0095] In all of the above noted embodiments 1 to 2b where the hydraulic means comprises an expandable cavity in the constriction device, the cavity can be exchanged by a cylinder/piston mechanism for adjusting the constriction device. In this case, the operation device distributes hydraulic fluid between the reservoir and the cylinder/piston mechanism to adjust the constriction device.
[0096]In a special embodiment of the invention, the operation device comprises a reverse servo operatively connected to the hydraulic means. The term "reverse servo" is to be understood as a mechanism that transfers a strong force acting on a moving element having a short stroke into a weak force acting on another moving element having a long stroke; i.e., the reverse function of a normal servo mechanism.
Thus, minor changes in the amount of fluid in a smaller reservoir could be transferred by the reverse servo into major changes in the amount of fluid in a larger reservoir.
The reverse servo is particularly suited for manual operation thereof.
[0097] Preferably, the reverse servo comprises an expandable servo reservoir containing servo fluid and a fluid supply reservoir hydraulically connected to the servo reservoir to form a closed conduit system for the servo fluid. The expandable servo reservoir has first and second wall portions, which are displaceable relative to each other in response to a change in the volume of the expandable servo reservoir.
[0098]In accordance with a first alternative, the first and second wall portions of the servo reservoir are operatively connected to the hydraulic means. The reverse servo SUBSTITUTE SHEET (RULE 26) distributes fluid between the fluid supply reservoir and the expandable servo reservoir to change the volume of the servo reservoir, whereby the hydraulic means is operated to adjust the constriction device.
[0099] In accordance with a second alternative, there is provided an implantable main reservoir containing a predetermined amount of hydraulic fluid, wherein the reverse servo is operable to distribute hydraulic fluid between the main reservoir and the hydraulic means to adjust the constriction device. More specifically, the main reservoir is provided with first and second wall portions operatively connected to the first and second wall portions of the expandable servo reservoir, such that the volume of the main reservoir is changed when the volume of the expandable servo reservoir is changed. Thus, when the reverse servo distributes servo fluid between the fluid supply reservoir and the expandable servo reservoir to change the volume of the main reservoir, hydraulic fluid is distributed from the main reservoir to the hydraulic means, or from the hydraulic means to the main reservoir. Advantageously, the servo and main reservoirs are dimensioned, such that when the volume of the servo reservoir is changed by a relatively small amount of servo fluid, the volume of the main reservoir is changed by a relatively large amount of hydraulic fluid.
[00100] In both of the above-described alternatives, the fluid supply reservoir may have first and second wall portions, which are displaceable relative to each other to change the volume of the fluid supply reservoir to distribute servo fluid between the fluid supply reservoir and the expandable servo reservoir. The first and second wall portions of the fluid supply reservoir may be displaceable relative to each other by manual manipulation, a magnetic device, a hydraulic device, or an electric control device to change the volume of the fluid supply reservoir to distribute servo fluid between the fluid supply reservoir and the expandable servo reservoir.
[00101] In all of the above noted embodiments 1 to 2b where the hydraulic means comprises an expandable cavity in the constriction device, or in embodiments where the hydraulic means comprises a hydraulically operable mechanical construction, the operation device may include the reverse servo described above. In a further embodiment of the invention, the hydraulic means include first and second hydraulically interconnected expandable/contractible reservoirs. The first reservoir is operatively connected to the constriction device, such that the constriction device changes the constriction of the patient's wall portion upon expansion or contraction of the first reservoir. By changing the volume of the second reservoir hydraulic fluid is SUBSTITUTE SHEET (RULE 26) distributed between the two reservoirs, so that the first reservoir is either expanded or contracted. This embodiment requires no non-return valve in the fluid communication conduits between the two reservoirs, which is beneficial to long-term operation of the hydraulic means.
[00102] Alternatively, the hydraulic means may include first and second hydraulically interconnected piston/cylinder mechanisms instead of the first and second reservoirs described above. The first piston/cylinder mechanism is operatively connected to the constriction device, such that the constriction device changes the constriction of the patient's wall portion upon operation of the first piston/cylinder mechanism. By operating the second piston/cylinder mechanism hydraulic fluid is distributed between the two piston/cylinder mechanisms, so that the first piston/cylinder mechanism adjusts the constriction device.
[00103] Where the constriction device does not include an expandable/contractible cavity, the constriction device may comprise at least two elongated clamping elements having the above-mentioned contact surfaces and extending along the wall portion on different sides of the organ. The hydraulic means, which may include the reverse servo described above, hydraulically moves the elongated clamping elements towards the wall portion to constrict the wall portion.
For example, the constriction device may have hydraulic chambers in which the clamping elements slide back and forth, and the hydraulic means may also include a pump and an implantable reservoir containing hydraulic fluid. The pump distributes hydraulic fluid from the reservoir to the chambers to move the clamping elements against the wall portion, and distributes hydraulic fluid from the chambers to the reservoir to move the clamping elements away from the wall portion.
Design of control device [00104] The control device suitably controls the constriction/stimulation unit from outside the patient's body. Preferably, the control device is operable by the patient. For example, the control device may comprise a manually operable switch for switching on and off the constriction/stimulation unit, wherein the switch is adapted for subcutaneous implantation in the patient to be manually or magnetically operated ' from outside the patient's body. Alternatively, the control device may comprise a hand-held wireless remote control, which is conveniently operable by the patient to SUBSTITUTE SHEET (RULE 26) switch on and off the constriction/stimulation unit. The wireless remote control may also be designed for application on the patient's body like a wristwatch. Such a wristwatch type of remote control may emit a control signal that follows the patient's body to implanted signal responsive means of the apparatus.
[00105] Where the control device wirelessly controls the constriction/stimulation unit from outside the patient's body, the wireless control function is preferably performed in a non-magnetic manner, i.e., the control device controls the constriction device of the constriction/stimulation unit in a non-magnetic manner. The patient may use the remote control to control the constriction/stimulation unit to adjust the stimulation intensity and/or adjust the constriction of the wall portion. The wireless remote control may comprise at least one external signal transmitter or transceiver and at least one internal signal receiver or transceiver implantable in the patient.
[00106] The wireless remote control preferably transmits at least one wireless control signal for controlling the constriction/stimulation unit. The control signal may comprise a frequency, amplitude, phase modulated signal or a combination thereof, and may be an analogue or a digital signal, or a combination of an analogue and digital signal. The remote control may transmit an electromagnetic carrier wave signal for carrying the digital or analogue control signal. Also the carrier signal may comprise digital, analogue or a combination of digital and analogue signals.
[00107] Any of the above control signals may comprise wave signals, for example a sound wave signal, an ultrasound wave signal, an electromagnetic wave signal, an infrared light signal, a visible light signal, an ultra violet light signal, a laser light signal, a microwave signal, a radio wave signal, an x-ray radiation signal or a gamma radiation signal. Alternatively, the control signal may comprise an electric or magnetic field, or a combined electric and magnetic field.
[00108] As mentioned above, the control signal may follow the patient's body to implanted signal responsive means of the apparatus.
[00109] The control device may include a programmable internal control unit, such as a microprocessor, implantable in the patient for controlling the constriction/stimulation unit. The control device may further include an external control unit intended to be outside the patient's body, wherein the internal control unit is programmable by the external control unit. For example, the internal control unit may be programmable for controlling the constriction/stimulation unit over time, suitably in accordance with an activity schedule program. The apparatus of the SUBSTITUTE SHEET (RULE 26) invention may comprise an external data communicator and an implantable internal data communicator communicating with the external data communicator, wherein the internal communicator feeds data related to the constriction/stimulation unit back to the external data communicator or the external data communicator feeds data to the internal data communicator.
Source of Energy [001101 The present invention also presents a solution for supplying energy for use in connection with the operation of the constriction/stimulation unit.
Thus, in a broad sense, the present invention provides an apparatus for controlling a flow of fluid and/or other bodily matter in a lumen formed by a tissue wall of a patient's organ, wherein the apparatus comprises an implantable constriction device for gently constricting a portion of the tissue wall to influence the flow in the lumen, a stimulation device for intermittently and individually stimulating different areas of the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the flow in the lumen, wherein the constriction and stimulation devices form an operable constriction/stimulation unit, a source of energy, and a control device operable from outside the patient's body to control the source of energy to release energy for use in connection with the operation of the constriction/stimulation unit. In a simple form of the invention, the source of energy, such as a battery or accumulator, is implantable in the patient's body.
Transmission of Wireless Energy [00111] In a more sophisticated form of the invention, which is preferable, the source of energy is external to the patient's body and the control device controls the external source of energy to release wireless energy. In this sophisticated form of the invention, the apparatus comprises an energy-transmission device that transmits the released wireless energy from outside the patient's body to inside the patient's body.
Among many things the wireless energy may comprise electromagnetic energy, an electric field, an electromagnetic field or a magnetic field, or a combination thereof, or SUBSTITUTE SHEET (RULE 26) electromagnetic waves. The energy-transmission device may transmit wireless energy for direct use in connection with the operation of the constriction/stimulation unit, as the wireless energy is being transmitted. For example, where an electric motor or pump operates the constriction device, wireless energy in the form of a magnetic or an electromagnetic field may be used for direct power of the motor or pump.
[00112] Thus, the motor or pump is running directly during transmission of the wireless energy. This may be achieved in two different ways: a) using a transforming device implanted in the patient to transform the wireless energy into energy of a different form, preferably electric energy, and powering the motor or pump with the transformed energy, or b) using the wirelessly transmitted energy to directly power the motor or pump. Preferably wireless energy in the form of an electromagnetic or magnetic field is used to directly influence specific components of the motor or pump to create kinetic energy for driving the motor or pump. Such components may include coils integrated in the motor or pump, or materials influenced by magnetic fields, or permanent magnets, wherein the magnetic or electromagnetic field influences the coils to generate a current for driving the motor or pump, or influences the material or permanent magnets to create kinetic energy for driving the motor or pump.
[00113] Preferably, the energy-transmission device transmits energy by at least one wireless signal, suitably a wave signal. The wave signal may comprise an electromagnetic wave signal including one of an infrared light signal, a visible light signal, an ultra violet light signal, a laser signal, a microwave signal, a radio wave signal, an x-ray radiation signal, and a gamma radiation signal.
Alternatively, the wave signal may comprise a sound or ultrasound wave signal. The wireless signal may be a digital or analogue signal, or a combination of a digital and analogue signal.
Transforming Wireless Energy [00114] In accordance with a particular embodiment of the invention, an implantable energy-transforming device is provided for transforming wireless energy of a first form transmitted by the energy-transmission device into energy of a second =
form, which typically is different from the energy of the first form. The constriction/stimulation unit is operable in response to the energy of the second form.
For example, the wireless energy of the first form may comprise sound waves, SUBSTITUTE SHEET (RULE 26) whereas the energy of the second form may comprise electric energy. In this case, the energy-transforming device may include a piezo-electric element for transforming the sound waves into electric energy. Optionally, one of the energy of the first form and the energy of the second form may comprise magnetic energy, kinetic energy, sound energy, chemical energy, radiant energy, electromagnetic energy, photo energy, nuclear energy or thermal energy. Preferably, one of the energy of the first form and the energy of the second form is non-magnetic, non-kinetic, non-chemical, non-sonic, non-nuclear or non-thermal.
[001151 The energy-transforming device may function differently from or similar to the energy-transmission device. In a special embodiment, the energy-transforming device comprises at least one element, such as at least one semiconductor, having a positive region and a negative region, when exposed to the energy of the first form transmitted by the energy-transmission device, wherein the element is capable of creating an energy field between the positive and negative regions, and the energy field produces the energy of the second form. More specifically, the element may comprise an electrical junction element, which is capable of inducing an electric field between the positive and negative regions when exposed to the energy of the first form transmitted by the energy-transmission device, whereby the energy of the second form comprises electric energy.
[00116] The energy-transforming device may transform the energy of the first form directly or indirectly into the energy of the second form. An implantable motor or pump for operating the constriction device of the constriction/stimulation unit may be provided, wherein the motor or pump is powered by the energy of the second form.
The constriction device may be operable to perform at least one reversible function and the motor may be capable of reversing the function. For example, the control device may shift polarity of the energy of the second form to reverse the motor.
[00117] The energy-transforming device may directly power the motor or pump with the transformed energy, as the energy of the second form is being transformed from the energy of the first form. Preferably, the energy-transforming device directly operates the constriction/stimulation unit with the energy of the second form in a non-magnetic, non-thermal or non-mechanical manner.
[00118] Normally, the constriction/stimulation unit comprises electric components that are energized with electrical energy. Other implantable electric components of the apparatus may be at least one voltage level guard or at least one SUBSTITUTE SHEET (RULE 26) constant current guard. Therefore, the energy-transforming device may transform the energy of the first form into a direct current or pulsating direct current, or a combination of a direct current and pulsating direct current. Alternatively, the energy-transforming device may transform the energy of the first form into an alternating current or a combination of a direct and alternating current.
[00119] The apparatus of the invention may comprise an internal source of energy implantable in the patient for supplying energy for the operation of the constriction/stimulation unit. The apparatus may further comprise an implantable switch operable to switch from an "off' mode, in which the internal source of energy is not in use, to an "on" mode, in which the internal source of energy supplies energy for the operation of the constriction/stimulation unit, and/or for energizing implanted electronic components of the apparatus. The switch may be operable by the energy of the first form transmitted by the energy-transmission device or by the energy of the second form supplied by the energy-transforming device. The described switch arrangement reduces power consumption of the apparatus between operations.
[00120] The internal source of energy may store the energy of the second form supplied by the energy-transforming device. In this case, the internal source of energy suitably comprises an accumulator, such as at least one capacitor or at least one rechargeable battery, or a combination of at least one capacitor and at least one rechargeable battery. Where the internal source of energy is a rechargeable battery it may be charged only at times convenient for the patient, for example when the patient is sleeping. Alternatively, the internal source of energy may supply energy for the operation of the constriction/stimulation unit but not be used for storing the energy of the second form. In this alternative, the internal source of energy may be a battery and the switch described above may or may not be provided.
[00121] Suitably, the apparatus of the invention comprises an implantable stabilizer for stabilizing the energy of the second form. Where the energy of the second form is electric energy the stabilizer suitably comprises at least one capacitor.
[00122] The energy-transforming device may be designed for implantation subcutaneously in the abdomen, thorax or cephalic region of the patient.
Alternatively, it may be designed for implantation in an orifice of the patient's body and under the mucosa or intramuscularly outside the mucosa of the orifice.
[00123] Although the constriction/stimulation unit in the embodiments described above is designed as a single piece, which is most practical for implantation, it should SUBSTITUTE SHEET (RULE 26) be noted that as an alternative the constriction device and stimulation device could be designed as separate pieces. Any one of the constriction and stimulation units described above may alternatively be replaced by two or more separate constriction/stimulation elements, which are controlled independently of one another.
[00124] The above-described apparatus of the invention is suited for treating dysfunctions of an organ of a human being or animal. For example, for treating urinary and anal incontinence, constipation and impotence. The apparatus of the invention is also suited for treating obesity or gallstone troubles, and for controlling blood flow in a blood vessel or the release of eggs into a female's uterus.
[00125] Where the apparatus is used for controlling the food flow through the stomach of a patient, the apparatus comprises an implantable constriction device for gently constricting at least one portion of the tissue wall of the patient's stomach to influence the food flow in the stomach, a stimulation device for stimulating the wall portion of the tissue wall, and a control device for controlling said stimulation device to stimulate the wall portion, as said constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the food flow in the stomach.
[00126] Where the apparatus is used for controlling the flow of intestinal contents in the intestines of a patient, the apparatus comprises an implantable constriction device for gently constricting at least one portion of the tissue wall of the patient's intestines to influence the flow of intestinal contents in the intestines, a stimulation device for stimulating the wall portion of the tissue wall, and a control device for controlling said stimulation device to stimulate the wall portion, as said constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the flow of intestinal contents in the intestines.
[00127] Where the apparatus is used for controlling the flow of urine in the urethra or urine bladder of a patient, the apparatus comprises an implantable constriction device for gently constricting at least one portion of the tissue wall of the patient's urethra or urine bladder to influence the urine flow in the urethra or urine bladder, a stimulation device for stimulating the wall portion of the tissue wall, and a control device for controlling said stimulation device to stimulate the wall portion, as said constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the urine flow in the urethra or urine bladder.
[00128] Where the apparatus is used/ as an impotence treatment apparatus, it comprises a constriction device implantable in a male impotent patient for gently SUBSTITUTE SHEET (RULE 26) constricting at least one penile portion of the patient's normal penile tissue or the prolongation thereof, an implantable stimulation device for stimulating the penile portion, and a control device for controlling said stimulation device to stimulate the penile portion, as said constriction device constricts the penile portion, to cause contraction of the penile portion to restrict the blood flow leaving the penis to achieve erection. The term "normal penile tissue" is to be understood as excluding implanted tissue. Thus, the normal penile tissue includes one or both of the corpora cavernosa and the corpus spongiosum. The term "prolongation thereof" includes the bulbospongious and adjacent area.
[00129] Alternatively, the impotence treatment apparatus comprises a constriction device implantable in a male impotent patient for gently constricting at least one penile portion of the patient's normal penile tissue or the prolongation thereof to restrict the blood flow leaving the penis, an implantable stimulation device for stimulating the penile portion as said constriction device constricts the penile portion, and a control device for controlling said stimulation device to stimulate the penile portion, as said constriction device constricts the penile portion, to cause contraction of the penile portion to further restrict the blood flow leaving the penis to achieve erection.
[00130] Alternatively, impotence treatment apparatus comprises a stimulation device implantable in a male impotent patient for stimulating at least one penile portion of the patient's normal penile tissue or the prolongation thereof, and a control device for controlling said stimulation device to stimulate the penile portion to cause contraction thereof to restrict the blood flow leaving the penis to achieve erection.
[00131] Where the apparatus is used for controlling the blood flow in a blood vessel of a patient, the apparatus comprises an implantable constriction device for gently constricting at least one portion of the tissue wall of the blood vessel to influence the blood flow in the blood vessel, a stimulation device for stimulating the tissue wall portion, and a control device for controlling said stimulation device to stimulate the tissue wall portion as said constriction device constricts the tissue wall portion to cause contraction of the tissue wall portion to further influence the blood flow in the blood vessel.
[00132] Where the a apparatus is used for controlling the flow of eggs into the uterus of a female, the apparatus comprises an implantable constriction device for' constricting each one of the female's uterine tubes to restrict the passageway SUBSTITUTE SHEET (RULE 26) thereof, and a control device for controlling said constriction device to constrict the uterine tube such that an egg appearing in the passageway of the uterine tube is prevented from entering the uterine cavity, and to release the uterine tube such that an egg existing in the passageway of the uterine tube is allowed to enter the uterine cavity. The constriction device may gently constrict at least one portion of the tissue wall of the uterine tube to restrict the passageway thereof, and an implantable stimulation device may be provided for stimulating the tissue wall portion, wherein the control device controls said stimulation device to stimulate the tissue wall portion, as said constriction device constricts the tissue wall portion, to cause contraction of the tissue wall portion to further restrict the passageway of the uterine tube.
[00133] Alternatively, the egg flow control apparatus comprises an implantable constriction device for gently constricting at least one portion of the tissue wall of each one of the female's uterine tubes to restrict the passageway thereof, a stimulation device for stimulating the tissue wall portion of the uterine tube, and a control device for controlling said stimulation device to stimulate the tissue wall portion, as said constriction device constricts the tissue wall portion, to cause contraction of the tissue wall portion to further restrict the passageway of the uterine tube to prevent an egg existing in the uterine tube from entering the uterine cavity.
[00134] Alternatively, the egg flow control apparatus comprises an implantable stimulation device for stimulating a portion of the tissue wall of each one of the female's uterine tubes, and a control device for controlling said stimulation device to stimulate the tissue wall portion of the uterine tube to cause contraction of the tissue wall portion, such that the passageway of the uterine tube is restricted to prevent an egg appearing in the uterine tube from entering the uterine cavity, and to cease stimulating the tissue wall portion of the uterine tube to allow an egg existing in the passageway of the uterine tube to enter the uterine cavity.
[00135] Where the apparatus is used for controlling the flow of gallstones in a patient suffering from gallstone trouble, the apparatus comprises an implantable stimulation device for stimulating a portion of the tissue wall of the patient's cystic, hepatic or bile duct, and a control device for controlling said stimulation device to progressively stimulate the tissue wall portion to cause progressive contraction of the tissue wall portion to move one or more gallstones appearing in the duct in the direction towards the duodenum.
SUBSTITUTE SHEET (RULE 26) [00136] The present invention also provides a method for using an apparatus as described above to control a flow of fluid and/or other bodily matter in a lumen formed by a tissue wall of a patient's organ, the method comprising:
- providing a wireless remote control adapted to control the constriction device and/or stimulation device from outside the patient's body, and - operating the wireless remote control by the patient, when the patient wants to influence the flow of fluid and/or other bodily matter in the lumen.
[00137] The present invention also provides a method for controlling a flow of fluid and/or other bodily matter in a lumen formed by a tissue wall of a patient's organ, the method comprising:
a) gently constricting at least one portion of the tissue wall to influence the flow in the lumen, and b) stimulating the constricted wall portion to cause contraction of the wall portion to further influence the flow in the lumen.
[00137a] According to one aspect of the present invention, there is provided a flow control apparatus for controlling a flow of fluid and/or other matter in a fluid conduit formed by a conduit wall, the apparatus comprising: an energizing device configured to influence the flow in the conduit, the energizing device including a stimulation device configured to stimulate a wall portion of the conduit wall, and a control device operable to control the stimulation device to stimulate the wall portion to cause contraction of the wall portion to influence the flow in the conduit.
[00137b] According to another aspect of the present invention, there is provided an intestinal dysfunction treatment apparatus comprising an implantable constriction device configured to gently constrict at least one portion of the tissue wall of a patient's intestines to influence the flow of intestinal contents in the intestinal passageway of the intestines, a stimulation device configured to stimulate the wall 36a portion of the tissue wall, and a control device operable to control the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the flow of intestinal contents.
[00137c] According to still another aspect of the present invention, there is provided a urinary dysfunction treatment apparatus comprising an implantable constriction device configured to gently constrict at least one portion of the tissue wall of patient's urethra, ureter, renal pelvis or urine bladder to influence the flow of urine, a stimulation device configured to stimulate the wall portion of the tissue wall, and a control device operable to control the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the flow of urine.
[00137d] According to yet another aspect of the present invention, there is provided an obesity treatment apparatus comprising an implantable constriction device configured to gently constrict at least one portion of the tissue wall of a patient's stomach to influence the food flow in a food passageway of the stomach, a stimulation device configured to stimulate the wall portion of the tissue wall, and a control device operable to control the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the food flow in the food passageway of the stomach.
[00137e] According to a further aspect of the present invention, there is provided an obesity treatment apparatus for treating an obese patient surgically modified by any one of a group of operations called Vertical Banded Gastroplasty, wherein the stomach is compartmentalized into a smaller proximal compartment adjacent the esophagus and a larger distal compartment, the smaller proximal compartment communicating with the larger distal compartment through an outlet opening, the apparatus comprising an implantable constriction device configured to gently constrict at least one wall portion of the tissue wall of the patient's stomach to influence the 36b food flow in a food passageway extending in the smaller proximal compartment through the outlet opening, an implantable stimulation device configured to stimulate the wall portion of the tissue wall, and a control device operable to control the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the food flow in the food passageway.
[00137f] According to yet a further aspect of the present invention, there is provided a sexual dysfunction treatment apparatus for treating an impotent male patient comprising: a stimulation device configured to stimulate at least one penile portion of the patient's normal penile tissue or the prolongation thereof, and a control device operable to control the stimulation device to stimulate the penile portion to cause contraction thereof to at least restrict the blood flow leaving the penis to achieve erection.
[00137g] According to still a further aspect of the present invention, there is provided a sexual dysfunction treatment apparatus for treating a female patient comprising: an implantable stimulation device configured to stimulate at least one portion of the patient's female erectile tissue, and a control device operable to control the stimulation device to stimulate the erectile tissue portion to cause contraction thereof to at least restrict the venous blood flow leaving the erectile tissue to obtain engorgement with blood of the female erectile tissue.
[00137h] According to another aspect of the present invention, there is provided a pregnancy control apparatus comprising: a movement influence device configured to influence the movement of an egg appearing in the lumen of a uterine tube of a female patient, and a control device operable to control the movement influence device to influence the movement of the egg in the lumen of the uterine tube.
[001371] According to yet another aspect of the present invention, there is provided a pregnancy control apparatus comprising: a flow influence device configured to influence a flow of sperms appearing in the lumen of a uterine tube of a 36c female patient, and a control device operable to control the flow influence device to influence the flow of sperms in the uterine tube.
[00137j] According to another aspect of the present invention, there is provided a blood flow control apparatus for controlling a flow of blood and/or other bodily matter in a patient's blood vessel, the apparatus comprising an implantable constriction device configured to gently constrict at least one portion of the tissue wall of the blood vessel to influence the flow in the blood vessel, a stimulation device configured to stimulate the wall portion of the tissue wall, and a control device operable to control the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the flow in the blood vessel.
[00137k] According to still another aspect of the present invention, there is provided a vascular aneurysm treatment apparatus for treating a vascular aneurysm of a blood vessel in a human or mammal patient, the apparatus comprising an implantable constriction device configured to gently constrict at least one portion of the tissue wall of the blood vessel extending along the aneurysm to reduce the bulge of the blood vessel caused by the aneurysm, a stimulation device for stimulating the wall portion of the blood vessel tissue wall, and a control device for controlling the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further reduce the bulge of the blood vessel and strengthen the blood vessel tissue wall.
[001371] According to yet another aspect of the present invention, there is provided a male contraception apparatus for obtaining a time-limited sterility of a male mammalian individual comprising: a flow influence device configured to influence a flow of sperms appearing in the lumen of a vas deference of a male patient, and a control device operable to control the flow influence device to influence the flow of sperms in the vas deference.
36d [00137m] According to a further aspect of the present invention, there is provided a gallstone trouble treatment apparatus for treating a patient suffering from gallstone trouble, comprising at least one implantable stimulation device configured to stimulate at least one portion of the tissue wall of a biliary duct of the patient, and a control device operable to control the stimulation device to stimulate the tissue wall portion to cause contraction of the tissue wall portion to influence the movement of bile and/or gallstones in the biliary duct.
[00137n] According to yet a further aspect of the present invention, there is provided a pregnancy control system for promoting pregnancy comprising a restriction device configured to postoperatively be adjusted to restrict and release an oviduct of the patient.
[001370] According to still a further aspect of the present invention, there is provided a pregnancy control apparatus for avoiding pregnancy comprising a restriction device configured to postoperatively be adjusted to restrict and release an oviduct of the patient.
[00137p] According to another aspect of the present invention, there is provided a male contraception apparatus for obtaining temporary sterility of a male mammalian individual comprising an implantable restriction device configured to restrict the patient's vas deference in the region downstream the ampulla during a controlled period, the restriction device thereby being capable of preventing sperms to reach the urethra, and a control device operable to control the operation of the restriction device.
[00137q] According to yet another aspect of the present invention, there is provided a female sexual dysfunction treatment apparatus, comprising a stimulation device configured to stimulate a female patient's erectile blood flow passageway to increase the amount of blood in the female erectile tissue and thereby obtaining engorgement with blood of the female erectile tissue by affecting the erectile blood flow passageway.
36e [00137r] According to another aspect of the present invention, there is provided a female sexual dysfunction treatment apparatus, comprising a device configured to increase the amount of blood in the female erectile tissue and thereby obtaining engorgement with blood of the female erectile tissue.
[00137s] According to still another aspect of the present invention, there is provided a system comprising an artificial intestine section adapted to being implanted inside a patient's body along with an accumulator for accumulating energy, wherein said intestine section has a first open end portion and a second open end portion in flow communication with one another, at least the first open end portion being adapted to being connected to a surgically created opening in the patient's intestine, wherein the system comprises at least one conduit connected to the artificial intestine section and adapted to be introduced into a surgically divided intestinal opening in the intestine to hold an intestinal wall portion on the outside of the conduit, the system further comprising a flexible sleeve adapted to be placed onto the intestine, when the intestine section is implanted, so as to extend over the intestinal wall portion and the conduit such that at least part of the intestinal wall portion is located intermediate the sleeve and the outer surface of the conduit, wherein the sleeve is adapted to increase the strength of the connection between the intestine section and the patient's intestine against axial forces resulting from peristaltic movements of the intestine and which tend to pull on the intestine, when said artificial intestine section is long term implanted, and wherein said accumulator is adapted to be charged wirelessly with energy and arranged to supply energy directly or indirectly to at least one energy consuming part of said artificial intestine section.
[00137t] According to yet another aspect of the present invention, there is provided an artificial intestine section adapted to be implanted inside a patient's body, said intestine section having a first open end portion and a second open end portion in flow communication with one another, wherein at least the first open end portion is adapted to being connected to a surgically created lateral opening in a wall of the patient's intestine, wherein the artificial intestine section comprising at least one 36f element adapted to directly or indirectly interact with intestinal contents contained in the artificial intestine section between the first and second open end portions thereof, wherein the at least one element comprises at least an artificial reservoir between the first and second open end portions for receiving and temporarily collecting therein intestinal contents supplied through the first open end portion, wherein said second open end portion is adapted to receive intestinal contents for emptying said reservoir.
[00137u] According to a further aspect of the present invention, there is provided an apparatus for treating a patient having a disorder related to the passageway of the patient's intestines, the apparatus comprising a pump for implantation in the patient operable on at least one selected portion of the intestines to pump intestinal contents through the passageway of the intestines, wherein said pump includes a constriction device adapted to alternately constrict and release the selected portion to at least substantially reduce the volume of the passageway of the intestines along the selected portion and release the selected portion to increase the volume of the passageway of the intestines along the selected portion, such that intestinal contents is displaced through the passageway of the intestines.
[00137v] According to yet a further aspect of the present invention, there is provided a system for treating a patient having a disorder related to a patient's intestine and a reservoir for receiving and temporarily collecting therein intestinal contents, the reservoir being formed from surgically modified intestine that has been cut along a mutual contact line of laterally adjacent sections of a bent portion of intestine and connected so that the resulting upper and lower halves of the intestine form an intestinal wall of the reservoir, wherein the system comprises an artificial flow control device implantable in the patient's body and adapted to control flow of the intestinal contents from said reservoir, the flow control device comprising at least one pump adapted to act on said intestinal wall so as to reduce the reservoir's volume, thereby emptying the reservoir.
36g [00137w] According to still a further aspect of the present invention, there is provided a system for treating a patient having a disorder related to the patient's intestine, comprising an artificial reservoir adapted for receiving and temporarily collecting therein intestinal contents and further adapted to remain within the patient's body when emptying the reservoir, wherein the system further comprises an at least partly artificial flow control device implantable in the patient's body and adapted to control flow of the intestinal contents in the intestine, wherein said reservoir comprises a single opening, said opening being adapted to be connected to a surgically created opening in the patient's intestine when implanted so as to be in flow communication with the intestine, wherein the reservoir is adapted for receiving and temporarily collecting therein intestinal contents as well as emptying the intestinal contents from the reservoir through said single opening, the system further comprising an implantable pump for emptying the reservoir, wherein said pump is adapted to be controlled from outside the human body.
[00137x] According to another aspect of the present invention, there is provided a stimulation device for treating a vascular aneurysm of a human or mammal patient comprising: at least one implantable electrode adapted to placed in close connection to the aneurysm, the at least one electrode being adapted to provide an electrical stimulation pulse on a wall portion of the aneurysm.
BRIEF DESCRIPTION OF THE DRAWINGS
[00138] FIGURES 1A, 1B, 1C, 1D and 1E schematically illustrate different states of operation of a general embodiment of an apparatus according to the present invention.
[00139] FIGURES 1F, 1G and 1H illustrate different states of operation of a modification of the general embodiment.
[00140] FIGURES 11, 1K and 1L illustrate an alternative mode of operation of the modification of the general embodiment.
36h [00141] FIGURE 2 is a longitudinal cross-section of a preferred embodiment of the apparatus according to the invention including a constriction device and an electric stimulation device.
[00142] FIGURE 3 is a cross-section along line in FIGURE 2.
[00143] FIGURE 4 is the same cross-section shown in FIGURE 3, but with the apparatus in a different state of operation.
[00144] FIGURES 5A, 5B and 5C are cross-sections of the embodiment of FIGURE 2 showing different states of operations with the apparatus applied on a tissue wall of a patient's organ.
[00145] FIGURES 6A, 6B and 60 are cross-sections of a modification of the embodiment of FIGURE 2 showing different states of operations with the apparatus applied on a tissue wall of a patient's organ.
[00146] FIGURES 7A and 7B show different steps of an electric stimulation mode performed by the apparatus of FIGURE 2, while the apparatus is constricting a tissue wall of a patient's organ.
[00147] FIGURE 8A is a pulse/time diagram showing electric stimulation pulses generated by the apparatus of the invention for stimulating a tissue wall of a patient's organ.
[00148] FIGURE 8B is pulse/time diagram showing a modification of the electric stimulation shown in FIGURE 8A, in which pulses of mixed frequencies and/or amplitudes are employed.
[00149] FIGURES 9A and 9B show two pulse/time diagrams, respectively, representing electric stimulation of two different areas of the tissue wall with pulses forming pulse trains.
[00150] FIGURES 10A and 10B show the pulse/time diagrams of FIGURES 9A
and 9B with modified pulse trains.
[00151] FIGURE 11A is a longitudinal cross-section of an embodiment of the apparatus of the invention including a thermal stimulation device, wherein the apparatus is constricting a tissue wall of a patient's organ.
[00152] FIGURE 11B is the same embodiment of FIGURE 11A with the thermal stimulation device activated.
[00153] FIGURE 12A is a schematic view of hydraulic operation means suited for operating the constriction device of the embodiments of FIGURES 2-11.
[00154] FIGURE 12B shows the embodiment of FIGURE 12A with the constriction device constricting a tissue wall of a patient's organ.
[00155] FIGURE 13A is a schematic view of mechanical operation means suited for operating the constriction device of the embodiments of FIGURES 2-11.
[00156] FIGURE 13B shows the embodiment of FIGURE 13A with the constriction device constricting a tissue wall of a patient's organ.
[00157] FIGURE 13C shows a modification of the embodiment of FIGURE 13B.
SUBSTITUTE SHEET (RULE 26) [00158] FIGURE 14A illustrates the apparatus of the invention applied on the small intestines of a colostomy patient having a stoma opening in the abdomen.
[00159] FIGURE 14B illustrates the apparatus of the invention applied on the small intestines of a colostomy patient having the small intestines ending at the patient's anus.
[00160] FIGURE 15 is a schematic sectional view of a mechanically operable non-inflatable constriction device for use in accordance with the invention.
[00161] FIGURES 16 and 17 are cross-sectional views taken along the lines XVI-XVI and XVII-XVII, respectively, of FIGURE 15.
[00162] FIGURE 18 schematically shows an alternative design of the embodiment of FIGURE 15;
[00163] FIGURE 19 schematically illustrates a motor arrangement for the design according to FIGURE 18;
[00164] FIGURES 20 and 21 are schematic sectional views of two alternative designs of non-inflatable constriction devices of the invention.
[00165] FIGURES 22 and 23 illustrate a fully open and a reduced constriction opening, respectively, of the embodiment of FIGURE 21;
[00166] FIGURE 24 is a schematic view of a further alternative design of a non-inflatable constriction device of the invention.
[00167] FIGURES 25 and 26 illustrate a fully open and a reduced constriction opening, respectively, of the embodiment of FIGURE 24;
[00168] FIGURE 27 is a schematic view of another alternative design of a non-inflatable constriction device of the invention.
[00169] FIGURES 28 and 29 are schematic sectional views, respectively, of yet another alternative design of a non-inflatable constriction device of the invention.
[00170] FIGURE 30A is a schematic view of a hydraulically operable inflatable constriction device for use in accordance with the invention.
[00171] FIGURE 30B is the same embodiment shown in FIGURE 30A with the constriction device inflated.
[00172] FIGURES 31A, 31B, 31C and 31D are block diagrams illustrating four different principles for hydraulic operation of the constriction device shown in =
FIGURE 30A.
[00173] FIGURE 32 is a cross-sectional view of a reservoir having a variable volume controlled by a remote control motor.
SUBSTITUTE SHEET (RULE 26) [00174] FIGURES 33A and 33B are perspective views of a reverse servo in accordance with a particular embodiment of the hydraulic operation principle shown in FIGURE 31C.
[00175] FIGURE 34 is a schematic view of another hydraulically operable constriction device for use in accordance with the invention.
[00176] FIGURE 35A illustrates the constriction device of FIGURE 34 in a constricted state.
[00177] FIGURE 35B illustrates the constriction device of FIGURE 34 in a released state.
[00178] FIGURES 36A ¨ 36E schematically illustrate different operation stages of an embodiment of the invention, in which a constriction device and a stimulation device co-operate to move the fluid and/or other bodily matter in the lumen of a patient's organ.
[00179] FIGURE 37 is a schematic block diagram illustrating a general embodiment of the apparatus of the invention, in which energy is transferred to energy consuming components of the apparatus implanted in the patient.
[00180] FIGURES 38 to 49 are schematic block diagrams illustrating twelve embodiments, respectively, based on the general embodiment shown in FIGURE 37, wherein wireless energy is transmitted from outside a patient's body to energy consuming components of the apparatus implanted in the patient.
[00181] FIGURE 50 illustrates an energy-transforming device in the form of an electrical junction element for use in the apparatus of the present invention.
[00182] FIGURE 51 is a block diagram illustrating control components of an embodiment of the invention.
[00183] FIGURE 52 is a schematic view of exemplary circuitry of an embodiment of the invention, in which wireless energy is transformed into a current.
[00184] FIGURES 53A ¨ 53C schematically illustrate different operation stages of another embodiment of the invention of the type shown in FIGURE 2, in which a constriction device and a stimulation device co-operate to move the fluid and/or other bodily matter in the lumen of a patient's organ.
[00185] FIGURES 54A ¨ 54B schematically illustrate different operation stages of another embodiment of the invention of the type shown in FIGURES 36A ¨ 36E, in which a constriction device and a stimulation device co-operate to move the fluid and/or other bodily matter in the lumen of a patient's organ.
SUBSTITUTE SHEET (RULE 26) , 81596208 [00186] FIGURE 55A is a schematic view of another mechanically operable non-inflatable constriction device for use in accordance with the invention.
[00187] FIGURE 55B shows the constriction device of FIGURE 55A in a constricted state.
[00188] FIGURE 55C is an end view of the embodiment of FIGURE 55B.
[00189] FIGURE 56 is a schematic block diagram illustrating an arrangement for supplying an accurate amount of wireless energy used for the operation of the constriction/stimulation unit as described above.
[00190] FIGURE 57 schematically shows an embodiment of the system, in which the apparatus is operated with wire bound energy.
[00191] FIGURE 58 is a more detailed block diagram of an arrangement for controlling the transmission of wireless energy used for the operation of the constriction/stimulation unit as described above.
[00192] FIGURE 59 is a circuit for the arrangement shown in Fig. 19, according to a possible implementation example.
[00192a] According to one aspect of the present invention, there is provided an apparatus for controlling a flow of fluid and/or other bodily matter in a lumen formed by a tissue wall of a patient's organ, the apparatus comprising: an implantable constriction device for gently constricting at least one portion of the tissue wall to influence the flow in the lumen, a stimulation device for stimulating the constricted wall portion of the tissue wall as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the flow in the lumen, aa control device for controlling the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the flow in the lumen and wherin the control device is adapted to control the constriction and stimulation devices independently of each other, and simultaneously.
= 81596208 40a DETAILED DESCRIPTION OF THE INVENTION
[00193] Referring to the drawing figures, like reference numerals designate identical or corresponding elements throughout the several figures.
[00194] FIGURES 1A, 1B and 1C schematically illustrate different states of operation of a generally designed apparatus according to the present invention, when the apparatus is applied on a wall portion of a bodily organ designated BO. The apparatus includes a constriction device and a stimulation device, which are designated CSD, and a control device designated CD for controlling the constriction and stimulation devices CSD. FIGURE 1A shows the apparatus in an inactivation state, in which the constriction device does not constrict the organ BO and the stimulation device does not stimulate the organ BO. FIGURE 1B shows the apparatus in a constriction state, in which the control device CD controls the constriction device to gently constrict the wall portion of the organ BO to a constricted state, in which the blood circulation in the constricted wall portion is substantially unrestricted and the flow in the lumen of the wall portion is restricted.
shows the apparatus in a stimulation state, in which the control device CD
controls the stimulation device to stimulate different areas of the constricted wall portion, so that almost the entire wall portion of the organ BO contracts (thickens) and closes the lumen.
[00195] FIGURES 1D and 1E show how the stimulation of the constricted wall portion can be cyclically varied between a first stimulation mode, in which the left area of the wall portion (see FIGURE 1D) is stimulated, while the right area of the wall portion is not stimulated, and a second stimulation mode, in which the right area of the wall portion (see FIGURE 1E) is stimulated, while the left area of the wall portion is not stimulated, in order to maintain over time satisfactory blood circulation in the constricted wall portion.
[00196] It should be noted that the stimulation modes shown in FIGURES 1D
and 1E only constitute a principle example of how the constricted wall portion of the organ BO may be stimulated. Thus, more than two different areas of the constricted wall portion may be simultaneously stimulated in cycles or successively stimulated.
Also, groups of different areas of the constricted wall portion may be successively stimulated.
[00197] FIGURES IF, 1G and 1H illustrate different states of operation of a modification of the general embodiment shown in FIGURES 1A-1E, wherein the constriction and stimulation devices CSD include several separate constriction/stimulation elements, here three elements CSDE1, CSDE2 and CSDE3.
FIGURE IF shows how the element CSDE1 in a first state of operation is activated to both constrict and stimulate the organ BO, so that the lumen of the organ BO
is closed, whereas the other two elements CSDE2 and CSDE3 are inactivated.
FIGURE 1G shows how the element CSDE2 in a second following state of operation is activated, so that the lumen of the organ BO is closed, whereas the other two elements CSDE1 and CSDE3 are inactivated. FIGURE 1H shows how the element CSDE3 in a following third state of operation is activated, so that the lumen of the organ BO is closed, whereas the other two elements CSDE1 and CSDE2 are inactivated. By shifting between the first, second and third states of operation, either randomly or in accordance with a predetermined sequence, different portions of the organ can by temporarily constricted and stimulated while maintaining the lumen of the organ closed, whereby the risk of injuring the organ is minimized. It is also possible to activate the elements CSDE1-CSDE3 successively along the lumen of the organ to move fluids and/or other bodily matter in the lumen.
SUBSTITUTE SHEET (RULE 26) [00198] FIGURES 11, 1K and 1L illustrate an alternative mode of operation of the modification of the general embodiment. Thus, FIGURE 11 shows how the element CSDE1 in a first state of operation is activated to both constrict and stimulate the organ BO, so that the lumen of the organ BO is closed, whereas the other two elements CSDE2 and CSDE3 are activated to constrict but not stimulate the organ BO, so that the lumen of the organ BO is not completely closed where the elements CSDE2 and CSDE3 engage the organ BO. FIGURE 1K shows how the element CSDE2 in a second following state of operation is activated to both constrict and stimulate the organ BO, so that the lumen of the organ BO is closed, whereas the other two elements CSDE1 and CSDE3 are activated to constrict but not stimulate the organ BO, so that the lumen of the organ BO is not completely closed where the elements CSDE1 and CSDE3 engage the organ BO. FIGURE 1L shows how the element CSDE3 in a following third state of operation is activated to both constrict and stimulate the organ BO, so that the lumen of the organ BO is closed, whereas the other two elements CSDE1 and CSDE2 are activated to constrict but not stimulate the organ BO, so that the lumen of the organ BO is not completely closed where the elements CSDE1 and CSDE2 engage the organ BO. By shifting between the first, second and third states of operation, either randomly or in accordance with a predetermined sequence, different portions of the organ can by temporarily stimulated while maintaining the lumen of the organ closed, whereby the risk of injuring the organ is reduced. It is also possible to activate the stimulation of the elements CSDE1-CSDE3 successively along the lumen of the organ BO to move fluids and/or other bodily matter in the lumen.
[00199] FIGURES 2-4 show basic components of an embodiment of the apparatus according to the invention for controlling a flow of fluid and/or other bodily matter in a lumen formed by a tissue wall of a patient's organ. The apparatus comprises a tubular housing 1 with open ends, a constriction device 2 arranged in the housing 1, a stimulation device 3 integrated in the constriction device 2, and a control device 4 (indicated in FIGURE 4) for controlling the constriction and stimulation devices 2 and 3. The constriction device 2 has two elongate clamping elements 5, 6, which are radially movable in the tubular housing 1 towards and away from each other between retracted positions, see FIGURE 3, and clamping positions, see FIGURE 4. The stimulation device 3 includes a multiplicity of electrical elements 7 positioned on the clamping elements 5, 6, so that the electrical elements 7 on one of SUBSTITUTE SHEET (RULE 26) the clamping elements 5, 6 face the electrical elements 7 on the other clamping element. Thus, in this embodiment the constriction and stimulation devices form a constriction/stimulation unit, in which the constriction and stimulation devices are integrated in a single piece.
[00200] The constriction and stimulation devices may also be separate from each other. In this case, a structure may be provided for holding the electrical elements 7 in a fixed orientation relative to one another. Alternatively, the electrical elements 7 may include electrodes that are separately attached to the wall portion of the patient's organ.
[00201] FIGURES 5A - 5C illustrate in principle the function of the apparatus of FIGURE 2 when the apparatus is applied on a portion 8 of a tubular tissue wall of a patient's organ. Thus, FIGURE 5A shows the apparatus in a non-clamping state, in which the clamping elements 5, 6 are in their retracted positions and the wall portion 8 extends through the open ends of the housing 1 without being constricted by the clamping elements 5, 6. FIGURE 58 shows the apparatus in a clamping state, in which the clamping elements 5, 6 have been moved from their retracted positions to their clamping positions, in which the clamping elements 5, 6 gently constrict the wall portion 8 to a constricted state, in which the blood circulation in the constricted wall portion 8 is substantially unrestricted and the flow in the lumen of the wall portion 8 is restricted. FIGURE 5C shows the apparatus in a stimulation state, in which the clamping elements 5, 6 constrict the wall portion 8 and the electrical elements 7 of the stimulation device 3 electrically stimulate different areas of the wall portion 8, so that the wall portion 8 contracts (thickens) and closes the lumen.
[00202] When the apparatus is in its stimulation state, it is important to stimulate the different areas of the wall portion 8 in a manner so that they essentially maintains their natural physical properties over time to prevent the areas from being injured.
Consequently, the control device 4 controls the stimulation device 3 to intermittently stimulate each area of the wall portion 8 during successive time periods, wherein each time period is short enough to maintain over time satisfactory blood circulation in the area. Furthermore, the control device 4 controls the stimulation of the areas of the wall portion 8, so that each area that currently is not stimulated restores substantially normal blood circulation before it is stimulated again. To maintain over time the effect of stimulation, i.e., to keep the lumen closed by maintaining the wall portion 8 contracted, the control device 4 controls the stimulation device 3 to SUBSTITUTE SHEET (RULE 26) stimulate one or more of the areas at a time and to shift the stimulation from one area to another over time. The control device 4 may control the stimulation device 3 to cyclically propagate the stimulation of the areas along the tubular wall portion 8, for example, in accordance with a determined stimulation pattern. To achieve the desired reaction of the tissue wall during the stimulation thereof, the control device may control the stimulation device to, preferably cyclically, vary the intensity of the stimulation of the wall portion 8.
[00203] In the embodiment of FIGURES 2 - 4, the electrical elements 7 form a series of fourteen groups of electrical elements 7 extending longitudinally along each elongate clamping element 5 and 6, respectively, see FIGURE 2. The electrical elements 7 of each group of electrical elements 7 form a first path of four electrical elements 7 positioned in a row on clamping element 5 and extending tranverse thereto, and a second path of four electrical elements 7 positioned in a row on clamping element 6 and extending tranverse thereto. Thus, the two paths of electrical elements 7 extend on mutual sides of the patient's organ. The control device 4 controls the stimulation device 3 to successively energize the groups of electrical elements 7 in the series of groups in a direction opposite to or, alternatively, in the same direction as that of the flow in the lumen of the patient's organ. Of course, the number of electrical elements 7 of each path of electrical elements 7 can be greater or smaller than four, and several parallel rows electrical elements 7 can form each path of electrical elements 7.
[00204] FIGURES 6A - BC show another embodiment of the invention which includes a tubular housing 9 and three elongate clamping elements 10a, 10b, 10c, which are radially movable in the tubular housing 9 towards and away from a central axis thereof between retracted positions, see FIGURE 6A, and clamping positions, see FIGURE 6B. The three clamping elements 10a-10c are symmetrically disposed around the central axis of the housing 9. The stimulation device of this embodiment includes electrical elements 11 a, 11 b, 11c that form a series of groups of elements extending longitudinally along the elongate clamping elements 10a-10c, wherein the electrical elements 11a ¨ 11c of each group of electrical elements form a path of three electrical elements 11a, llb and 11c extending circumferentially around the central axis of the housing 9. The three electrical elements 11a ¨ 11 c of each group are positioned on the three clamping elements 10a-10c, respectively. Thus, the path of three electrical elements lla-11c extends around the patient's organ. Of course, SUBSTITUTE SHEET (RULE 26) the number of electrical elements 11a-11c of each path of electrical elements can be greater than three, and several parallel rows electrical elements 11a-11c can form each path of electrical elements.
[00205] FIGURES 7A and 7B show different steps of an electric stimulation mode performed by the apparatus of FIGURE 2 while the clamping elements 5, 6 of the apparatus are constricting a portion of a tubular tissue wall of a patient's organ 12 to restrict the flow in the lumen 13 of the organ 12. For the sake of clarity only the clamping elements 5, 6 of the constriction device 2 are shown in FIGURES 7A, 7B.
Thus, FIGURE 7A illustrates how energized electrical elements 7 of groups of electrical elements electrically stimulate a first portion 14 and a second portion 15 of the tubular wall to contract and close the lumen 13. FIGURE 7B illustrates how energized electrical elements 7 of other groups of electrical elements electrically stimulate a third portion 16 of the tubular wall different from the first and second portions to contract and close the lumen 13, while the electrical stimulation of the first and second portions 14, 15 of the tubular wall has been ceased, so that substantially normal blood circulation in the first and second portions is restored. In this manner, the electric stimulation of the constricted tubular wall is shifted over time from one portion of the tubular wall to another to insure recurrent restoration of blood circulation in the constricted tubular wall.
[00206] The control device 4 controls the stimulation device 3 to energize the electrical elements 7 with electric biphasic pulses, i.e., combined positive and negative pulses. The desired stimulation effect is achieved by varying different pulse parameters. Thus, the control device 4 controls the stimulation device 3 to vary the pulse amplitude (voltage), the off time period between successive pulses, the pulse duration and the pulse repetition frequency. The pulse current should be between 1 to 30mA. For neural stimulation, a pulse current of about 5mA and a pulse duration of about 30011s are suitable, whereas a pulse current of about 20mA and a pulse duration of about 301.ts are suitable for muscular stimulation. The pulse repetition frequency suitably is about 10Hz. For example, as illustrated in the Pulse/time diagram P/t of FIGURE 8A, a pulse combination including a negative pulse PS of short duration and high amplitude (voltage), and a positive pulse PL of long duration and low amplitude following the negative pulse may be cyclically repeated to form a pulse train of such pulse combinations. The energy content of the negative Pulse PS
should be substantially equal to the energy content of the positive pulse PL.
SUBSTITUTE SHEET (RULE 26) [00207] FIGURE 8B is a pulse/time diagram showing a modification of the electric stimulation shown in FIGURE 8A. Thus, the pulse combination of FIGURE
is mixed with a pulse train combination having a first relatively long pulse train PTL of high frequency/low amplitude pulses, appearing simultaneously with the positive pulse PL of the pulse combination of FIGURE 8A, and a second relatively short pulse train PTS of high frequency/low amplitude appearing simultaneously with the negative pulse PS of the pulse combination shown in FIGURE 8A. As a result, the high frequency/low amplitudes pulse trains PTL and PTS are superimposed on the positive and negative pulses PL and PS of FIGURE 8A, as illustrated in FIGURE
8B.
The pulse configuration of FIGURE 8B, and variations thereof, is beneficial to use in connection with the stimulation of particular human organs, in order to achieve the desired stimulation effect.
[00208] Preferably, the electric pulses form pulse trains, as illustrated in the Pulse/time diagrams P/t of FIGURES 9A, 9B, 9C and 9D. The Pulse/time diagram P/t of FIGURE 9A represents an individual area of the wall portion of the patient's tubular organ which is stimulated with a pulse train 18A. The pulse train 18A includes three initial negative pulses, each of which is of short duration and high amplitude (voltage), and one positive pulse of long duration and low amplitude following the negative pulses. After a delay to enable the area of the organ to restore substantially normal blood circulation, the pulse train 18A is repeated.
[00209] The Pulse/time diagram P/t of FIGURE 9B represents another individual area of the wall portion, which is stimulated with a pulse train 18B having the same configuration as the pulse train 18A. The pulse trains 18A and 18B
are shifted relative to each other, so that they partially overlap one another to ensure that the constricted wall portion always is stimulated to contract as desired.
[00210] The pulse/time diagrams P/t of FIGURES 10A and 10B represent two different areas of the wall portion, which are stimulated with cyclically repeated pulse trains 18C and 18D, respectively, having the same configuration. Each pulse train 180, 18D includes two initial negative pulses, each of which is of short duration and high amplitude (voltage), and one positive pulse of long duration and low amplitude following the two negative pulses. In this case, the pulse trains 180 and 18D
are shifted relative to each other, so that they do not overlap each other. Thus, the off time period between adjacent pulse trains 180 is longer than the duration of pulse SUBSTITUTE SHEET (RULE 26) train 18D and the off time period between adjacent pulse trains 18D is longer than the duration of pulse train 180.
[00211] The pulse trains 18A, 18B, 18C and 18D can be configured in many different ways. Thus, the control device 4 can control the stimulation device 2 to vary the length of each pulse train, the repetition frequency of the pulse trains, the number of pulses of each pulse train, and/or the off time periods between the pulse trains.
Typically, the control device 4 controls each off time period between the pulse trains to last long enough to restore substantially normal blood circulation in the area that just has been stimulated before that area again is stimulated with electric pulses.
[00212] FIGURES 11A and 11B show another embodiment of the invention that controls blood flow in a blood vessel 19, comprising a constriction device with two clamping elements 20a and 20b, a stimulation device in the form of two thermal stimulation elements 21a and 21b integrated in the clamping elements 20a, 20b, respectively, and a control device 4 for controlling the clamping elements 20a, 20b and stimulation elements 21a, 21b. The clamping elements 20a and 20b are movable towards and away from each other in the same manner as described above in connection with the embodiment according to FIGURES 5A-5C. The thermal stimulation elements 21a and 21b, which may include Pertier elements, are positioned on the clamping elements 20a, 20b, so that the thermal elements 21a are facing the thermal elements 21b. FIGURE 11A shows how the clamping elements 20a, 20b constrict the blood vessel 19, so that the blood flow is restricted.
FIGURE
11B shows how the control device 4 controls the thermal stimulation elements 21a, 21b to cool the wall of the blood vessel 19, so that the wall contracts and closes the blood vessel 19. To release the blood vessel 19, the control device 4 controls the thermal stimulation elements 21a, 21b to heat the wall of the blood vessel 19, so that the wall expands.
[00213] FIGURES 12A and 12B show hydraulic operation means suited for operating the constriction device of the embodiments described above.
Specifically, FIGURES 12A and 12B show the apparatus of FIGURE 2 provided with such means for hydraulic operation of the constriction device 2. (The stimulation device is not shown.) Thus, the housing 1 forms two hydraulic chambers 22a and 22b, in which the two clamping elements 5, 6 are slidable back and forth relative to the tubular tissue wall portion 8 of a patient's organ. The hydraulic operation means include an expandable reservoir 23, such as an elastic balloon, containing hydraulic fluid, SUBSTITUTE SHEET (RULE 26) conduits 24a and 24b between the reservoir 23 and the hydraulic chambers 22a, 22b, and a two-way pump 25 for pumping the hydraulic fluid in the conduits 24a, 24b.
The control device 4 controls the pump 25 to pump hydraulic fluid from the reservoir 23 to the chambers 22a, 22b to move the clamping elements 5, 6 against the wall portion 8, whereby the tubular wall portion 8 is constricted, see FIGURE 12B, and to pump hydraulic fluid from the chambers 22a, 22b to the reservoir 23 to move the clamping elements 5, 6 away from the wall portion 8, whereby the tubular wall 8 is released, see FIGURE 12A.
[00214] Alternatively, the embodiment of FIGURES 12A and 12B may be manually operated by applying suitable manually operable hydraulic means for distributing the hydraulic fluid between the expandable reservoir 23 and the hydraulic chambers 22a, 22b. In this case the pump 25 is omitted.
[00215] FIGURES 13A and 13B schematically show a mechanically operable embodiment of the invention, comprising an open ended tubular housing 26 applied on the tubular tissue wall portion 8 of a patient's organ, a constriction device 27 arranged in the housing 26 and a control device 4 for controlling the constriction device 27. A stimulation device (not shown) as described above is also provided in the housing 26. The constriction device 27 includes a clamping element 28, which is radially movable in the tubular housing 26 towards and away from the tubular wall portion 8 between a retracted position, see FIGURE 13A, and a clamping position, see FIGURE 13B, in which the clamping element 28 gently constricts the tubular wall portion 8. Mechanical operation means for mechanically operating the clamping element 28 includes an electric motor 29 attached to the housing 26 and a telescopic device 30, which is driven by the motor 29 and operatively connected to the clamping element 28. The control device 4 controls the electric motor 29 to expand the telescopic device 30 to move the clamping element 28 against the wall portion 8, whereby the tubular wall portion 8 is constricted, see FIGURE 13B, and controls the motor 29 to retract the telescopic device 30 to move the clamping element 28 away from the wall portion 8, whereby the wall portion 8 is released, see FIGURE
13A.
[00216] Alternatively, the motor 29 may be omitted and the telescopic device 30 be modified for manual operation, as shown in FIGURE 13C. Thus, a spring 30a may be provided acting to keep the telescopic device 30 expanded to force the clamping element 28 against the wall portion 8. The mechanical operation means may include a subcutaneously implanted lever mechanism 29a that is operatively connected to SUBSTITUTE SHEET (RULE 26) the telescopic device 30. The patient may push the lever mechanism 29a through the patient's skin 29b to pull the telescopic device 30 against the action of the spring 30a to the retracted position of the telescopic device 30, as indicated in phantom lines.
When the patient releases the lever mechanism 29a, the spring 30a expands the telescopic device 30, whereby clamping element 28 is forced against the wall portion 8.
[00217] The mechanical operation means as described above in connection with FIGURES 13A, 13B and 13C may also be implemented in the embodiments according to FIGURES 1-11.
[00218] FIGURE 14A illustrates the embodiment of FIGURE 2 applied on the small intestines 31 of a colostomy patient having a stoma in the abdomen. The clamping elements 5, 6 of the constriction device 2 constrict the small intestines 31 and the stimulation device 3 is energized to close the intestinal passageway.
(For the sake of clarity, the housing is not shown and the clamping elements 5, 6 are exaggerated.) In this embodiment, a control device includes an external control unit in the form of a hand-held wireless remote control 32, and an implanted internal control unit 33, which may include a microprocessor, for controlling the constriction and stimulation devices. The remote control 32 is operable by the patient to control the internal control unit 33 to switch on and off the constriction device and/or the stimulation device. Alternatively, however, the remote control 32 may be replaced by a subcutaneously implanted push button that is manually switched by the patient between "on" and"off . Such a manually operable push button may also be provided in combination with the remote control 32 as an emergency button to allow the patient to stop the operation of the apparatus in case of emergency or malfunction.
[00219] The internal control unit 33 controls an implanted operation device 34 to move the clamping elements 5, 6. An implanted source of energy 35, such as a rechargeable battery, powers the operation device 34. The internal control unit 33, which may be implanted subcutaneously or in the abdomen, also works as en energy receiver, i.e., for transforming wireless energy into electric energy and charging the implanted source of energy 35 (rechargeable battery) with the electric energy.
[00220] An implanted sensor 36 senses a physical parameter of the patient, such as the pressure in the intestines, or a parameter that relates to the pressure in the intestines, wherein the internal control unit 33 controls the constriction device 2 and/or the stimulation device 3 in response to signals from the sensor 36. In this SUBSTITUTE SHEET (RULE 26) embodiment the sensor 36 is a pressure sensor, wherein the internal control unit 33 controls the constriction device and/or stimulation device to change the constriction of the patient's intestines 31 in response to the pressure sensor 36 sensing a predetermined value of measured pressure. For example, the control unit 33 may control the constriction device and/or stimulation device to increase the constriction of the patient's intestines 31 in response to the pressure sensor sensing an increased pressure. Alternatively or in combination, the remote control 32 controls the constriction device and/or stimulation device in response to signals from the sensor 36, in the same manner as the internal control unit 33.
[00221] The remote control 32 may be equipped with means for producing an indication, such as a sound signal or displayed information, in response to signals from the sensor 36. When the patient's attention is taken by such an indication indicating an increased pressure exceeding a threshold value, he or she may use the remote control to control the constriction device and stimulation device to pump intestinal contents through the patient's stoma.
[00222] FIGURE 14B shows an embodiment which is similar to the embodiment of FIGURE 14A except that the constriction device is applied on the small intestines of a colostomy patient having the small intestines surgically connected to the patient's anus.
[00223] Of course, the constriction device 2 shown in FIGURES 14A and 14B
may be replaced by any one of the constriction devices described in the various embodiments of the present invention, where applicable.
[00224] FIGURES 15-17 show a mechanically operable constriction device having an elongated constriction member in the form of a circular resilient core 37 with two overlapping end portions 38, 39. The core 37 defines a substantially circular restriction opening and is enclosed in an elastic soft hose 40 except at a releasable and lockable joint 41 of the core 37, which when released enables application of the core 37 with its hose 40 around a portion of a tubular tissue wall of a patient's organ.
The materials of all of these elements are bio-compatible so that the patient' body will not reject them. An operation device 42 for mechanically operating the longitudinal extension of the core 37 to change the size of the restriction opening comprises a drive wheel 43 in frictional engagement with the overlapping end portions 38, 39 of the core 37. The drive wheel 43 is journalled on a holder 44 placed in the hose 40 and provided with two counter pressure rollers 45, 46 pressing the respective end SUBSTITUTE SHEET (RULE 26) portions 38, 39 of the core 37 against the drive wheel 43 to increase the frictional engagement there between. An electric motor 47 of the operation device is connected to the drive wheel 43 via a long flexible drive shaft 48, and is moulded together with a remote controlled power supply unit 49 in a body 50 of silicone rubber. The length of the flexible drive shaft 48 is selected so that the body 50 can be placed in a desired position in the patient's body, suitably in the abdomen.
[00225] The power supply unit 49 can be controlled to power the electric motor 47 to turn the drive wheel 43 in one direction to reduce the diameter of the core 37, so that the wall portion is constricted, or to turn the drive wheel 43 in the opposite direction to increase the diameter of the core 37, so that the wall portion is released.
[00226] In accordance with a first alternative, a rack gear may be formed on one of the end portions 38, 39 of the core 37 and the drive wheel 43 may be replaced by a drive gear wheel connected to the other end portion of the core 37 and in mesh with the rack gear.
[00227] In accordance with a second alternative, the operation device 42 may be designed as a worm-driven hose clamp, i. e., one of the end portions 38, 39 of the core 37 may be provided with threads and the other end portion of the core 37 may be provided with a worm, the threads of which interacts with the threads of said one end portion of the core 37. The threads of such a worm may also interact with threads provided on both end portions 38, 39 of the core 37. In this alternative, the electric motor 47 turns the worm in one direction to reduce the diameter of the core 37, so that the wall portion is constricted, or turn the worm in the opposite direction to increase the diameter of the core 37, so that the wall portion is released in one direction to reduce the diameter of the core 37, so that the wall portion is constricted, or turns the clamping screw in the opposite direction to increase the diameter of the core 37, so that the wall portion is released.
[00228] FIGURE 18 shows a constriction device which is identical to the embodiment of FIGURES 15-17, except that the motor 47 is encapsulated in the hose 40 so that it is fixed to the core 37 and has a short drive shaft 51, and that the motor 47 is positioned relative to the core 37, such that the drive shaft 51 extends substantially tangentially to the circular core 37. There is an angular gearing 52 connecting the drive shaft 51 to the drive wheel 43.
[00229] FIGURE 19 shows a suitable alternative arrangement for the motor 47 in the embodiment of FIGURE 18, comprising a first clamping member 53 secured to SUBSTITUTE SHEET (RULE 26) one end portion of the core 37 and a second clamping member 54 secured to the other end portion 39 of the core 37. The motor 47 is secured to the first clamping member 53 and is operatively connected to a worm gear 55 via a gear transmission 56. The worm gear 55 is journalled at its opposite ends on holders 57 and 58, which are rigidly secured to the clamping member 53 and the motor 47, respectively.
The second clamping member 54 has a pinion in mesh with the worm gear 55. When the motor 47 is powered, the worm gear 55 rotates, and will thereby pull the end portion 39 of the core 37 in one or the opposite longitudinal direction, so that the diameter of the substantially circular core 37 is either increased or decreased. The motor 47, worm gear 55, gear transmission 56 and second clamping member 54 constitute a servo system of the type that transfers a weak force acting on a moving element having a long stroke into a strong force acting on another moving element having a short stroke.
[00230] FIGURE 20 shows a constriction device including a plurality of arcuate lamellae 59 arranged like the conventional adjustable aperture mechanism of a camera. A motor 60 operates the lamellae 59 to change the size of a restriction opening defined by the lamellae 59.
[00231] FIGURES 21-23 show a constriction device including two semi-circular elements 61 and 62, which are hinged together such that the semi-circular elements 61, 62 are swingable relative to each other between a fully open state in which they substantially form a circle, as illustrated in FIGURE 22, and an angular state, in which the size of the restriction opening defined by the semi-circular elements 61, 62 is reduced, as illustrated in FIGURE 23. A motor 63 operates the semi-circular elements 61, 62 to swing them relative to each other.
[00232] FIGURES 24-26 show a constriction device including an elastic belt forming a circle and having a substantially oval cross-section. A motor 67 operates the belt 64 to turn around the longitudinal extension thereof between a fully open state, in which the inner broader side of the belt 64 forms a substantially cylindrical surface, as illustrated in FIGURE 25, and a reduced open state, in which the inner broader side of the belt 64 forms a substantially conical surface, as illustrated in FIGURE 26.
[00233] FIGURE 27 shows a constriction device 68 having two rigid articulated clamping elements 69 positioned on opposite sides of a portion of a tubular tissue wall 70 of a patient's organ. An operation device 71 turns the clamping elements 69 SUBSTITUTE SHEET (RULE 26) toward each other to clamp the wall portion 70 between the clamping elements 69 to thereby contract the wall portion, and turns the clamping elements 69 away from each other to release the wall portion from the clamping elements 69.
[002341 FIGURES 28 and 29 show an embodiment of the apparatus of the invention comprising a constriction device 300 having three bending members 301, 302 and 303 displaced relative to one another in a row along a portion of a tubular tissue wall 304 of a patient's organ and positioned alternately on opposite sides of the tubular wall 304. (Alternatively, each member 301, 302 and 303 may take the shape of an hour-glass.) An operation device (not shown) moves the two outer members 301, 303 laterally against the tubular wall 304 in one direction and the intermediate member 302 against the tubular wall 304 in the opposite direction to bend the tubular wall 304, to thereby constrict the tubular wall portion 304, as illustrated in FIGURE 29. To release the wall portion 304 the operation device moves the members 301-303 away from the tubular wall portion 304 to the position shown in FIGURE 28.
[00235] FIGURES 30A and 30B show a hydraulically operable elongated constriction device in the form of a band 72 having an expandable/contractible cavity 73, which is in fluid communication with an adjustable reservoir 74 containing hydraulic fluid. FIGURE 30A illustrates when the band is in a non-constriction state, whereas FIGURE 30B illustrates when the band is in a constriction state, in which the cavity 73 is expanded by hydraulic fluid supplied by the reservoir 74.
[00236] FIGURES 31A, 31B, 31C and 31D are block diagrams of four differently operated hydraulic constriction devices. FIGURE 31A shows the band 72 of FIGURE
30A, the cavity 73 of which is in fluid communication with a reservoir 75.
FIGURE
31B shows the embodiment of FIGURE 30A, in which the cavity 73 of the band 72 is in fluid communication with the reservoir 74 via an operation device in the form of a two-way pump 76. FIGURE 31C shows an operation device in the form of a reverse servo system with a first closed system controlling a second system. The reverse servo system comprises an adjustable fluid supply reservoir 77 and an adjustable servo reservoir 78. The servo reservoir 78 controls a larger adjustable reservoir 79 which in connection with the band 72 applied around a portion of tubular tissue wall of a patient's organ varies the volume of the cavity 73 of the band 72, which in turn varies the constriction of the wall portion. FIGURE 31D shows an embodiment identical to the embodiment of FIGURE 31C, except that the larger reservoir 79 is SUBSTITUTE SHEET (RULE 26) omitted. Instead, the servo reservoir 78 is in fluid communication with the cavity of the band 72.
[00237] In all of the above embodiments according to FIGURES 12A through 30B, stimulation devices may be provided to form constriction/stimulation units, in which the stimulation devices include a multiplicity of electrical elements 7 (indicated in FIGURES 12A ¨ 15, 18, 20¨ 23, 26¨ 31B) positioned on the constriction devices.
[00238] FIGURE 32 is a cross-sectional view of a fluid supply device including a bellows reservoir 80 defining a chamber 81, the size of which is variable by an operation device comprising a remote controlled electric motor 82. The reservoir 80 and the motor 82 are placed in a housing 83. Moving a large wall 84 varies the chamber 81. The wall 84 is secured to a nut 85, which is threaded on a rotatable spindle 86. The spindle 86 is rotated by the motor 82. A battery 89 placed in the housing 83 powers the motor 82. A signal receiver 90 for controlling the motor 82 is also placed in the housing 83. Alternatively, the battery 89 and the signal receiver 90 may be mounted in a separate place. The motor 82 may also be powered with energy transferred from transmitted signals.
[00239] Where applicable, the fluid supply device of FIGURE 32 may be used for supplying hydraulic fluid for the operation of the constriction devices described in this specification. For example, the fluid supply device of FIGURE 32 may be substituted for the reservoir 74 in the embodiment according to FIGURE 30A.
[00240] FIGURES 33A and 33B show a reverse servo including a rectangular housing 91 and an intermediate wall 92, which is movable in the housing 91. A
relatively large, substantially cylindrical bellows reservoir 93 is arranged in the housing 91 and is joined to the movable intermediate wall 92. Another cylindrical bellows reservoir 94, which is substantially smaller than reservoir 93, is arranged in the housing 91 at the other side of the intermediate wall 92 and is also joined to the wall 92. The small bellows reservoir 94 has a fluid supply pipe 95 and the large bellows reservoir 93 has a fluid supply pipe 96.
[00241] Referring to FIGURE 33A, when a small amount of hydraulic fluid is conducted through the supply pipe 95 into the small bellows reservoir 94, the small bellows reservoir 94 expands and pushes the movable intermediate wall 92 towards the large bellows reservoir 93. As a result, the large bellows reservoir 93 is contracted by the intermediate wall 92, whereby a large amount of hydraulic fluid is SUBSTITUTE SHEET (RULE 26) forced out of the large bellows reservoir 93 through the supply pipe 96, as shown in FIGURE 33B.
[00242] For example, the reverse servo of FIGURES 33A and 33B may be used in the embodiment of FIGURE 31C, wherein the small bellows reservoir 94 corresponds to the small servo reservoir 78 and the large bellows reservoir 93 corresponds to the large reservoir 79. Also, the reverse servo of FIGURES 33A
and 33B may be used in the embodiment of FIGURE 30A and 30B, wherein the small bellows reservoir 94 is connected to the adjustable reservoir 74, and the large bellows reservoir 93 is connected to the cavity 73 of the band 72.
[00243] FIGURE
34 schematically shows a hydraulically operable constriction device 97 of the apparatus of the invention, which is similar to the embodiment shown in FIGURE 30A, except that the hydraulic system is designed differently.
Thus, the constriction device 97 includes a relatively small inflatable cavity 98, which is in fluid communication with a reservoir 99 containing hydraulic fluid, and a relatively large cavity 100, which is displaceable by small cavity 98. Small cavity 98 is adapted to displace large cavity 100 to constrict the patient's tubular wall portion when small cavity 98 is inflated and to displace large cavity 100 to release the wall portion when small cavity 98 is deflated. Thus, a relatively small addition of hydraulic fluid from reservoir 99 to small cavity 98 causes a relatively large increase in the constriction of the wall portion.
[00244] Large cavity 100 is defined by a contraction element in the form of a big balloon 101, which may be connected to an injection port (not shown) for calibration of the volume of large cavity 100. Adding fluid to or withdrawing fluid from the injection port with the aid of a syringe calibrates the volume of balloon 101.
Small cavity 98 is defined by a small bellows 102 attached to an annular frame 103 of constriction device 97 and at the opposite end is attached to balloon 101.
[00245] FIGURES
35A and 35B schematically illustrate the operation of constriction device 97, when annular frame 103 is applied around the tubular wall portion of the patient's organ. Referring to FIGURE 35A, when small cavity 98 is deflated bellows 102 pulls balloon 101 inwardly into annular frame 103, so that constriction device 97 constricts the wall portion. Referring to FIGURE 35B, when small cavity 98 is inflated bellows 102 pulls balloon 101 out of annular frame 103, so that constriction device 97 releases the wall portion.
SUBSTITUTE SHEET (RULE 26) [00246] As mentioned above, the constriction device and stimulation device can co-operate to actively move the fluid and/or other bodily matter in the lumen of a patient's organ. This can be achieved using the constriction/stimulation unit shown in FIGURE 2. Thus, in accordance with a first cooperation option, the clamping elements 5, 6 of the constriction device constricts the wall portion 8 without completely closing the lumen, whereby the flow in the lumen is restricted, and the control device 4 controls the electrical elements 7 to progressively stimulate the constricted wall portion in the downstream or upstream direction of the lumen to cause progressive contraction of the wall portion 8 to move the fluid and/or other bodily matter in the lumen.
[00247] In accordance with a second cooperation option, the constriction device constricts the wall portion so that the flow in the lumen is restricted, and the control device 4 controls a few electrical elements 7 at one end of the elongate clamping elements 5, 6 to stimulate the constricted wall portion 8 to close the lumen either at an upstream end or a downstream end of the wall portion 8. With the lumen closed in this manner, the control device 4 controls the constriction device to increase the constriction of the wall portion, whereby the fluid and/or other bodily matter in the lumen is moved downstream or upstream of the wall portion 8.
[00248] In another embodiment of the invention for performing the second cooperation option, the constriction device constricts the wall portion so that the flow in the lumen is restricted, and the control device 4 controls the stimulation device to stimulate the constricted wall portion while the constriction device varies the constriction of the different areas of the wall portion, such that the wall portion is progressively constricted in the downstream or upstream direction of the lumen.
FIGURES 36A ¨ 36E show different operation stages of such an alternative embodiment, which comprises a constriction device 104 including two elongate constriction elements 105, 106 having convex surfaces 107, 108 that abut a length of the wall portion 8 on mutual sides thereof, and a multiplicity of electrical elements 7 (such as electrodes) that are positioned on the convex surfaces 107, 108. The control device 4 controls the electrical elements 7 during operation of the constriction device 104 and controls the elongate constriction elements 105, 106 to move relative to the tubular wall portion 8 so that the constriction elements 105, 106 progressively constrict the wall portion 8, as appears from FIGURES 36A to 36D.
SUBSTITUTE SHEET (RULE 26) [00249] Thus, in an initial position of the constriction elements 105, 106 shown in FIGURE 36A, the wall portion is not constricted by the constriction elements 105, 106 and the electrical elements 7 are not energized. Starting from this initial position, the control device 4 controls the constriction elements 105, 106 to swing the left ends of the constriction elements 105, 106 toward the wall portion (indicated by arrows) to constrict the tubular wall portion 8, see FIGURE 36B, while energizing the electrical elements 7, so that the electrical elements 7 that contact the wall portion 8 contract the latter. FIGURE 36 C shows how the lumen of the tubular wall portion 8 is completely closed by the thickened wall portion 8. Then, as shown in FIGURE
360, the control device 4 controls the constriction elements 105, 106 to move so that their right ends are moving towards each other (indicated by arrows), while the convex surfaces 107, 108 of the constriction elements 105, 106 are rolling on each other with the contracted wall portion 8 between them, see FIGURE 36D. As a result, the bodily matter in the lumen of the organ is forced to the right (indicated by a white arrow).
When the constriction elements 105, 106 have rolled on each other to the position shown in FIGURE 36E, the control device 4 controls the right ends of the constriction elements 105, 106 to move away from each other (indicated by arrows in FIGURE
36E) to the initial position shown in FIGURE 36A. The operation stages described according to FIGURES 36A to 36E can be cyclically repeated a number of times until the desired amount of bodily matter has been moved in the lumen of the organ in a peristaltic manner.
[00250] Alternatively, only one of the constriction elements 105, 106 can be provided with a convex surface, whereas the other constriction element has a plane surface that abuts the wall portion. It is also possible to use a single constriction element with a convex surface that presses the tubular portion 8 of the organ against a bone of the patient.
[00251] In the embodiment according to FIGURES 36A to 36E, the control device 4 may control the electrical elements 7 to progressively stimulate the constricted wall portion 8 to cause progressive contraction thereof in harmony with the movement of the elongate constriction elements 105, 106, as the convex surfaces 107, 108 of the constriction elements 105, 106 are rolling on each other.
[00252] .FIGURE 37 schematically shows a general embodiment of the apparatus of the invention, in which energy is transferred to energy consuming components of the apparatus implanted in the patient. The apparatus of FIGURE
SUBSTITUTE SHEET (RULE 26) comprises an implanted constriction/stimulation unit 110, which is operable to gently constrict a portion of a tubular tissue wall of a patient's organ and to stimulate different areas of the constricted portion to cause contraction of the wall portion. The constriction device of the constriction/stimulation unit 110 is capable of performing a reversible function, i.e., to constrict and release the wall portion, so that the constriction/stimulation unit 110 works as an artificial sphincter.
[00253] A source of energy 111 is adapted to supply energy consuming components of the constriction/stimulation unit 110 with energy via a power supply line 112. A wireless remote control or a subcutaneously implanted switch operable by the patient to switch on or off the supply of energy from the source of energy may be provided. The source of energy may be an implantable permanent or rechargeable battery, or be included in an external energy-transmission device, which may be operable directly by the patient or be controlled by a remote control operable by the patient to transmit wireless energy to the energy consuming components of the constriction/stimulation unit. Alternatively, the source of energy may comprise a combination of an implantable rechargeable battery, an external energy-transmission device and an implantable energy-transforming device for transforming wireless energy transmitted by the external energy-transmission device into electric energy for the charge of the implantable rechargeable battery.
[00254] FIGURE 38 shows a special embodiment of the general embodiment of FIGURE 37 having some parts implanted in a patient and other parts located outside the patient's body. Thus, in FIGURE 38 all parts placed to the right of the patient's skin 109 are implanted and all parts placed to the left of the skin 109 are located outside the patient's body. An implanted energy-transforming device 111A of the apparatus is adapted to supply energy consuming components of the constriction/stimulation unit 110 with energy via the power supply line 112.
An external energy-transmission device 113 of the apparatus includes a wireless remote control transmitting a wireless signal, which is received by a signal receiver incorporated in the implanted energy-transforming device 111A. The implanted energy-transforming device 111A transforms energy from the signal into electric energy, which is supplied via the power supply line 112 to the constriction/stimulation unit 110.
[00255] The apparatus of FIGURE 38 may also include an implanted rechargeable battery for energizing energy consuming implanted components of the SUBSTITUTE SHEET (RULE 26) apparatus. In this case, the implanted energy-transforming device 111A also charges the battery with electric energy, as the energy-transforming device transforms energy from the signal into the electric energy.
[00256] A reversing device in the form of an electric switch 114, such as a microprocessor, is implanted in the patient for reversing the constriction device of the constriction/stimulation unit 110. The wireless remote control of the external energy-transmission device 113 transmits a wireless signal that carries energy and the implanted energy-transforming device 111A transforms the wireless energy into a current for operating the switch 114. When the polarity of the current is shifted by the energy-transforming-device 111A the switch 114 reverses the function performed by the constriction device of the constriction/stimulation unit 110.
[00257] FIGURE 39 shows an embodiment of the invention including the energy-transforming device 111A, the constriction/stimulation unit 110 and an implanted operation device in the form of a motor 115 for operating the constriction device of the constriction/stimulation unit 110. The motor 115 is powered with energy from the energy-transforming device 111A, as the remote control of the external energy-transmission device113 transmits a wireless signal to the receiver of the energy-transforming device 111A.
[00258] FIGURE 40 shows an embodiment of the invention including the energy-transforming device 111A, the constriction/stimulation unit 110 and an implanted assembly 116 including a motor/pump unit 117 and a fluid reservoir 118. In this case the constriction device of the constriction/stimulation unit 110 is hydraulically operated, i.e., hydraulic fluid is pumped by the motor/pump unit from the reservoir 118 to the constriction/stimulation unit 110 to constrict the wall portion, and hydraulic fluid is pumped by the motor/pump unit 117 back from the constriction/stimulation unit 110 to the reservoir 118 to release the wall portion. The implanted energy-transforming device 111A transforms wireless energy into a current, for powering the motor/pump unit 117.
[00259] FIGURE 41 shows an embodiment of the invention comprising the external energy-transmission device 113.that controls the control unit 122 to reverse the motor 115 when needed, the constriction/stimulation unit 110, the constriction device of which is hydraulically operated, and the implanted energy-transforming device 111A, and further comprising an implanted hydraulic fluid reservoir 119, an implanted motor/pump unit 120, an implanted reversing device in the form of a SUBSTITUTE SHEET (RULE 26) hydraulic valve shifting device 121 and a separate external wireless remote control 111B. The motor of the motor/pump unit 120 is an electric motor. In response to a control signal from the wireless remote control of the external energy-transmission device 113, the implanted energy-transforming device 111A powers the motor/pump unit 120 with energy from the energy carried by the control signal, whereby the motor/pump unit 120 distributes hydraulic fluid between the reservoir 119 and the constriction device of the constriction/stimulation unit 110. The remote control 111B
controls the shifting device 121 to shift the hydraulic fluid flow direction between one direction in which the fluid is pumped by the motor/pump unit 120 from the reservoir 119 to the constriction device of the constriction/stimulation unit 110 to constrict the wall portion, and another opposite direction in which the fluid is pumped by the motor/pump unit 120 back from the constriction device of the constriction/stimulation unit 110 to the reservoir 119 to release the wall portion.
[00260] FIGURE 42 shows an embodiment of the invention including the energy-transforming device 111A and the constriction/stimulation unit 110. A
control unit 122, an accumulator 123 and a capacitor 124 are also implanted in the patient. A
separate external wireless remote control 111B controls the control unit 122.
The control unit 122 controls the energy-transforming device 111A to store electric energy in the accumulator 123, which supplies energy to the constriction/stimulation unit 110.
In response to a control signal from the wireless remote control 111B, the control unit 122 either releases electric energy from the accumulator 123 and transfers the released energy via power lines, or directly transfers electric energy from the energy-transforming device 111A via the capacitor 124, which stabilises the electric current, for the operation of the constriction/stimulation unit 110.
[00261] In accordance with one alternative, the capacitor 124 in the embodiment of FIGURE 42 may be omitted. In accordance with another alternative, the accumulator 123 in this embodiment may be omitted.
[00262] FIGURE 43 shows an embodiment of the invention including the energy-transforming device 111A, the constriction/stimulation unit 110. A
battery 125 for supplying energy for the operation of the constriction/stimulation unit 110 and an electric switch 126 for switching the operation of the constriction/stimulation unit 110 are also implanted in the patient. The switch 126 is operated by the energy supplied by the energy-transforming device 111A to switch from an off mode, in which the SUBSTITUTE SHEET (RULE 26) battery 125 is not in use, to an on mode, in which the battery 125 supplies energy for the operation of the constriction/stimulation unit 110.
[00263] FIGURE 44 shows an embodiment of the invention identical to that of FIGURE 43, except that a control unit 122 also is implanted in the patient. A
separate external wireless remote control 111B controls the control unit 122. In this case, the switch 126 is operated by the energy supplied by the energy-transforming device 111A to switch from an off mode, in which the wireless remote control 111B is prevented from controlling the control unit 122 and the battery 125 is not in use, to a standby mode, in which the remote control 111B is permitted to control the control unit 122 to release electric energy from the battery 125 for the operation of the constriction/stimulation unit 110.
[00264] FIGURE 45 shows an embodiment of the invention identical to that of FIGURE 44, except that the accumulator 123 is substituted for the battery 125 and the implanted components are interconnected differently. In this case, the accumulator 123 stores energy from the energy-transforming device 111A. In response to a control signal from the wireless remote control 111B, the implanted control unit 122 controls the switch 126 to switch from an off mode, in which the accumulator 123 is not in use, to an on mode, in which the accumulator 123 supplies energy for the operation of the constriction/stimulation unit 110.
[00265] FIGURE 46 shows an embodiment of the invention identical to that of FIGURE 45, except that the battery 125 also is implanted in the patient, and the implanted components are interconnected differently. In response to a control signal from the wireless remote control 111B, the implanted control unit 122 controls the accumulator 123, which may be a capacitor, to deliver energy for operating the switch 126 to switch from an off mode, in which the battery 125 is not in use, to an on mode, in which the battery 125 supplies electric energy for the operation of the constriction/stimulation unit 110.
[00266] Alternatively, the switch 126 may be operated by energy supplied by the accumulator 123 to switch from an off mode, in which the wireless remote control 111B is prevented from controlling the battery 125 to supply electric energy and the battery 125 is not in use, to a standby mode, in which the wireless remote control 111B is permitted to control the battery 125 to supply electric energy for the operation of the constriction/stimulation unit 110.
SUBSTITUTE SHEET (RULE 26) [00267] FIGURE 47 shows an embodiment of the invention identical to that of FIGURE 43, except that a motor 115, a mechanical reversing device in the form of a gearbox 127 and a control unit 122 for controlling the gearbox 127 also are implanted in the patient. A separate external wireless remote control 111B controls the implanted control unit 122 to control the gearbox 127 to reverse the function performed by the constriction device (mechanically operated) of the constriction/stimulation unit 110.
[00268] FIGURE 48 shows an embodiment of the invention identical to that of FIGURE 46, except that the implanted components are interconnected differently.
Thus, in this case, the battery 125 powers the control unit 122 when the accumulator 123, suitably a capacitor, activates the switch 126 to switch to an on mode.
When the switch 126 is in its on mode the control unit 122 is permitted to control the battery 125 to supply, or not supply, energy for the operation of the constriction/stimulation unit 110.
[00269] FIGURE 49 shows an embodiment of the invention identical to that of FIGURE 39, except that a gearbox 127 that connects the motor 115 to the constriction/stimulation unit 110, and a control unit 122 that controls the energy-transforming device 111A to power the motor 115 also are implanted in the patient.
There is a separate external wireless remote control 111B that controls the control unit 122 to reverse the motor 115 when needed.
[00270] Optionally, the accumulator 123 shown in FIGURE 42 may be provided in the embodiment of FIGURE 49, wherein the implanted control unit 122 controls the energy-transforming device 111A to store the transformed energy in the accumulator 123. In response to a control signal from the wireless remote control 111B, the control unit 122 controls the accumulator 123 to supply energy for the operation of the constriction/stimulation unit 110.
[00271] Those skilled in the art will realise that the above various embodiments according to FIGURES 38-49 could be combined in many different ways. For example, the energy operated switch 114 could be incorporated in any of the embodiments of FIGURES 39, 42-49, the hydraulic shifting device 121 could be incorporated in the embodiment of FIGURE 40, and the gearbox 127 could be incorporated in the embodiment of FIGURE 39. The switch 114 may be of a type that includes electronic components, for example a microprocessor, or a FGPA (Field Programmable Gate Array) designed for switching. Alternatively, however, the energy SUBSTITUTE SHEET (RULE 26) operated switch 114 may be replaced by a subcutaneously implanted push button that is manually switched by the patient between "on" and"off".
[00272]
Alternatively, a permanent or rechargeable battery may be substituted for the energy-transforming devices 111A of the embodiments shown in FIGURES
38-49.
[00273] FIGURE
50 shows the energy-transforming device in the form of an electrical junction element 128 for use in any of the above embodiments according to FIGURES 37-49. The element 128 is a flat p-n junction element comprising a p-type semiconductor layer 129 and an n-type semiconductor layer 130 sandwiched together. A light bulb 131 is electrically connected to opposite sides of the element 128 to illustrate how the generated current is obtained. The output of current from such a p-n junction element 128 is correlated to the temperature. See the formula below.
I = 10 (exp(qVikT)-1) Where I is the external current flow, is the reverse saturation current, q is the fundamental electronic charge of 1.602 x 10-19 coulombs, V is the applied voltage, k is the Boltzmann constant, and T is the absolute temperature.
[00274] Under large negative applied voltage (reverse bias), the exponential term becomes negligible compared to 1.0, and I is approximately -10. 10 is strongly dependent on the temperature of the junction and hence on the intrinsic-carrier concentration. 10 is larger for materials with smaller bandgaps than for those with larger bandgaps. The rectifier action of the diode, that is, its restriction of current flow to only one direction, is in this particular embodiment the key to the operation of the p-n junction element 128.
[00275] The alternative way to design a p-n junction element is to deposit a thin layer of semiconductor onto a supporting material which does not absorb the kind of energy utilised in the respective embodiments. For use with wirelessly transmitted energy in terms of light waves, glass could be a suitable material. Various materials may be used in the semiconductor layers, such as, but not limited to, cadmium SUBSTITUTE SHEET (RULE 26) telluride, copper-indium-diselenide and silicon. It is also possible to use a multilayer structure with several layers of p and n-type materials to improve efficiency.
[00276] The electric energy generated by the p-n junction element 128 could be of the same type as generated by solar cells, in which the negative and positive fields create a direct current. Alternatively, the negative and positive semiconductor layers may change polarity following the transmitted waves, thereby generating the alternating current.
[00277] The p-n junction element 128 is designed to make it suited for implantation. Thus, all the external surfaces of the element 128 in contact with the human body are made of a biocompatible material. The p-n junction semiconductors are designed to operate optimally at a body temperature of 37 C because the current output, which should be more than 1 IAA, is significantly dependent upon such temperature, as shown above. Since both the skin and subcutis absorb energy, the relation between the sensitivity or working area of the element 128 and the intensity or strength of the wireless energy-transmission is considered. The p-n junction element 128 preferably is designed flat and small. Alternatively, if the element 128 is made in larger sizes it should be flexible, in order to adapt to the patient's body movements. The volume of the element 128 should be kept less than 2000 cm3.
[00278] FIGURE 51 shows basic parts of a remote control of the apparatus of the invention for controlling the constriction/stimulation unit 110. In this case, the stimulation device of the constriction/stimulation unit stimulates the wall portion with electric pulses. The remote control is based on wireless transmission of electromagnetic wave signals, often of high frequencies in the order of 100 kHz - 1 gHz, through the skin 132 of the patient. In FIGURE 51, all parts placed to the left of the skin 132 are located outside the patient's body and all parts placed to the right of the skin 132 are implanted.
[00279] An external signal-transmission device 133 is to be positioned close to a signal-receiving device 134 implanted close to the skin 132. As an alternative, the signal-receiving device 134 may be placed for example inside the abdomen of the patient. The signal-receiving device 134 comprises a coil, approximately 1-100 mm, preferably 25 mm in diameter, wound with a very thin wire and tuned with a capacitor to a specific high frequency. A small coil is chosen if it is to be implanted under the skin of the patient and a large coil is chosen if it is to be implanted in the abdomen of the patient. The signal transmission device 133 comprises a coil having about the SUBSTITUTE SHEET (RULE 26) same size as the coil of the signal-receiving device 134 but wound with a thick wire that can handle the larger currents that is necessary. The coil of the signal transmission device 133 is tuned to the same specific high frequency as the coil of the signal-receiving device 134.
[00280] The signal-transmission device 133 is adapted to send digital information via the power amplifier and signal-receiving device 134 to an implanted control unit 135. To avoid that accidental random high frequency fields trigger control commands, digital signal codes are used. A conventional keypad placed on the signal transmission device 133 is used to order the signal transmission device 133 to send digital signals for the control of the constriction/stimulation unit. The signal transmission device 133 starts a command by generating a high frequency signal.
After a short time, when the signal has energized the implanted parts of the control system, commands are sent to operate the constriction device of the constriction/stimulation unit 110 in predefined steps. The commands are sent as digital packets in the form illustrated below.
Start pattern, Command, Count, Checksum, 8 bits 8 bits 8 bits 8 bits [00281] The commands are sent continuously during a rather long time period (e.g., about 30 seconds or more). When a new constriction or release step is desired, the Count byte is increased by one to allow the implanted control unit 135 to decode and understand that another step is demanded by the signal transmission device 133. If any part of the digital packet is erroneous, its content is simply ignored.
[00282] Through a line 136, an implanted energizer unit 137 draws energy from the high frequency electromagnetic wave signals received by the signal-receiving device 134. The energizer unit 137 stores the energy in a source of energy, such as a large capacitor, powers the control unit 135 and powers the constriction/stimulation unit 110 via a line 138.
[00283] The control unit 135 comprises a demodulator and a microprocessor.
The demodulator demodulates digital signals sent from the signal transmission device 133. The microprocessor receives the digital packet, decodes it and sends a SUBSTITUTE SHEET (RULE 26) control signal via a signal line 139 to control the constriction device of the constriction/stimulation unit 110 to either constrict or release the wall portion of the patient's organ depending on the received command code.
[00284] FIGURE 52 shows a circuitry of an embodiment of the invention, in which wireless energy is transformed into a current. External components of the circuitry include a microprocessor 140, a signal generator 141 and a power amplifier 142 connected thereto. The microprocessor 140 is adapted to switch the signal generator 141 on/off and to modulate signals generated by the signal generator with digital commands. The power amplifier 142 amplifies the signals and sends them to an external signal-transmitting antenna coil 143. The antenna coil 143 is connected in parallel with a capacitor 144 to form a resonant circuit tuned to the frequency generated by the signal generator 141.
[00285] Implanted components of the circuitry include a signal receiving antenna coil 145 and a capacitor 146 forming together a resonant circuit that is tuned to the same frequency as the transmitting antenna coil 143. The signal receiving antenna coil 145 induces a current from the received high frequency electromagnetic waves and a rectifying diode 147 rectifies the induced current, which charges a storage capacitor 148. The storage capacitor 148 powers a motor 149 for driving the constriction device of the constriction/stimulation unit 110. A coil 150 connected between the antenna coil 145 and the diode 147 prevents the capacitor 148 and the diode 147 from loading the circuit of the signal-receiving antenna 145 at higher frequencies. Thus, the coil 150 makes it possible to charge the capacitor 148 and to transmit digital information using amplitude modulation.
[00286] A capacitor 151 and a resistor 152 connected in parallel and a diode 153 form a detector used to detect amplitude modulated digital information. A
filter circuit is formed by a resistor 154 connected in series with a resistor 155 connected in series with a capacitor 156 connected in series with the resistor 154 via ground, and a capacitor 157, one terminal of which is connected between the resistors 154,155 and the other terminal of which is connected between the diode 153 and the circuit formed by the capacitor 151 and resistor 152. The filter circuit is used to filter out undesired low and high frequencies. The detected and filtered signals are fed to an implanted microprocessor 158 that decodes the digital information and controls the motor 149 via an H-bridge 159 comprising transistors 160, 161, 162 and 163. The motor 149 can be driven in two opposite directions by the H-bridge 159.
SUBSTITUTE SHEET (RULE 26) [00287] The microprocessor 158 also monitors the amount of stored energy in the storage capacitor 148. Before sending signals to activate the motor 149, the microprocessor 158 checks whether the energy stored in the storage capacitor 148 is enough. If the stored energy is not enough to perform the requested operation, the microprocessor 158 waits for the received signals to charge the storage capacitor 148 before activating the motor 149.
[00288] Alternatively, the energy stored in the storage capacitor 148 may only be used for powering a switch, and the energy for powering the motor 149 may be obtained from another implanted energy source of relatively high capacity, for example a battery. In this case the switch is adapted to connect the battery to the motor 149 in an on mode when the switch is powered by the storage capacitor and to keep the battery disconnected from the motor 149 in a standby mode when the switch is not powered.
[00289] FIGURES 53A ¨ 53C show an embodiment of the invention, which is similar to the embodiment of FIGURE 2, except that the constriction/stimulation unit, here denoted by reference numeral 200, is provided with additional clamping elements. The embodiment of FIGURES 53A ¨ 53C is suited for actively moving the fluid and/or other bodily matter in the lumen of a patient's organ. Thus, the constriction/stimulation unit 200 also includes a first pair of short clamping elements 201 and 202, and a second pair of short clamping elements 203 and 204, wherein the first and second pairs of clamping elements are positioned at mutual sides of the elongate clamping elements 5, 6. The two short clamping elements 201, 202 of the first pair are radially movable towards and away from each other between retracted positions (FIGURE 53A) and clamping positions (FIGURES 53B and 530), and the two short clamping elements 203, 204 of the second pair are radially movable towards and away from each other between retracted positions (FIGURE 530) and clamping positions (FIGURES 53A and 53B). The stimulation device 3 also includes electrical elements 7 positioned on the short clamping elements 201 - 204, so that the electrical elements 7 on one of the short clamping elements 201 and 203, respectively, of each pair of short elements face the electrical elements 7 on the other short clamping element 202 and 204, respectively, of each pair of short elements.
[00290] The constriction/stimulation unit 200 is applied on a wall portion 8 of a tubular tissue wall of a patient's organ, so that the short clamping elements 201, 202 SUBSTITUTE SHEET (RULE 26) are positioned at an upstream end of the wall portion 8, whereas the short clamping elements 203, 204 202 are positioned at a downstream end of the wall portion 8. In FIGURES 53A to 53C the upstream end of the wall portion 8 is to the left and the downstream end of the wall portion 8 is to the right.
[00291] The control device 4 controls the pair of short clamping elements 202, the pair of elongate clamping elements 5, 6 and the pair of short elements 203, 204 to constrict and release the wall portion 8 independently of one another.
The control device also controls the electrical elements 7 on a clamping element that is constricting the wall portion to stimulate the constricted wall portion 8 with electric pulses to cause contraction of the wall portion 8, so that the lumen of the wall portion 8 is closed.
[00292] FIGURES 53A ¨ 53C illustrate how the control device 4 controls the operation of the constriction/stimulation unit 200 to cyclically move fluid and/or other bodily matter downstream in the lumen of the wall portion 8. Thus, in FIGURE
the short clamping elements 201, 202 and the elongate clamping elements 5, 6 are in their retracted positions, whereas the short clamping elements 203, 204 are in their clamping positions while the electrical elements 7 on elements 203, 204 electrically stimulate the wall portion 8. The electrical stimulation causes the wall portion 8 at the elements 203, 204 to thicken, whereby the lumen is closed. FIGURE 53B
illustrates how also the short clamping elements 201, 202 have been moved radially inwardly to their clamping positions, while the electrical elements 7 on elements 201, 202 electrically stimulate the wall portion 8, whereby a volume of bodily matter is trapped in the lumen between the upstream and downstream ends of the wall portion 8.
FIGURE 53C illustrates how initially the short clamping elements 203, 204 have been moved radially outwardly to their retracted positions, and then the elongate clamping elements 5, 6 have been moved radially inwardly to their clamping positions while the electrical elements 7 on elements 5, 6 electrically stimulate the wall portion 8. As a result, the bodily matter in the lumen between the upstream and downstream ends of the wall portion 8 has been moved downstream in the lumen Then, the control device 4 controls the constriction/stimulation unit 200 to assume the state shown in FIGURE
53A, whereby bodily matter may flow into and fill the lumen between the upstream and downstream ends of the wall portion 8, so that the cycle of the operation is completed.
SUBSTITUTE SHEET (RULE 26) [00293] Alternatively, the operation cycle of the constriction/stimulation unit 200 described above may be reversed, in order to move bodily matter upstream in the lumen. In this case, the control device 4 controls the short clamping elements 203, 204 to constrict the wall portion 8 at the downstream end thereof to restrict the flow in the lumen and controls the electric elements 7 to stimulate the constricted wall portion 8 with electric pulses at the downstream end to close the lumen. With the lumen closed at the downstream end of the constricted wall portion 8 and the short clamping elements 201, 202 in their retracted positions, as shown in FIGURE
53A, the control device 4 controls the elongate clamping elements 5, 6 to constrict the wall portion 8 between the upstream and downstream ends thereof. As a result, the fluid and/or other bodily matter contained in the wall portion 8 between the upstream and downstream ends thereof is moved upstream in the lumen.
[00294] Although FIGURES 53A ¨ 53C disclose pairs of clamping elements, it should be noted that it is conceivable to design the constriction/stimulation unit 200 with only a single short clamping element 201, a single elongate clamping element 5 and a single short clamping element 203. In this case the bottom of the tubular wall portion 8 is supported by stationary elements of the constriction/stimulation unit 200 opposite to the clamping elements 201, 5, and 203.
[00295] FIGURES 54A and 54B schematically show another embodiment of the invention, in which a constriction/stimulation unit 205 is designed for actively moving the fluid and/or other bodily matter in the lumen of a patient's tubular organ. The constriction device 206 of the constriction/stimulation unit 205 includes a rotor 207, which carries three cylindrical constriction elements 208A, 208B and 208C
positioned equidistantly from the axis 209 of the rotor 207. The constriction elements 208C may be designed as rollers. Each cylindrical element 208A-208C is provided with electrical elements 7. A stationary elongate support element 210 is positioned spaced from but close to the rotor 207 and has a part cylindrical surface 211 concentric with the axis 209 of the rotor 207. The constriction/stimulation unit 205 is applied on a patient's tubular organ 212, so that the organ 212 extends between the support element 210 and the rotor 207.
[00296] The control device 4 controls the rotor 207 of the constriction device to rotate, such that the constriction elements 208A-208C successively constrict wall portions of a series of wall portions of the tubular organ 212 against the elongate support element 210. The electrical elements 7 of the constriction elements SUBSTITUTE SHEET (RULE 26) 208C stimulate the constricted wall portions with electric pulses so that the wall portions thicken and close the lumen of the organ 212. FIGURE 54A illustrates how the constriction element 208A has started to constrict the wall of the organ 212 and how the lumen of the organ 212 is closed with the aid of the electrical elements 7 on the constriction element 208A, whereas the constriction element 208B is about to release the organ 212. FIGURE 54B illustrates how the constriction element has advanced about halfway along the elongate support element 210 and moved the bodily matter in the lumen in a direction indicated by an arrow. The constriction element 208B has released the organ 212, whereas the constriction element 208C
is about to engage the organ 212. Thus, the control device 4 controls the rotor 207 to cyclically move the constriction elements 208A-2080, one after the other, along the elongate support element 210, while constricting the wall portions of the organ 212, so that the bodily matter in the organ 212 is moved in a peristaltic manner.
[00297] FIGURES 55A, 55B and 55C show another mechanically operable constriction device 213 for use in the apparatus of the invention. Referring to FIGURE 55A, the constriction device 213 includes a first ring-shaped holder applied on a tubular organ 8 of a patient and a second ring-shaped holder 215 also applied on the organ 8 spaced apart from holder 214. There are elastic strings (here twelve strings) that extend in parallel along the tubular organ 8 and interconnect the two holders 213, 214 without contacting the organ 8. FIGURE
illustrate an inactivated state of the constriction device 213 in which the organ 8 is not constricted.
[00298] Referring to FIGURES 55B and 55C, when organ 8 is to be constricted the ring-shaped holders 213 and 214 are rotated by an operation means (not shown) in opposite directions, whereby the elastic strings 216 constrict the organ 8 in a manner that appears from FIGURES 55B and 55C. For the sake of clarity, only five strings 216 are shown in FIGURE 55B.
[00299] In accordance with the present invention, electrodes for electrically stimulating the organ 8 to cause contraction of the wall of the organ 8 are attached to the strings 216 (not shown in FIGURES 55A-55C).
[00300] FIGURE 56 schematically illustrates an arrangement of the apparatus that is capable of sending information from inside the patient's body to the outside thereof to give information related to at least one functional parameter of the apparatus, and/or related to a physical parameter of the patient, in order to supply an SUBSTITUTE SHEET (RULE 26) accurate amount of energy to an implanted internal energy receiver 302 connected to energy consuming components of an implanted constriction/stimulation unit 301 of the apparatus of the invention. Such an energy receiver 302 may include a source of energy and/or an energy-transforming device. Briefly described, wireless energy is transmitted from an external source of energy 304a located outside the patient and is received by the internal energy receiver 302 located inside the patient. The internal energy receiver is adapted to directly or indirectly supply received energy to the energy consuming components of the constriction/stimulation unit 301 via a switch 326. An energy balance is determined between the energy received by the internal energy receiver 302 and the energy used for the constriction/stimulation unit 301, and the transmission of wireless energy is then controlled based on the determined energy balance. The energy balance thus provides an accurate indication of the correct amount of energy needed, which is sufficient to operate the constriction/stimulation unit 301 properly, but without causing undue temperature rise.
[00301] In FIGURE 56 the patient's skin is indicated by a vertical line 305. Here, the energy receiver comprises an energy-transforming device 302 located inside the patient, preferably just beneath the patient's skin 305. Generally speaking, the implanted energy-transforming device 302 may be placed in the abdomen, thorax, muscle fascia (e.g. in the abdominal wall), subcutaneously, or at any other suitable location. The implanted energy-transforming device 302 is adapted to receive wireless energy E transmitted from the external source of energy 304a provided in an external energy-transmission device 304 located outside the patient's skin 305 in the vicinity of the implanted energy-transforming device 302.
[00302] As is well known in the art, the wireless energy E may generally be transferred by means of any suitable Transcutaneous Energy Transfer (TET) device, such as a device including a primary coil arranged in the external source of energy 304a and an adjacent secondary coil arranged in the implanted energy-transforming device 302. When an electric current is fed through the primary coil, energy in the form of a voltage is induced in the secondary coil which can be used to power the implanted energy consuming components of the apparatus, e.g. after storing the incoming energy in an implanted source of energy, such as a rechargeable battery or a capacitor. However, the present invention is generally not limited to any particular SUBSTITUTE SHEET (RULE 26) energy transfer technique, TET devices or energy sources, and any kind of wireless energy may be used.
[00303] The amount of energy received by the implanted energy receiver may be compared with the energy used by the implanted components of the apparatus.
The term "energy used" is then understood to include also energy stored by implanted components of the apparatus. A control device includes an external control unit 304b that controls the external source of energy 304a based on the determined energy balance to regulate the amount of transferred energy. In order to transfer the correct amount of energy, the energy balance and the required amount of energy is determined by means of a determination device including an implanted internal control unit 315 connected between the switch 326 and the constriction/stimulation unit 301. The internal control unit 315 may thus be arranged to receive various measurements obtained by suitable sensors or the like, not shown, measuring certain characteristics of the constriction/stimulation unit 301, somehow reflecting the required amount of energy needed for proper operation of the constriction/stimulation unit 301. Moreover, the current condition of the patient may also be detected by means of suitable measuring devices or sensors, in order to provide parameters reflecting the patient's condition. Hence, such characteristics and/or parameters may be related to the current state of the constriction/stimulation unit 301, such as power consumption, operational mode and temperature, as well as the patient's condition reflected by parametyers such as: body temperature, blood pressure, heartbeats and breathing. Other kinds of physical parameters of the patient and functional parameters of the device are described elsewhere.
00304] Furthermore, a source of energy in the form of an accumulator 316 may optionally be connected to the implanted energy-transforming device 302 via the control unit 315 for accumulating received energy for later use by the constriction/stimulation unit 301. Alternatively or additionally, characteristics of such an accumulator, also reflecting the required amount of energy, may be measured as well. The accumulator may be replaced by a rechargeable battery, and the measured characteristics may be related to the current state of the battery, any electrical parameter such as energy consumption voltage, temperature, etc. In order to provide sufficient voltage and current to the constriction/stimulation unit 301, and also to avoid excessive heating, it is clearly understood that the battery should be charged optimally by receiving a correct amount of energy from the implanted energy-SUBSTITUTE SHEET (RULE 26) transforming device 302, i.e. not too little or too much. The accumulator may also be a capacitor with corresponding characteristics.
[00306] For example, battery characteristics may be measured on a regular basis to determine the current state of the battery, which then may be stored as state information in a suitable storage means in the internal control unit 315.
Thus, whenever new measurements are made, the stored battery state information can be updated accordingly. In this way, the state of the battery can be "calibrated"
by transferring a correct amount of energy, so as to maintain the battery in an optimal condition.
[00306] Thus, the internal control unit 315 of the determination device is adapted to determine the energy balance and/or the currently required amount of energy, (either energy per time unit or accumulated energy) based on measurements made by the above-mentioned sensors or measuring devices of the apparatus, or the patient, or an implanted source of energy if used, or any combination thereof.
The internal control unit 315 is further connected to an internal signal transmitter 327, arranged to transmit a control signal reflecting the determined required amount of energy, to an external signal receiver 304c connected to the external control unit 304b. The amount of energy transmitted from the external source of energy 304a may then be regulated in response to the received control signal.
[00307] Alternatively, the determination device may include the external control unit 304b. In this alternative, sensor measurements can be transmitted directly to the external control unit 304b wherein the energy balance and/or the currently required amount of energy can be determined by the external control unit 304b, thus integrating the above-described function of the internal control unit 315 in the external control unit 304b. In that case, the internal control unit 315 can be omitted and the sensor measurements are supplied directly to the internal signal transmitter which sends the measurements over to the external signal receiver 304c and the external control unit 304b. The energy balance and the currently required amount of energy can then be determined by the external control unit 304b based on those sensor measurements.
[00308] Hence, the present solution according to the arrangement of FIGURE
56 employs the feed back of information indicating the required energy, which is more efficient than previous s'olutions because it is based on the actual use of energy that is compared to the received energy, e.g. with respect to the amount of energy, SUBSTITUTE SHEET (RULE 26) the energy difference, or the energy receiving rate as compared to the energy rate used by implanted energy consuming components of the apparatus. The apparatus may use the received energy either for consuming or for storing the energy in an implanted source of energy or the like. The different parameters discussed above would thus be used if relevant and needed and then as a tool for determining the actual energy balance. However, such parameters may also be needed per se for any actions taken internally to specifically operate the apparatus.
[00309] The internal signal transmitter 327 and the external signal receiver 304c may be implemented as separate units using suitable signal transfer means, such as radio, IR (Infrared) or ultrasonic signals. Alternatively, the internal signal transmitter 327 and the external signal receiver 304c may be integrated in the implanted energy-transforming device 302 and the external source of energy 304a, respectively, so as to convey control signals in a reverse direction relative to the energy transfer, basically using the same transmission technique. The control signals may be modulated with respect to frequency, phase or amplitude.
[00310] Thus, the feedback information may be transferred either by a separate communication system including receivers and transmitters or may be integrated in the energy system. In accordance with the present invention, such an integrated information feedback and energy system comprises an implantable internal energy receiver for receiving wireless energy, the energy receiver having an internal first coil and a first electronic circuit connected to the first coil, and an external energy transmitter for transmitting wireless energy, the energy transmitter having an external second coil and a second electronic circuit connected to the second coil. The external second coil of the energy transmitter transmits wireless energy which is received by the first coil of the energy receiver. This system further comprises a power switch for switching the connection of the internal first coil to the first electronic circuit on and off, such that feedback information related to the charging of the first coil is received by the external energy transmitter in the form of an impedance variation in the load of the external second coil, when the power switch switches the connection of the internal first coil to the first electronic circuit on and off. In implementing this system in the arrangement of Fig. 17, the switch 326 is either separate and controlled by the internal control unit 315, or integrated in the internal control unit 315. It should be understood that the switch 326 should be interpreted in its broadest embodiment.
SUBSTITUTE SHEET (RULE 26) This means a transistor, MCU, MCPU, ASIC FPGA or a DA converter or any other electronic component or circuit that may switch the power on and off.
[00311] To conclude, the energy supply arrangement illustrated in FIGURE 56 may operate basically in the following manner. The energy balance is first determined by the internal control unit 315 of the determination device. A control signal reflecting the required amount of energy is also created by the internal control unit 315, and the control signal is transmitted from the internal signal transmitter 327 to the external signal receiver 304c. Alternatively, the energy balance can be determined by the external control unit 304b instead depending on the implementation, as mentioned above. In that case, the control signal may carry measurement results from various sensors. The amount of energy emitted from the external source of energy 304a can then be regulated by the external control unit 304b, based on the determined energy balance, e.g. in response to the received control signal. This process may be repeated intermittently at certain intervals during ongoing energy transfer, or may be executed on a more or less continuous basis during the energy transfer.
[00312] The amount of transferred energy can generally be regulated by adjusting various transmission parameters in the external source of energy 304a, such as voltage, current, amplitude, wave frequency and pulse characteristics.This system may also be used to obtain information about the coupling factors between the coils in a TET system even to calibrate the system both to find an optimal place for the external coil in relation to the internal coil and to optimize energy transfer.
Simply comparing in this case the amount of energy transferred with the amount of energy received. For example if the external coil is moved the coupling factor may vary and correctly displayed movements could cause the external coil to find the optimal place for energy transfer. Preferably, the external coil is adapted to calibrate the amount of transferred energy to achieve the feedback information in the determination device, before the coupling factor is maximized.
[00313] This coupling factor information may also be used as a feedback during energy transfer. In such a case, the energy system of the present invention comprises an implantable internal energy receiver for receiving wireless energy, the energy receiver having an internal first coil and a first electronic circuit connected to the first coil, and an external energy transmitter for transmitting wireless energy, the energy transmitter having an external second coil and a second electronic circuit connected to the second coil. The external second coil of the energy transmitter SUBSTITUTE SHEET (RULE 26) transmits wireless energy which is received by the first coil of the energy receiver.
This system further comprises a feedback device for communicating out the amount of energy received in the first coil as a feedback information, and wherein the second electronic circuit includes a determination device for receiving the feedback information and for comparing the amount of transferred energy by the second coil with the feedback information related to the amount of energy received in the first coil to obtain the coupling factor between the first and second coils. The energy transmitter may regulate the transmitted energy in response to the obtained coupling factor.
[00314] With reference to FIGURE 57, although wireless transfer of energy for operating the apparatus has been described above to enable non-invasive operation, it will be appreciated that the apparatus can be operated with wire bound energy as well. Such an example is shown in FIGURE 57, wherein an external switch 326 is interconnected between the external source of energy 304a and an operation device, such as an electric motor 307 operating the constriction/stimulation unit 301.
An external control unit 304b controls the operation of the external switch 326 to effect proper operation of the constriction/stimulation unit 301.
[00315] FIGURE 58 illustrates different embodiments for how received energy can be supplied to and used by the constriction/stimulation unit 301. Similar to the example of FIGURE 56, an internal energy receiver 302 receives wireless energy E
from an external source of energy 304a which is controlled by a transmission control unit 304b. The internal energy receiver 302 may comprise a constant voltage circuit, indicated as a dashed box "constant V" in FIGURE 58, for supplying energy at constant voltage to the constriction/stimulation unit 301. The internal energy receiver 302 may further comprise a constant current circuit, indicated as a dashed box "constant C" in the figure, for supplying energy at constant current to the constriction/stimulation unit 301.
[00316] The constriction/stimulation unit 301 comprises an energy consuming part 301a, which may be a motor, pump, restriction device, or any other medical appliance that requires energy for its electrical operation. The constriction/stimulation unit 301 may further comprise an energy storage device 301b for storing energy supplied from the internal energy receiver 302. Thus, the supplied energy may be directly consumed by the energy consuming part 301a, or stored by the energy storage device 301b, or the supplied energy may be partly consumed and partly SUBSTITUTE SHEET (RULE 26) stored. The constriction/stimulation unit 301 may further comprise an energy stabilizing unit 301c for stabilizing the energy supplied from the internal energy receiver 302. Thus, the energy may be supplied in a fluctuating manner such that it may be necessary to stabilize the energy before consumed or stored.
[00317] The energy supplied from the internal energy receiver 302 may further be accumulated and/or stabilized by a separate energy stabilizing unit 328 located outside the constriction/stimulation unit 301, before being consumed and/or stored by the constriction/stimulation unit 301. Alternatively, the energy stabilizing unit 328 may be integrated in the internal energy receiver 302. In either case, the energy stabilizing unit 328 may comprise a constant voltage circuit and/or a constant current circuit.
[00318] It should be noted that FIGURE 56 and FIGURE 58 illustrate some possible but non-limiting implementation options regarding how the various shown functional components and elements can be arranged and connected to each other.
However, the skilled person will readily appreciate that many variations and modifications can be made within the scope of the present invention.
[00319] FIGURE 59 schematically shows an energy balance measuring circuit of one of the proposed designs of the apparatus for controlling transmission of wireless energy, or energy balance. The circuit has an output signal centered on 2.5V
and proportionally related to the energy imbalance. The derivative of this signal shows if the value goes up and down and how fast such a change takes place. If the amount of received energy is lower than the energy used by implanted components of the apparatus, more energy is transferred and thus charged into the source of energy. The output signal from the circuit is typically fed to an ND converter and converted into a digital format. The digital information can then be sent to the external energy-transmission device allowing it to adjust the level of the transmitted energy.
Another possibility is to have a completely analog system that uses comparators comparing the energy balance level with certain maximum and minimum thresholds sending information to external energy-transmission device if the balance drifts out of the max/min window.
[00320] The schematic FIGURE 59 shows a circuit implementation for a system that transfers energy to the implanted energy components of the apparatus of the present invention from outside of the patient's body using inductive energy transfer.
An inductive energy transfer system typically uses an external transmitting coil and SUBSTITUTE SHEET (RULE 26) an internal receiving coil. The receiving coil, L1, is included in the schematic FIGURE
59; the transmitting parts of the system are excluded.
[00321] The implementation of the general concept of energy balance and the way the information is transmitted to the external energy transmitter can of course be implemented in numerous different ways. The schematic FIGURE 20 and the above described method of evaluating and transmitting the information should only be regarded as examples of how to implement the control system.
CIRCUIT DETAILS
[00322] In FIGURE 59 the symbols Y1, Y2, Y3 and so on symbolize test points within the circuit. The components in the diagram and their respective values are values that work in this particular implementation which of course is only one of an infinite number of possible design solutions.
[00323] Energy to power the circuit is received by the energy receiving coil L1.
Energy to implanted components is transmitted in this particular case at a frequency of 25 kHz. The energy balance output signal is present at test point Yl.
[00324] The embodiments described in connection with FIGURES 56, 58 and 59 identify a general method for controlling transmission of wireless energy to implanted energy consuming components of the apparatus of the present invention.
Such a method will be defined in general terms in the following.
[00325] A method is thus provided for controlling transmission of wireless energy supplied to implanted energy consuming components of an apparatus as described above. The wireless energy E is transmitted from an external source of energy located outside the patient and is received by an internal energy receiver located inside the patient, the internal energy receiver being connected to the implanted energy consuming components of the apparatus for directly or indirectly supplying received energy thereto. An energy balance is determined between the energy received by the internal energy receiver and the energy used for the operation of the implanted parts of the apparatus. The transmission of wireless energy E
from the external source of energy is then controlled based on the determined energy balance.
[00326] The wireless energy may be transmitted inductively from a primary coil in the external source of energy to a secondary coil in the internal energy receiver. A
SUBSTITUTE SHEET (RULE 26) change in the energy balance may be detected to control the transmission of wireless energy based on the detected energy balance change. A difference may also be detected between energy received by the internal energy receiver and energy used for the operation of the implanted parts of the apparatus, to control the transmission of wireless energy based on the detected energy difference.
[00327] When controlling the energy transmission, the amount of transmitted wireless energy may be decreased if the detected energy balance change implies that the energy balance is increasing, or vice versa. The decrease/increase of energy transmission may further correspond to a detected change rate.
[00328] The amount of transmitted wireless energy may further be decreased if the detected energy difference implies that the received energy is greater than the used energy, or vice versa. The decrease/increase of energy transmission may then correspond to the magnitude of the detected energy difference.
[00329] As mentioned above, the energy used for the operation of the implanted parts of the apparatus be consumed to operate the implanted parts of the apparatus and/or stored in at least one implanted energy storage device of the apparatus.
[00330] When electrical and/or physical parameters of the implanted parts of the apparatus and/or physical parameters of the patient are determined, the energy may be transmitted for consumption and storage according to a transmission rate per time unit which is determined based on said parameters. The total amount of transmitted energy may also be determined based on said parameters.
[00331] When a difference is detected between the total amount of energy received by the internal energy receiver and the total amount of consumed and/or stored energy, and the detected difference is related to the integral over time of at least one measured electrical parameter related to said energy balance, the integral may be determined for a monitored voltage and/or current related to the energy balance.
[00332] When the derivative is determined over time of a measured electrical parameter related to the amount of consumed and/or stored energy, the derivative may be determined for a monitored voltage and/or current related to the energy balance.
[00333] The transmission of wireless energy from the external source of energy may be controlled by applying to the external source of energy electrical pulses from a first electric circuit to transmit the wireless energy, the electrical pulses having SUBSTITUTE SHEET (RULE 26) leading and trailing edges, varying the lengths of first time intervals between successive leading and trailing edges of the electrical pulses and/or the lengths of second time intervals between successive trailing and leading edges of the electrical pulses, and transmitting wireless energy, the transmitted energy generated from the electrical pulses having a varied power, the varying of the power depending on the lengths of the first and/or second time intervals.
[00334] In that case, the frequency of the electrical pulses may be substantially constant when varying the first and/or second time intervals. When applying electrical pulses, the electrical pulses may remain unchanged, except for varying the first and/or second time intervals. The amplitude of the electrical pulses may be substantially constant when varying the first and/or second time intervals.
Further, the electrical pulses may be varied by only varying the lengths of first time intervals between successive leading and trailing edges of the electrical pulses.
[00335] A train of two or more electrical pulses may be supplied in a row, wherein when applying the train of pulses, the train having a first electrical pulse at the start of the pulse train and having a second electrical pulse at the end of the pulse train, two or more pulse trains may be supplied in a row, wherein the lengths of the second time intervals between successive trailing edge of the second electrical pulse in a first pulse train and leading edge of the first electrical pulse of a second pulse train are varied [00336] When applying the electrical pulses, the electrical pulses may have a substantially constant current and a substantially constant voltage. The electrical pulses may also have a substantially constant current and a substantially constant voltage. Further, the electrical pulses may also have a substantially constant frequency. The electrical pulses within a pulse train may likewise have a substantially constant frequency.
[00337] The circuit formed by the first electric circuit and the external source of energy may have a first characteristic time period or first time constant, and when effectively varying the transmitted energy, such frequency time period may be in the range of the first characteristic time period or time constant or shorter.
[00338] The embodiments described in connection with FIGURES 56, 58 and 59 also identify general features for controlling transmission of wireless energy to implanted energy consuming components of the apparatus of the present invention.
Such features of the apparatus will be defined in general terms in the following.
SUBSTITUTE SHEET (RULE 26) [00339] In its broadest sense, the apparatus comprises a control device for controlling the transmission of wireless energy from an energy-transmission device, and an implantable internal energy receiver for receiving the transmitted wireless energy, the internal energy receiver being connected to implantable energy consuming components of the apparatus for directly or indirectly supplying received energy thereto. The apparatus further comprises a determination device adapted to determine an energy balance between the energy received by the internal energy receiver and the energy used for the implantable energy consuming components of the apparatus, wherein the control device controls the transmission of wireless energy from the external energy-transmission device, based on the energy balance determined by the determination device.
[00340] Further, the apparatus of the invention may comprise any of the following features:
[00341] - A primary coil in the external source of energy adapted to transmit the wireless energy inductively to a secondary coil in the internal energy receiver.
[00342] - The determination device is adapted to detect a change in the energy balance, and the control device controls the transmission of wireless energy based on the detected energy balance change.
[00343] - The determination device is adapted to detect a difference between energy received by the internal energy receiver and energy used for the implantable energy consuming components of the apparatus, and the control device controls the transmission of wireless energy based on the detected energy difference.
[00344] - The control device controls the external energy-transmission device to decrease the amount of transmitted wireless energy if the detected energy balance change implies that the energy balance is increasing, or vice versa, wherein the decrease/increase of energy transmission corresponds to a detected change rate.
[00345] - The control device controls the external energy-transmission device to decrease the amount of transmitted wireless energy if the detected energy difference implies that the received energy is greater than the used energy, or vice versa, wherein the decrease/increase of energy transmission corresponds to the magnitude of said detected energy difference.
[00346] - The energy used for implanted parts of the apparatus is consumed to operate the implanted parts, and/or stored in at least one energy storage device of the apparatus.
SUBSTITUTE SHEET (RULE 26) [00347] - Where electrical and/or physical parameters of the apparatus and/or physical parameters of the patient are determined, the energy-transmission device transmits the energy for consumption and storage according to a transmission rate per time unit which is determined by the determination device based on said parameters. The determination device also determines the total amount of transmitted energy based on said parameters.
[00348] - When a difference is detected between the total amount of energy received by the internal energy receiver and the total amount of consumed and/or stored energy, and the detected difference is related to the integral over time of at least one measured electrical parameter related to the energy balance, the determination device determines the integral for a monitored voltage and/or current related to the energy balance.
[00349] - When the derivative is determined over time of a measured electrical parameter related to the amount of consumed and/or stored energy, the determination device determines the derivative for a monitored voltage and/or current related to the energy balance.
[00350] - The energy-transmission device comprises a coil placed externally to the human body, and an electric circuit is provided to power the external coil with electrical pulses to transmit the wireless energy. The electrical pulses have leading and trailing edges, and the electric circuit is adapted to vary first time intervals between successive leading and trailing edges and/or second time intervals between successive trailing and leading edges of the electrical pulses to vary the power of the transmitted wireless energy. As a result, the energy receiver receiving the transmitted wireless energy has a varied power.
[00351] - The electric circuit is adapted to deliver the electrical pulses to remain unchanged except varying the first and/or second time intervals.
[00352] - The electric circuit has a time constant and is adapted to vary the first and second time intervals only in the range of the first time constant, so that when the lengths of the first and/or second time intervals are varied, the transmitted power over the coil is varied.
[00353] - The electric circuit is adapted to deliver the electrical pulses to be varied by only varying the lengths of first time intervals between successive leading and trailing edges of the electrical pulses.
SUBSTITUTE SHEET (RULE 26) . 81596208 [00354] - The electric circuit is adapted to supplying a train of two or more electrical pulses in a row, said train having a first electrical pulse at the start of the pulse train and having a second electrical pulse at the end of the pulse train, and [00355] - the lengths of the second time intervals between successive trailing edge of the second electrical pulse in a first pulse train and leading edge of the first electrical pulse of a second pulse train are varied by the first electronic circuit.
[00356] - The electric circuit is adapted to provide the electrical pulses as pulses having a substantially constant height and/or amplitude and/or intensity and/or voltage and/or current and/or frequency.
[00357] - The electric circuit has a time constant, and is adapted to vary the first and second time intervals only in the range of the first time constant, so that when the lengths of the first and/or second time intervals are varied, the transmitted power over the first coil are varied.
[00358] - The electric circuit is adapted to provide the electrical pulses varying the lengths of the first and/or the second time intervals only within a range that includes the first time constant or that is located relatively close to the first time constant, compared to the magnitude of the first time constant.
[00359] While the invention has been described in connection with what is presently considered to be the most practical and preferred embodiment, it is to be understood that the invention is not to be limited to the disclosed embodiment, but on the contrary, is intended to cover various modifications and equivalent arrangements included within the scope of the appended claims.
[0051]The various solutions described above under the headline: "Flow restriction" to stop the flow in the lumen of the organ may also be used in any of the above noted embodiments (1 a), (lb), (4a), (5), (6), (6a) and (6b).
Stimulation [0052]When stimulating neural or muscular tissue there is a risk of injuring or deteriorating the tissue over time, if the stimulation is not properly performed. The apparatus of the present invention is designed to reduce or even eliminate that risk.
Thus, in accordance with the present invention, the control device controls the stimulation device to intermittently stimulate different areas of the wall portion of the organ, such that at least two of the areas are stimulated at different points of time that is, the stimulation is shifted from one area to another area over time. In addition, the control device controls the stimulation device, such that an area of the different areas that currently is not stimulated has time to restore substantially normal blood circulation before the stimulation device stimulates the area again.
Furthermore, the control device controls the stimulation device to stimulate each area during successive time periods, wherein each time period is short enough to maintain satisfactory blood circulation in the area until the lapse of the time period.
This gives the advantage that the apparatus of the present invention enables continuous stimulation of the wall portion of the organ to achieve the desired flow control, while essentially maintaining over time the natural physical properties of the organ without risking injuring the organ.
[0053]Also, by physically changing the places of stimulation on the organ over time as described above it is possible to create an advantageous changing stimulation pattern on the organ, in order to achieve a desired flow control.
[0054]The control device may control the stimulation device to stimulate one or more of the areas of the wall portion at a time, for example by sequentially stimulating the different areas. Furthermore, the control device may control the stimulation device to SUBSTITUTE SHEET (RULE 26) cyclically propagate the stimulation of the areas along the wall portion, preferably in accordance with a determined stimulation pattern. To achieve the desired reaction of the tissue wall during the stimulation thereof, the control device may control the stimulation device to, preferably cyclically, vary the intensity of the stimulation of the wall portion.
[0055]In a preferred embodiment of the invention, the control device controls the stimulation device to intermittently stimulate the areas of the wall portion with pulses that preferably form pulse trains. At least a first area and a second area of the areas of the wall portion may be repeatedly stimulated with a first pulse train and a second pulse train, respectively, such that the first and second pulse trains over time are shifted relative to each other. For example, the first area may be stimulated with the first pulse train, while the second area is not stimulated with said second pulse train, and vice versa. Alternatively, the first and second pulse trains may be shifted relative to each other, such that the first and second pulse trains at least partially overlap each other.
[0056]The pulse trains can be configured in many different ways. Thus, the control device may control the stimulation device to vary the amplitudes of the pulses of the pulse trains, the duty cycle of the individual pulses of each pulse train, the width of each pulse of the pulse trains, the length of each pulse train, the repetition frequency of the pulses of the pulse trains, the repetition frequency of the pulse trains, the number of pulses of each pulse train, and/or the off time periods between the pulse trains. Several pulse trains of different configurations may be employed to achieve the desired effect.
[0057] In case the control device controls the stimulation device to vary the off time periods between pulse trains that stimulate the respective area of the wall portion, it is also possible to control each off time period between pulse trains to last long enough to restore substantially normal blood circulation in the area when the latter is not stimulated during the off time periods.
Electric Stimulation [0058]In accordance with a preferred embodiment of the invention, the stimulation device is an electrically powered stimulation device that electrically stimulates the tissue wall portion of the patient's bodily organ, preferably with electric pulses. This SUBSTITUTE SHEET (RULE 26) embodiment is particularly suited for applications in which the wall portion includes muscle fibers that react to electrical stimula. In this embodiment, the control device controls the stimulation device to stimulate the wall portion with electric pulses preferably in the form of electric pulse trains, when the wall portion is in the constricted state, to cause contraction of the wall portion. Of course, the configuration of the electric pulse trains may be similar to the above described pulse trains and the control device may control the stimulation device to electrically stimulate the different areas of the wall of the organ in the same manner as described above.
[0059]The electric stimulation device suitably comprises at least one, preferably a plurality of electrical elements, such as electrodes, for engaging and stimulating the wall portion with electric pulses. Optionally, the electrical elements may be placed in a fixed orientation relative to one another. The control device controls the electric stimulation device to electrically energize the electrical elements, one at a time, or groups of electrical elements at a time. Preferably, the control device controls the electric stimulation device to cyclically energize each element with electric pulses.
Optionally, the control device may control the stimulation device to energize the electrical elements, such that the electrical elements are energized one at a time in sequence, or such that a number or groups of the electrical elements are energized at the same time. Also, groups of electrical elements may be sequentially energized, either randomly or in accordance with a predetermined pattern.
[0060]The electrical elements may form any pattern of electrical elements.
Preferably, the electrical elements form an elongate pattern of electrical elements, wherein the electrical elements are applicable on the patient's wall of the organ, such that the elongate pattern of electrical elements extends lengthwise along the wall of the organ, and the elements abut the respective areas of the wall portion. The elongate pattern of electrical elements may include one or more rows of electrical elements extending lengthwise along the wall of the organ. Each row of electrical elements may form a straight, helical or zig-zag path of electrical elements, or any form of path. The control device may control the stimulation device to successively energize the electrical elements longitudinally along the elongate pattern of electrical elements in a direction opposite to, or in the same direction as that of, the flow in the patient's lumen.
[0061]Optionally, the control device may control the stimulation device to successively energize the electrical elements from a position substantially at the SUBSTITUTE SHEET (RULE 26) center of the constricted wall portion towards both ends of the elongate pattern of electrical elements. Where the lumen of the organ is to be kept closed for a relatively long time, the control device may control the stimulation device to energize the electrical elements, such that energized electrical elements form two waves of energized electrical elements that simultaneously advance from the center of the constricted wall portion in two opposite directions towards both ends of the elongate pattern of electrical elements. Such waves of energized electrical elements can be repeated over and over again without harming the organ and without moving fluid or gas in any direction in the lumen of the organ.
[0062]The control device suitably controls the stimulation device to energize the electrical elements, such that the electrical elements currently energized form at least one group of adjacent energized electrical elements. In accordance with a first alternative, the elements in the group of energized electrical elements form one path of energized electrical elements. The path of energized electrical elements may extend at least in part around the patient's organ. In a second alternative, the elements of the group of energized electrical elements may form two paths of energized electrical elements extending on mutual sides of the patient's organ, preferably substantially transverse to the flow direction in the lumen of the organ. In a third alternative, the elements of the group of energized electrical elements may form more than two paths of energized electrical elements extending on different sides of the patient's organ, preferably substantially transverse to the flow direction in the patient's lumen.
[0063] In accordance with a preferred embodiment of the invention, the electrical elements form a plurality of groups of elements, wherein the groups form a series of groups extending along the patient's organ in the flow direction in the patient's lumen.
The electrical elements of each group of electrical elements may form a path of elements extending at least in part around the patient's organ. In a first alternative, the electrical elements of each group of electrical elements may form more than two paths of elements extending on different sides of the patient's organ, preferably substantially transverse to the flow direction in the patient's lumen. The control device may control the stimulation device to energize the groups of electrical elements in the series of groups in random, or in accordance with a predetermined pattern.
Alternatively, the control device may control the stimulation device to successively energize the groups of electrical elements in the series of groups in a direction SUBSTITUTE SHEET (RULE 26) opposite to, or in the same direction as that of, the flow in the patient's lumen, or in both said directions starting from a position substantially at the center of the constricted wall portion. For example, groups of energized electrical elements may form advancing waves of energized electrical elements, as described above;
that is, the control device may control the stimulation device to energize the groups of electrical elements, such that energized electrical elements form two waves of energized electrical elements that simultaneously advance from the center of the constricted wall portion in two opposite directions towards both ends of the elongate pattern of electrical elements.
[0064]A structure may be provided for holding the electrical elements in a fixed orientation. Although the structure may be separate from the constriction device, it is preferable that the structure is integrated in the constriction device, which is a practical design and facilitates implantation of the constriction and stimulation devices. Where the electrical elements form an elongate pattern of electrical elements, the structure may be applicable on the patient's organ such that the elongate pattern of electrical elements extends along the organ in the same direction as that of the flow in the patient's lumen and the elements abut the respective areas of the wall portion of the organ.
Thermal stimulation [0065]In another embodiment of the invention, the stimulation device thermally stimulates the wall portion of the organ. Thus, the control device may control the stimulation device to cool the wall portion, when the wall portion is constricted, to =
cause contraction of the wall portion. For example, the constriction device may constrict the wall portion to at least restrict the flow in the lumen, and the control device may control the stimulation device to cool the constricted wall portion to cause contraction thereof, such that the flow in the lumen is at least further restricted, or further restricted but not stopped, or stopped. Alternatively, the control device may control the stimulation device to heat the wall portion, when the wall portion is constricted and contracted, to cause expansion of the wall portion. Where the wall portion includes a blood vessel, the control device may control the stimulation device to cool the blood vessel to cause contraction thereof, or heat the blood vessel to cause expansion thereof. Where applicable, thermal stimulation may be practised in SUBSTITUTE SHEET (RULE 26) any of the embodiments of the present invention, and the thermal stimulation may be controlled in response to various sensors, for example strain, motion or pressure sensors.
Sensor Controlled Constriction and/or Stimulation Device [0066]As mentioned above, the apparatus may comprise at least one implantable sensor, wherein the control device controls the constriction device and/or the stimulation device in response to signals from the sensor. Generally, the sensor directly or indirectly senses at least one physical parameter of the patient, or at least one functional parameter of the apparatus, or at least one functional parameter of a medical implant in the patient.
[0067] Many different kinds of sensor for sensing physical parameters may be used.
For example motion sensors for sensing organ motion, i.e. natural contractions, such as stomach or intestinal contractions, pressure sensors for sensing pressure in the organ, strain sensors for sensing strain of the organ, flow sensors for sensing fluid flow in the lumen of the organ, spectro-photometrical sensors, Ph-sensors for sensing acidity or alkalinity of the fluid in the lumen of the organ, oxygen-sensors sensors for sensing the oxygen content of the fluid in the lumen of the organ, or sensors for sensing the distribution of the stimulation on the stimulated organ. Any conceivable sensors for sensing any other kind of useful physical parameter may be used.
[0068]Many different kinds of sensors that sense functional parameters of the apparatus may also be used for the control of the constriction device and/or the stimulation device. For example sensors for sensing electric parameters of implanted electric components of the apparatus, or sensors for sensing the performance of implanted motors of the apparatus.
[0069]The sensor may comprise a pressure sensor for sensing as the physical parameter a pressure in the patient's body that relates to the pressure in the lumen of the patient's bodily organ, wherein the control device controls the constriction device and/or stimulation device to change the constriction of the patient's wall portion in response to the pressure sensor sensing a predetermined value of measured pressure.
SUBSTITUTE SHEET (RULE 26) [00701Alternatively, or in combination with the pressure sensor, a position sensor may be provided for sensing as the physical parameter the orientation of the patient with respect to the horizontal. The position sensor may be a biocompatible version of what is shown in U.S. patents 4 942 668 and 5 900 909. For example, the control device may control the constriction device and/or stimulation device to change the constriction of the patient's wall portion in response to the position sensor sensing that the patient has assumed a substantially horizontal orientation, i.e. that the patient is lying down.
[0071]The above described sensors may be used in any of the embodiments of the invention, where applicable.
[0072]The control device may control the constriction device and/or stimulation device to change the constriction of the patient's wall portion in response to the time of day. For that purpose the control device may include a clock mechanism for controlling the constriction device and/or stimulation device to change the constriction of the patient's wall portion to increase or decrease the influence on the flow in the lumen during different time periods of the day. In case a sensor of any of the above-described types for sensing a physical or functional parameter is provided, either the clock mechanism is used for controlling the constriction device and/or stimulation device provided that the parameter sensed by the sensor does not override the clock mechanism, or the sensor is used for controlling the constriction device and/or stimulation device provided that the clock mechanism does not override the sensor.
Suitably, the control device produces an indication, such as a sound signal or displayed information, in response to signals from the sensor.
[0073]The control device may comprise an implantable internal control unit that directly controls the constriction device and/or stimulation device in response to signals from the sensor. The control device may further comprise a wireless remote control adapted to set control parameters of the internal control unit from outside the patient without mechanically penetrating the patient. At least one of the control parameters, which is settable by the wireless remote control, is the physical or functional parameter. Suitably, the internal control unit includes the above mentioned clock mechanism, wherein the wireless remote control also is adapted to set the clock mechanism.
SUBSTITUTE SHEET (RULE 26) [0074]Alternatively, the control device may comprise an external control unit outside the patient's body for controlling the constriction device and/or stimulation device in response to signals from the sensor.
Adjustable Constriction Device [0075] In several alternative embodiments of the invention, the constriction device is adjustable. In these embodiments, there is an operation device for operating the adjustable constriction device to change the constriction of the patient's tissue wall portion, and the constriction and stimulation devices form a constriction/stimulation unit. Preferably, the constriction and stimulation devices of the constriction/stimulation unit are integrated in a single piece suitable for implantation.
The constriction device of the unit comprises contact surfaces dimensioned to contact a length of a tissue wall portion of a patient's organ, and the stimulation device of the unit comprises a plurality of stimulation elements provided on and distributed along the contact surfaces. When the control device controls the stimulation device to stimulate the wall portion, the stimulation elements stimulate different areas of the wall portion along the length of the wall portion. The stimulation elements preferably comprise electric elements, as described above, for stimulating the wall portion with electric pulses. However, in most applications of the present invention, other kinds of stimulations, such as thermal stimulation, could be suitable to employ.
[0076] The operation device operates the adjustable constriction device of the constriction/stimulation unit in a manner that depends on the design of the constriction device, as will be explained by the following examples of embodiments.
1) The constriction device comprises at least two elongated clamping elements having the contact surfaces and extending along the wall portion on different sides of the organ, and the operation device operates the clamping elements to clamp the wall portion between the clamping elements to constrict the wall portion of the organ.
[0077]2) The constriction device comprises one elongate clamping element having the contact surfaces and extending along the wall portion on one side of the organ, = and the operation device operates the clamping element to clamp the wall portion between the clamping element and the bone or tissue of the patient to constrict the wall portion.
SUBSTITUTE SHEET (RULE 26) [0078]3) The constriction device comprises at least two engagement elements having the contact surfaces and positioned on different sides of the organ, and the operation device rotates the engagement elements, such that the engagement elements engage and constrict the wall portion of the organ.
[007934) The constriction device comprises at least two articulated clamping elements having the contact surfaces and positioned on different sides of the organ, and the operation device moves the clamping elements towards each other to clamp the wall portion of the organ between the clamping elements, to constrict the wall portion.
[0080] 5) The constriction device comprises at least two separate clamping elements having the contact surfaces, at least one of the clamping elements being pivoted, such that it may turn in a plane in which the loop of the constriction member extends, and the operation device turns the pivoted clamping element to change the size of the constriction opening.
[008136) The constriction device comprises at least one elongated constriction member having the contact surfaces, and forming means for forming the constriction member into at least a substantially closed loop around the organ, wherein the loop defines a constriction opening. The operation device operates the constriction member in the loop to change the size of the constriction opening.
[0082] 6a) The elongated constriction member comprises a belt having the contact surfaces, and the operation device operates the belt to change the longitudinal extension of the belt in the loop to change the size of the constriction opening. The forming means may form the constriction member or belt into a loop having at least one predetermined size.
[0083] 6b) The elongated constriction member is operable to change the size of the constriction opening, such that the outer circumferential confinement surface of the constriction device is changed, or, alternatively, is unchanged.
[0084] 6c) The elongated constriction member is elastic and varies in thickness as seen in a cross-section there through, and is operable to turn around the longitudinal extension of the constriction member.
[0085] 6d) The elongated constriction member comprises two substantially or partly semi-circular frame elements having the contact surfaces and hinged together, such that the semi-circular elements are swingable relative to each other from a fully SUBSTITUTE SHEET (RULE 26) open state in which they substantially or partly form a circle to a fully folded state in which they substantially form a semi-circle.
[0086]7) The constriction device is adapted to bend the wall portion of the organ to constrict the latter.
[0087] In the above noted embodiments (1) to (7), it is important that the constriction device is designed to constrict said length of the tissue wall portion of the patient's organ. For this purpose, the constriction device may include two or more of the described constriction elements/members to be applied in a row along said length of the wall portion, wherein said row extends in the direction of flow in the lumen of the organ. Preferably, such constriction elements/members are non-inflatable and mechanically operable or adjustable.
[0088] In the above noted embodiments (1) to (7), the operation device may either mechanically or hydraulically adjust the constriction device of the constriction/stimulation unit. Also, the operation device may comprise an electrically powered operation device for operating the constriction device. For many applications of the present invention, the operation device suitably operates the constriction device, such that the through-flow area of the lumen assumes a size in the constricted state that enables the stimulation device to contract the wall portion such that the flow in the lumen is stopped.
Mechanical operation (0089] Where the operation device mechanically operates the constriction device of the constriction/stimulation unit, it may be non-inflatable. Furthermore, the operation device may comprise a servo system, which may include a gearbox. The term "servo system" encompasses the normal definition of a servo mechanism, i.e., an automatic device that controls large amounts of power by means of very small amounts of power, but may alternatively or additionally encompass the definition of a mechanism that transfers a weak force acting on a moving element having a long stroke into a strong force acting on another moving element having a short stroke.
Preferably, the operation device operates the constriction device in a non-magnetic and/or non-=
manual manner. A motor may be operatively connected to the operation device.
The operation device may be operable to perform at least one reversible function and the motor may be capable of reversing the function.
SUBSTITUTE SHEET (RULE 26) Hydraulic Operation (0090] Where the operation device hydraulically operates the constriction device of the constriction/stimulation unit, it includes hydraulic means for adjusting the constriction device.
[0091]In an embodiment of the invention, the hydraulic means comprises a reservoir and an expandable/contractible cavity in the constriction device, wherein the operation device distributes hydraulic fluid from the reservoir to expand the cavity, and distributes hydraulic fluid from the cavity to the reservoir to contract the cavity.
The cavity may be defined by a balloon of the constriction device that abuts the tissue wall portion of the patients organ, so that the patient's wall portion is constricted upon expansion of the cavity and released upon contraction of the cavity.
[0092]Alternatively, the cavity may be defined by a bellows that displaces a relatively large contraction element of the constriction device, for example a large balloon that abuts the wall portion, so that the patient's wall portion is constricted upon contraction of the bellows and released upon expansion of the bellows. Thus, a relatively small addition of hydraulic fluid to the bellows causes a relatively large increase in the constriction of the wall portion. Such a bellows may also be replaced by a suitably designed piston/cylinder mechanism.
(0093] Where the hydraulic means comprises a cavity in the constriction device, the apparatus of the invention can be designed in accordance with the options listed below.
[0094] 1) The reservoir comprises first and second wall portions, and the operation device displaces the first and second wall portions relative to each other to change the volume of the reservoir, such that fluid is distributed from the reservoir to the cavity, or from the cavity to the reservoir.
'1 a) The first and second wall portions of the reservoir are displaceable relative to each other by at least one of a magnetic device, a hydraulic device or an electric control device.
2) The operation device comprises a pump for pumping fluid between the reservoir and the cavity.
2a) The pump comprises a first activation member for activating the pump to pump fluid from the reservoir to the cavity and a second activation member for activating the pump to pump fluid from the cavity to the reservoir.
SUBSTITUTE SHEET (RULE 26) 2a1) The first and second activation members are operable by manual manipulation thereof.
2a2) At least one of the activation members operates when subjected to an external predetermined pressure.
2a3) At least one of the first and second activating members is operable by magnetic means, hydraulic means, or electric control means.
2b) The apparatus comprises a fluid conduit between the pump and the cavity, wherein the reservoir forms part of the conduit. The conduit and pump are devoid of any non-return valve. The reservoir forms a fluid chamber with a variable volume, and the pump distributes fluid from the chamber to the cavity by a reduction in the volume of the chamber and withdraws fluid from the cavity by an expansion of the volume of the chamber. The apparatus further comprises a motor for driving the pump, wherein the pump comprises a movable wall of the reservoir for changing the volume of the chamber.
[0095] In all of the above noted embodiments 1 to 2b where the hydraulic means comprises an expandable cavity in the constriction device, the cavity can be exchanged by a cylinder/piston mechanism for adjusting the constriction device. In this case, the operation device distributes hydraulic fluid between the reservoir and the cylinder/piston mechanism to adjust the constriction device.
[0096]In a special embodiment of the invention, the operation device comprises a reverse servo operatively connected to the hydraulic means. The term "reverse servo" is to be understood as a mechanism that transfers a strong force acting on a moving element having a short stroke into a weak force acting on another moving element having a long stroke; i.e., the reverse function of a normal servo mechanism.
Thus, minor changes in the amount of fluid in a smaller reservoir could be transferred by the reverse servo into major changes in the amount of fluid in a larger reservoir.
The reverse servo is particularly suited for manual operation thereof.
[0097] Preferably, the reverse servo comprises an expandable servo reservoir containing servo fluid and a fluid supply reservoir hydraulically connected to the servo reservoir to form a closed conduit system for the servo fluid. The expandable servo reservoir has first and second wall portions, which are displaceable relative to each other in response to a change in the volume of the expandable servo reservoir.
[0098]In accordance with a first alternative, the first and second wall portions of the servo reservoir are operatively connected to the hydraulic means. The reverse servo SUBSTITUTE SHEET (RULE 26) distributes fluid between the fluid supply reservoir and the expandable servo reservoir to change the volume of the servo reservoir, whereby the hydraulic means is operated to adjust the constriction device.
[0099] In accordance with a second alternative, there is provided an implantable main reservoir containing a predetermined amount of hydraulic fluid, wherein the reverse servo is operable to distribute hydraulic fluid between the main reservoir and the hydraulic means to adjust the constriction device. More specifically, the main reservoir is provided with first and second wall portions operatively connected to the first and second wall portions of the expandable servo reservoir, such that the volume of the main reservoir is changed when the volume of the expandable servo reservoir is changed. Thus, when the reverse servo distributes servo fluid between the fluid supply reservoir and the expandable servo reservoir to change the volume of the main reservoir, hydraulic fluid is distributed from the main reservoir to the hydraulic means, or from the hydraulic means to the main reservoir. Advantageously, the servo and main reservoirs are dimensioned, such that when the volume of the servo reservoir is changed by a relatively small amount of servo fluid, the volume of the main reservoir is changed by a relatively large amount of hydraulic fluid.
[00100] In both of the above-described alternatives, the fluid supply reservoir may have first and second wall portions, which are displaceable relative to each other to change the volume of the fluid supply reservoir to distribute servo fluid between the fluid supply reservoir and the expandable servo reservoir. The first and second wall portions of the fluid supply reservoir may be displaceable relative to each other by manual manipulation, a magnetic device, a hydraulic device, or an electric control device to change the volume of the fluid supply reservoir to distribute servo fluid between the fluid supply reservoir and the expandable servo reservoir.
[00101] In all of the above noted embodiments 1 to 2b where the hydraulic means comprises an expandable cavity in the constriction device, or in embodiments where the hydraulic means comprises a hydraulically operable mechanical construction, the operation device may include the reverse servo described above. In a further embodiment of the invention, the hydraulic means include first and second hydraulically interconnected expandable/contractible reservoirs. The first reservoir is operatively connected to the constriction device, such that the constriction device changes the constriction of the patient's wall portion upon expansion or contraction of the first reservoir. By changing the volume of the second reservoir hydraulic fluid is SUBSTITUTE SHEET (RULE 26) distributed between the two reservoirs, so that the first reservoir is either expanded or contracted. This embodiment requires no non-return valve in the fluid communication conduits between the two reservoirs, which is beneficial to long-term operation of the hydraulic means.
[00102] Alternatively, the hydraulic means may include first and second hydraulically interconnected piston/cylinder mechanisms instead of the first and second reservoirs described above. The first piston/cylinder mechanism is operatively connected to the constriction device, such that the constriction device changes the constriction of the patient's wall portion upon operation of the first piston/cylinder mechanism. By operating the second piston/cylinder mechanism hydraulic fluid is distributed between the two piston/cylinder mechanisms, so that the first piston/cylinder mechanism adjusts the constriction device.
[00103] Where the constriction device does not include an expandable/contractible cavity, the constriction device may comprise at least two elongated clamping elements having the above-mentioned contact surfaces and extending along the wall portion on different sides of the organ. The hydraulic means, which may include the reverse servo described above, hydraulically moves the elongated clamping elements towards the wall portion to constrict the wall portion.
For example, the constriction device may have hydraulic chambers in which the clamping elements slide back and forth, and the hydraulic means may also include a pump and an implantable reservoir containing hydraulic fluid. The pump distributes hydraulic fluid from the reservoir to the chambers to move the clamping elements against the wall portion, and distributes hydraulic fluid from the chambers to the reservoir to move the clamping elements away from the wall portion.
Design of control device [00104] The control device suitably controls the constriction/stimulation unit from outside the patient's body. Preferably, the control device is operable by the patient. For example, the control device may comprise a manually operable switch for switching on and off the constriction/stimulation unit, wherein the switch is adapted for subcutaneous implantation in the patient to be manually or magnetically operated ' from outside the patient's body. Alternatively, the control device may comprise a hand-held wireless remote control, which is conveniently operable by the patient to SUBSTITUTE SHEET (RULE 26) switch on and off the constriction/stimulation unit. The wireless remote control may also be designed for application on the patient's body like a wristwatch. Such a wristwatch type of remote control may emit a control signal that follows the patient's body to implanted signal responsive means of the apparatus.
[00105] Where the control device wirelessly controls the constriction/stimulation unit from outside the patient's body, the wireless control function is preferably performed in a non-magnetic manner, i.e., the control device controls the constriction device of the constriction/stimulation unit in a non-magnetic manner. The patient may use the remote control to control the constriction/stimulation unit to adjust the stimulation intensity and/or adjust the constriction of the wall portion. The wireless remote control may comprise at least one external signal transmitter or transceiver and at least one internal signal receiver or transceiver implantable in the patient.
[00106] The wireless remote control preferably transmits at least one wireless control signal for controlling the constriction/stimulation unit. The control signal may comprise a frequency, amplitude, phase modulated signal or a combination thereof, and may be an analogue or a digital signal, or a combination of an analogue and digital signal. The remote control may transmit an electromagnetic carrier wave signal for carrying the digital or analogue control signal. Also the carrier signal may comprise digital, analogue or a combination of digital and analogue signals.
[00107] Any of the above control signals may comprise wave signals, for example a sound wave signal, an ultrasound wave signal, an electromagnetic wave signal, an infrared light signal, a visible light signal, an ultra violet light signal, a laser light signal, a microwave signal, a radio wave signal, an x-ray radiation signal or a gamma radiation signal. Alternatively, the control signal may comprise an electric or magnetic field, or a combined electric and magnetic field.
[00108] As mentioned above, the control signal may follow the patient's body to implanted signal responsive means of the apparatus.
[00109] The control device may include a programmable internal control unit, such as a microprocessor, implantable in the patient for controlling the constriction/stimulation unit. The control device may further include an external control unit intended to be outside the patient's body, wherein the internal control unit is programmable by the external control unit. For example, the internal control unit may be programmable for controlling the constriction/stimulation unit over time, suitably in accordance with an activity schedule program. The apparatus of the SUBSTITUTE SHEET (RULE 26) invention may comprise an external data communicator and an implantable internal data communicator communicating with the external data communicator, wherein the internal communicator feeds data related to the constriction/stimulation unit back to the external data communicator or the external data communicator feeds data to the internal data communicator.
Source of Energy [001101 The present invention also presents a solution for supplying energy for use in connection with the operation of the constriction/stimulation unit.
Thus, in a broad sense, the present invention provides an apparatus for controlling a flow of fluid and/or other bodily matter in a lumen formed by a tissue wall of a patient's organ, wherein the apparatus comprises an implantable constriction device for gently constricting a portion of the tissue wall to influence the flow in the lumen, a stimulation device for intermittently and individually stimulating different areas of the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the flow in the lumen, wherein the constriction and stimulation devices form an operable constriction/stimulation unit, a source of energy, and a control device operable from outside the patient's body to control the source of energy to release energy for use in connection with the operation of the constriction/stimulation unit. In a simple form of the invention, the source of energy, such as a battery or accumulator, is implantable in the patient's body.
Transmission of Wireless Energy [00111] In a more sophisticated form of the invention, which is preferable, the source of energy is external to the patient's body and the control device controls the external source of energy to release wireless energy. In this sophisticated form of the invention, the apparatus comprises an energy-transmission device that transmits the released wireless energy from outside the patient's body to inside the patient's body.
Among many things the wireless energy may comprise electromagnetic energy, an electric field, an electromagnetic field or a magnetic field, or a combination thereof, or SUBSTITUTE SHEET (RULE 26) electromagnetic waves. The energy-transmission device may transmit wireless energy for direct use in connection with the operation of the constriction/stimulation unit, as the wireless energy is being transmitted. For example, where an electric motor or pump operates the constriction device, wireless energy in the form of a magnetic or an electromagnetic field may be used for direct power of the motor or pump.
[00112] Thus, the motor or pump is running directly during transmission of the wireless energy. This may be achieved in two different ways: a) using a transforming device implanted in the patient to transform the wireless energy into energy of a different form, preferably electric energy, and powering the motor or pump with the transformed energy, or b) using the wirelessly transmitted energy to directly power the motor or pump. Preferably wireless energy in the form of an electromagnetic or magnetic field is used to directly influence specific components of the motor or pump to create kinetic energy for driving the motor or pump. Such components may include coils integrated in the motor or pump, or materials influenced by magnetic fields, or permanent magnets, wherein the magnetic or electromagnetic field influences the coils to generate a current for driving the motor or pump, or influences the material or permanent magnets to create kinetic energy for driving the motor or pump.
[00113] Preferably, the energy-transmission device transmits energy by at least one wireless signal, suitably a wave signal. The wave signal may comprise an electromagnetic wave signal including one of an infrared light signal, a visible light signal, an ultra violet light signal, a laser signal, a microwave signal, a radio wave signal, an x-ray radiation signal, and a gamma radiation signal.
Alternatively, the wave signal may comprise a sound or ultrasound wave signal. The wireless signal may be a digital or analogue signal, or a combination of a digital and analogue signal.
Transforming Wireless Energy [00114] In accordance with a particular embodiment of the invention, an implantable energy-transforming device is provided for transforming wireless energy of a first form transmitted by the energy-transmission device into energy of a second =
form, which typically is different from the energy of the first form. The constriction/stimulation unit is operable in response to the energy of the second form.
For example, the wireless energy of the first form may comprise sound waves, SUBSTITUTE SHEET (RULE 26) whereas the energy of the second form may comprise electric energy. In this case, the energy-transforming device may include a piezo-electric element for transforming the sound waves into electric energy. Optionally, one of the energy of the first form and the energy of the second form may comprise magnetic energy, kinetic energy, sound energy, chemical energy, radiant energy, electromagnetic energy, photo energy, nuclear energy or thermal energy. Preferably, one of the energy of the first form and the energy of the second form is non-magnetic, non-kinetic, non-chemical, non-sonic, non-nuclear or non-thermal.
[001151 The energy-transforming device may function differently from or similar to the energy-transmission device. In a special embodiment, the energy-transforming device comprises at least one element, such as at least one semiconductor, having a positive region and a negative region, when exposed to the energy of the first form transmitted by the energy-transmission device, wherein the element is capable of creating an energy field between the positive and negative regions, and the energy field produces the energy of the second form. More specifically, the element may comprise an electrical junction element, which is capable of inducing an electric field between the positive and negative regions when exposed to the energy of the first form transmitted by the energy-transmission device, whereby the energy of the second form comprises electric energy.
[00116] The energy-transforming device may transform the energy of the first form directly or indirectly into the energy of the second form. An implantable motor or pump for operating the constriction device of the constriction/stimulation unit may be provided, wherein the motor or pump is powered by the energy of the second form.
The constriction device may be operable to perform at least one reversible function and the motor may be capable of reversing the function. For example, the control device may shift polarity of the energy of the second form to reverse the motor.
[00117] The energy-transforming device may directly power the motor or pump with the transformed energy, as the energy of the second form is being transformed from the energy of the first form. Preferably, the energy-transforming device directly operates the constriction/stimulation unit with the energy of the second form in a non-magnetic, non-thermal or non-mechanical manner.
[00118] Normally, the constriction/stimulation unit comprises electric components that are energized with electrical energy. Other implantable electric components of the apparatus may be at least one voltage level guard or at least one SUBSTITUTE SHEET (RULE 26) constant current guard. Therefore, the energy-transforming device may transform the energy of the first form into a direct current or pulsating direct current, or a combination of a direct current and pulsating direct current. Alternatively, the energy-transforming device may transform the energy of the first form into an alternating current or a combination of a direct and alternating current.
[00119] The apparatus of the invention may comprise an internal source of energy implantable in the patient for supplying energy for the operation of the constriction/stimulation unit. The apparatus may further comprise an implantable switch operable to switch from an "off' mode, in which the internal source of energy is not in use, to an "on" mode, in which the internal source of energy supplies energy for the operation of the constriction/stimulation unit, and/or for energizing implanted electronic components of the apparatus. The switch may be operable by the energy of the first form transmitted by the energy-transmission device or by the energy of the second form supplied by the energy-transforming device. The described switch arrangement reduces power consumption of the apparatus between operations.
[00120] The internal source of energy may store the energy of the second form supplied by the energy-transforming device. In this case, the internal source of energy suitably comprises an accumulator, such as at least one capacitor or at least one rechargeable battery, or a combination of at least one capacitor and at least one rechargeable battery. Where the internal source of energy is a rechargeable battery it may be charged only at times convenient for the patient, for example when the patient is sleeping. Alternatively, the internal source of energy may supply energy for the operation of the constriction/stimulation unit but not be used for storing the energy of the second form. In this alternative, the internal source of energy may be a battery and the switch described above may or may not be provided.
[00121] Suitably, the apparatus of the invention comprises an implantable stabilizer for stabilizing the energy of the second form. Where the energy of the second form is electric energy the stabilizer suitably comprises at least one capacitor.
[00122] The energy-transforming device may be designed for implantation subcutaneously in the abdomen, thorax or cephalic region of the patient.
Alternatively, it may be designed for implantation in an orifice of the patient's body and under the mucosa or intramuscularly outside the mucosa of the orifice.
[00123] Although the constriction/stimulation unit in the embodiments described above is designed as a single piece, which is most practical for implantation, it should SUBSTITUTE SHEET (RULE 26) be noted that as an alternative the constriction device and stimulation device could be designed as separate pieces. Any one of the constriction and stimulation units described above may alternatively be replaced by two or more separate constriction/stimulation elements, which are controlled independently of one another.
[00124] The above-described apparatus of the invention is suited for treating dysfunctions of an organ of a human being or animal. For example, for treating urinary and anal incontinence, constipation and impotence. The apparatus of the invention is also suited for treating obesity or gallstone troubles, and for controlling blood flow in a blood vessel or the release of eggs into a female's uterus.
[00125] Where the apparatus is used for controlling the food flow through the stomach of a patient, the apparatus comprises an implantable constriction device for gently constricting at least one portion of the tissue wall of the patient's stomach to influence the food flow in the stomach, a stimulation device for stimulating the wall portion of the tissue wall, and a control device for controlling said stimulation device to stimulate the wall portion, as said constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the food flow in the stomach.
[00126] Where the apparatus is used for controlling the flow of intestinal contents in the intestines of a patient, the apparatus comprises an implantable constriction device for gently constricting at least one portion of the tissue wall of the patient's intestines to influence the flow of intestinal contents in the intestines, a stimulation device for stimulating the wall portion of the tissue wall, and a control device for controlling said stimulation device to stimulate the wall portion, as said constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the flow of intestinal contents in the intestines.
[00127] Where the apparatus is used for controlling the flow of urine in the urethra or urine bladder of a patient, the apparatus comprises an implantable constriction device for gently constricting at least one portion of the tissue wall of the patient's urethra or urine bladder to influence the urine flow in the urethra or urine bladder, a stimulation device for stimulating the wall portion of the tissue wall, and a control device for controlling said stimulation device to stimulate the wall portion, as said constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the urine flow in the urethra or urine bladder.
[00128] Where the apparatus is used/ as an impotence treatment apparatus, it comprises a constriction device implantable in a male impotent patient for gently SUBSTITUTE SHEET (RULE 26) constricting at least one penile portion of the patient's normal penile tissue or the prolongation thereof, an implantable stimulation device for stimulating the penile portion, and a control device for controlling said stimulation device to stimulate the penile portion, as said constriction device constricts the penile portion, to cause contraction of the penile portion to restrict the blood flow leaving the penis to achieve erection. The term "normal penile tissue" is to be understood as excluding implanted tissue. Thus, the normal penile tissue includes one or both of the corpora cavernosa and the corpus spongiosum. The term "prolongation thereof" includes the bulbospongious and adjacent area.
[00129] Alternatively, the impotence treatment apparatus comprises a constriction device implantable in a male impotent patient for gently constricting at least one penile portion of the patient's normal penile tissue or the prolongation thereof to restrict the blood flow leaving the penis, an implantable stimulation device for stimulating the penile portion as said constriction device constricts the penile portion, and a control device for controlling said stimulation device to stimulate the penile portion, as said constriction device constricts the penile portion, to cause contraction of the penile portion to further restrict the blood flow leaving the penis to achieve erection.
[00130] Alternatively, impotence treatment apparatus comprises a stimulation device implantable in a male impotent patient for stimulating at least one penile portion of the patient's normal penile tissue or the prolongation thereof, and a control device for controlling said stimulation device to stimulate the penile portion to cause contraction thereof to restrict the blood flow leaving the penis to achieve erection.
[00131] Where the apparatus is used for controlling the blood flow in a blood vessel of a patient, the apparatus comprises an implantable constriction device for gently constricting at least one portion of the tissue wall of the blood vessel to influence the blood flow in the blood vessel, a stimulation device for stimulating the tissue wall portion, and a control device for controlling said stimulation device to stimulate the tissue wall portion as said constriction device constricts the tissue wall portion to cause contraction of the tissue wall portion to further influence the blood flow in the blood vessel.
[00132] Where the a apparatus is used for controlling the flow of eggs into the uterus of a female, the apparatus comprises an implantable constriction device for' constricting each one of the female's uterine tubes to restrict the passageway SUBSTITUTE SHEET (RULE 26) thereof, and a control device for controlling said constriction device to constrict the uterine tube such that an egg appearing in the passageway of the uterine tube is prevented from entering the uterine cavity, and to release the uterine tube such that an egg existing in the passageway of the uterine tube is allowed to enter the uterine cavity. The constriction device may gently constrict at least one portion of the tissue wall of the uterine tube to restrict the passageway thereof, and an implantable stimulation device may be provided for stimulating the tissue wall portion, wherein the control device controls said stimulation device to stimulate the tissue wall portion, as said constriction device constricts the tissue wall portion, to cause contraction of the tissue wall portion to further restrict the passageway of the uterine tube.
[00133] Alternatively, the egg flow control apparatus comprises an implantable constriction device for gently constricting at least one portion of the tissue wall of each one of the female's uterine tubes to restrict the passageway thereof, a stimulation device for stimulating the tissue wall portion of the uterine tube, and a control device for controlling said stimulation device to stimulate the tissue wall portion, as said constriction device constricts the tissue wall portion, to cause contraction of the tissue wall portion to further restrict the passageway of the uterine tube to prevent an egg existing in the uterine tube from entering the uterine cavity.
[00134] Alternatively, the egg flow control apparatus comprises an implantable stimulation device for stimulating a portion of the tissue wall of each one of the female's uterine tubes, and a control device for controlling said stimulation device to stimulate the tissue wall portion of the uterine tube to cause contraction of the tissue wall portion, such that the passageway of the uterine tube is restricted to prevent an egg appearing in the uterine tube from entering the uterine cavity, and to cease stimulating the tissue wall portion of the uterine tube to allow an egg existing in the passageway of the uterine tube to enter the uterine cavity.
[00135] Where the apparatus is used for controlling the flow of gallstones in a patient suffering from gallstone trouble, the apparatus comprises an implantable stimulation device for stimulating a portion of the tissue wall of the patient's cystic, hepatic or bile duct, and a control device for controlling said stimulation device to progressively stimulate the tissue wall portion to cause progressive contraction of the tissue wall portion to move one or more gallstones appearing in the duct in the direction towards the duodenum.
SUBSTITUTE SHEET (RULE 26) [00136] The present invention also provides a method for using an apparatus as described above to control a flow of fluid and/or other bodily matter in a lumen formed by a tissue wall of a patient's organ, the method comprising:
- providing a wireless remote control adapted to control the constriction device and/or stimulation device from outside the patient's body, and - operating the wireless remote control by the patient, when the patient wants to influence the flow of fluid and/or other bodily matter in the lumen.
[00137] The present invention also provides a method for controlling a flow of fluid and/or other bodily matter in a lumen formed by a tissue wall of a patient's organ, the method comprising:
a) gently constricting at least one portion of the tissue wall to influence the flow in the lumen, and b) stimulating the constricted wall portion to cause contraction of the wall portion to further influence the flow in the lumen.
[00137a] According to one aspect of the present invention, there is provided a flow control apparatus for controlling a flow of fluid and/or other matter in a fluid conduit formed by a conduit wall, the apparatus comprising: an energizing device configured to influence the flow in the conduit, the energizing device including a stimulation device configured to stimulate a wall portion of the conduit wall, and a control device operable to control the stimulation device to stimulate the wall portion to cause contraction of the wall portion to influence the flow in the conduit.
[00137b] According to another aspect of the present invention, there is provided an intestinal dysfunction treatment apparatus comprising an implantable constriction device configured to gently constrict at least one portion of the tissue wall of a patient's intestines to influence the flow of intestinal contents in the intestinal passageway of the intestines, a stimulation device configured to stimulate the wall 36a portion of the tissue wall, and a control device operable to control the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the flow of intestinal contents.
[00137c] According to still another aspect of the present invention, there is provided a urinary dysfunction treatment apparatus comprising an implantable constriction device configured to gently constrict at least one portion of the tissue wall of patient's urethra, ureter, renal pelvis or urine bladder to influence the flow of urine, a stimulation device configured to stimulate the wall portion of the tissue wall, and a control device operable to control the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the flow of urine.
[00137d] According to yet another aspect of the present invention, there is provided an obesity treatment apparatus comprising an implantable constriction device configured to gently constrict at least one portion of the tissue wall of a patient's stomach to influence the food flow in a food passageway of the stomach, a stimulation device configured to stimulate the wall portion of the tissue wall, and a control device operable to control the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the food flow in the food passageway of the stomach.
[00137e] According to a further aspect of the present invention, there is provided an obesity treatment apparatus for treating an obese patient surgically modified by any one of a group of operations called Vertical Banded Gastroplasty, wherein the stomach is compartmentalized into a smaller proximal compartment adjacent the esophagus and a larger distal compartment, the smaller proximal compartment communicating with the larger distal compartment through an outlet opening, the apparatus comprising an implantable constriction device configured to gently constrict at least one wall portion of the tissue wall of the patient's stomach to influence the 36b food flow in a food passageway extending in the smaller proximal compartment through the outlet opening, an implantable stimulation device configured to stimulate the wall portion of the tissue wall, and a control device operable to control the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the food flow in the food passageway.
[00137f] According to yet a further aspect of the present invention, there is provided a sexual dysfunction treatment apparatus for treating an impotent male patient comprising: a stimulation device configured to stimulate at least one penile portion of the patient's normal penile tissue or the prolongation thereof, and a control device operable to control the stimulation device to stimulate the penile portion to cause contraction thereof to at least restrict the blood flow leaving the penis to achieve erection.
[00137g] According to still a further aspect of the present invention, there is provided a sexual dysfunction treatment apparatus for treating a female patient comprising: an implantable stimulation device configured to stimulate at least one portion of the patient's female erectile tissue, and a control device operable to control the stimulation device to stimulate the erectile tissue portion to cause contraction thereof to at least restrict the venous blood flow leaving the erectile tissue to obtain engorgement with blood of the female erectile tissue.
[00137h] According to another aspect of the present invention, there is provided a pregnancy control apparatus comprising: a movement influence device configured to influence the movement of an egg appearing in the lumen of a uterine tube of a female patient, and a control device operable to control the movement influence device to influence the movement of the egg in the lumen of the uterine tube.
[001371] According to yet another aspect of the present invention, there is provided a pregnancy control apparatus comprising: a flow influence device configured to influence a flow of sperms appearing in the lumen of a uterine tube of a 36c female patient, and a control device operable to control the flow influence device to influence the flow of sperms in the uterine tube.
[00137j] According to another aspect of the present invention, there is provided a blood flow control apparatus for controlling a flow of blood and/or other bodily matter in a patient's blood vessel, the apparatus comprising an implantable constriction device configured to gently constrict at least one portion of the tissue wall of the blood vessel to influence the flow in the blood vessel, a stimulation device configured to stimulate the wall portion of the tissue wall, and a control device operable to control the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the flow in the blood vessel.
[00137k] According to still another aspect of the present invention, there is provided a vascular aneurysm treatment apparatus for treating a vascular aneurysm of a blood vessel in a human or mammal patient, the apparatus comprising an implantable constriction device configured to gently constrict at least one portion of the tissue wall of the blood vessel extending along the aneurysm to reduce the bulge of the blood vessel caused by the aneurysm, a stimulation device for stimulating the wall portion of the blood vessel tissue wall, and a control device for controlling the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further reduce the bulge of the blood vessel and strengthen the blood vessel tissue wall.
[001371] According to yet another aspect of the present invention, there is provided a male contraception apparatus for obtaining a time-limited sterility of a male mammalian individual comprising: a flow influence device configured to influence a flow of sperms appearing in the lumen of a vas deference of a male patient, and a control device operable to control the flow influence device to influence the flow of sperms in the vas deference.
36d [00137m] According to a further aspect of the present invention, there is provided a gallstone trouble treatment apparatus for treating a patient suffering from gallstone trouble, comprising at least one implantable stimulation device configured to stimulate at least one portion of the tissue wall of a biliary duct of the patient, and a control device operable to control the stimulation device to stimulate the tissue wall portion to cause contraction of the tissue wall portion to influence the movement of bile and/or gallstones in the biliary duct.
[00137n] According to yet a further aspect of the present invention, there is provided a pregnancy control system for promoting pregnancy comprising a restriction device configured to postoperatively be adjusted to restrict and release an oviduct of the patient.
[001370] According to still a further aspect of the present invention, there is provided a pregnancy control apparatus for avoiding pregnancy comprising a restriction device configured to postoperatively be adjusted to restrict and release an oviduct of the patient.
[00137p] According to another aspect of the present invention, there is provided a male contraception apparatus for obtaining temporary sterility of a male mammalian individual comprising an implantable restriction device configured to restrict the patient's vas deference in the region downstream the ampulla during a controlled period, the restriction device thereby being capable of preventing sperms to reach the urethra, and a control device operable to control the operation of the restriction device.
[00137q] According to yet another aspect of the present invention, there is provided a female sexual dysfunction treatment apparatus, comprising a stimulation device configured to stimulate a female patient's erectile blood flow passageway to increase the amount of blood in the female erectile tissue and thereby obtaining engorgement with blood of the female erectile tissue by affecting the erectile blood flow passageway.
36e [00137r] According to another aspect of the present invention, there is provided a female sexual dysfunction treatment apparatus, comprising a device configured to increase the amount of blood in the female erectile tissue and thereby obtaining engorgement with blood of the female erectile tissue.
[00137s] According to still another aspect of the present invention, there is provided a system comprising an artificial intestine section adapted to being implanted inside a patient's body along with an accumulator for accumulating energy, wherein said intestine section has a first open end portion and a second open end portion in flow communication with one another, at least the first open end portion being adapted to being connected to a surgically created opening in the patient's intestine, wherein the system comprises at least one conduit connected to the artificial intestine section and adapted to be introduced into a surgically divided intestinal opening in the intestine to hold an intestinal wall portion on the outside of the conduit, the system further comprising a flexible sleeve adapted to be placed onto the intestine, when the intestine section is implanted, so as to extend over the intestinal wall portion and the conduit such that at least part of the intestinal wall portion is located intermediate the sleeve and the outer surface of the conduit, wherein the sleeve is adapted to increase the strength of the connection between the intestine section and the patient's intestine against axial forces resulting from peristaltic movements of the intestine and which tend to pull on the intestine, when said artificial intestine section is long term implanted, and wherein said accumulator is adapted to be charged wirelessly with energy and arranged to supply energy directly or indirectly to at least one energy consuming part of said artificial intestine section.
[00137t] According to yet another aspect of the present invention, there is provided an artificial intestine section adapted to be implanted inside a patient's body, said intestine section having a first open end portion and a second open end portion in flow communication with one another, wherein at least the first open end portion is adapted to being connected to a surgically created lateral opening in a wall of the patient's intestine, wherein the artificial intestine section comprising at least one 36f element adapted to directly or indirectly interact with intestinal contents contained in the artificial intestine section between the first and second open end portions thereof, wherein the at least one element comprises at least an artificial reservoir between the first and second open end portions for receiving and temporarily collecting therein intestinal contents supplied through the first open end portion, wherein said second open end portion is adapted to receive intestinal contents for emptying said reservoir.
[00137u] According to a further aspect of the present invention, there is provided an apparatus for treating a patient having a disorder related to the passageway of the patient's intestines, the apparatus comprising a pump for implantation in the patient operable on at least one selected portion of the intestines to pump intestinal contents through the passageway of the intestines, wherein said pump includes a constriction device adapted to alternately constrict and release the selected portion to at least substantially reduce the volume of the passageway of the intestines along the selected portion and release the selected portion to increase the volume of the passageway of the intestines along the selected portion, such that intestinal contents is displaced through the passageway of the intestines.
[00137v] According to yet a further aspect of the present invention, there is provided a system for treating a patient having a disorder related to a patient's intestine and a reservoir for receiving and temporarily collecting therein intestinal contents, the reservoir being formed from surgically modified intestine that has been cut along a mutual contact line of laterally adjacent sections of a bent portion of intestine and connected so that the resulting upper and lower halves of the intestine form an intestinal wall of the reservoir, wherein the system comprises an artificial flow control device implantable in the patient's body and adapted to control flow of the intestinal contents from said reservoir, the flow control device comprising at least one pump adapted to act on said intestinal wall so as to reduce the reservoir's volume, thereby emptying the reservoir.
36g [00137w] According to still a further aspect of the present invention, there is provided a system for treating a patient having a disorder related to the patient's intestine, comprising an artificial reservoir adapted for receiving and temporarily collecting therein intestinal contents and further adapted to remain within the patient's body when emptying the reservoir, wherein the system further comprises an at least partly artificial flow control device implantable in the patient's body and adapted to control flow of the intestinal contents in the intestine, wherein said reservoir comprises a single opening, said opening being adapted to be connected to a surgically created opening in the patient's intestine when implanted so as to be in flow communication with the intestine, wherein the reservoir is adapted for receiving and temporarily collecting therein intestinal contents as well as emptying the intestinal contents from the reservoir through said single opening, the system further comprising an implantable pump for emptying the reservoir, wherein said pump is adapted to be controlled from outside the human body.
[00137x] According to another aspect of the present invention, there is provided a stimulation device for treating a vascular aneurysm of a human or mammal patient comprising: at least one implantable electrode adapted to placed in close connection to the aneurysm, the at least one electrode being adapted to provide an electrical stimulation pulse on a wall portion of the aneurysm.
BRIEF DESCRIPTION OF THE DRAWINGS
[00138] FIGURES 1A, 1B, 1C, 1D and 1E schematically illustrate different states of operation of a general embodiment of an apparatus according to the present invention.
[00139] FIGURES 1F, 1G and 1H illustrate different states of operation of a modification of the general embodiment.
[00140] FIGURES 11, 1K and 1L illustrate an alternative mode of operation of the modification of the general embodiment.
36h [00141] FIGURE 2 is a longitudinal cross-section of a preferred embodiment of the apparatus according to the invention including a constriction device and an electric stimulation device.
[00142] FIGURE 3 is a cross-section along line in FIGURE 2.
[00143] FIGURE 4 is the same cross-section shown in FIGURE 3, but with the apparatus in a different state of operation.
[00144] FIGURES 5A, 5B and 5C are cross-sections of the embodiment of FIGURE 2 showing different states of operations with the apparatus applied on a tissue wall of a patient's organ.
[00145] FIGURES 6A, 6B and 60 are cross-sections of a modification of the embodiment of FIGURE 2 showing different states of operations with the apparatus applied on a tissue wall of a patient's organ.
[00146] FIGURES 7A and 7B show different steps of an electric stimulation mode performed by the apparatus of FIGURE 2, while the apparatus is constricting a tissue wall of a patient's organ.
[00147] FIGURE 8A is a pulse/time diagram showing electric stimulation pulses generated by the apparatus of the invention for stimulating a tissue wall of a patient's organ.
[00148] FIGURE 8B is pulse/time diagram showing a modification of the electric stimulation shown in FIGURE 8A, in which pulses of mixed frequencies and/or amplitudes are employed.
[00149] FIGURES 9A and 9B show two pulse/time diagrams, respectively, representing electric stimulation of two different areas of the tissue wall with pulses forming pulse trains.
[00150] FIGURES 10A and 10B show the pulse/time diagrams of FIGURES 9A
and 9B with modified pulse trains.
[00151] FIGURE 11A is a longitudinal cross-section of an embodiment of the apparatus of the invention including a thermal stimulation device, wherein the apparatus is constricting a tissue wall of a patient's organ.
[00152] FIGURE 11B is the same embodiment of FIGURE 11A with the thermal stimulation device activated.
[00153] FIGURE 12A is a schematic view of hydraulic operation means suited for operating the constriction device of the embodiments of FIGURES 2-11.
[00154] FIGURE 12B shows the embodiment of FIGURE 12A with the constriction device constricting a tissue wall of a patient's organ.
[00155] FIGURE 13A is a schematic view of mechanical operation means suited for operating the constriction device of the embodiments of FIGURES 2-11.
[00156] FIGURE 13B shows the embodiment of FIGURE 13A with the constriction device constricting a tissue wall of a patient's organ.
[00157] FIGURE 13C shows a modification of the embodiment of FIGURE 13B.
SUBSTITUTE SHEET (RULE 26) [00158] FIGURE 14A illustrates the apparatus of the invention applied on the small intestines of a colostomy patient having a stoma opening in the abdomen.
[00159] FIGURE 14B illustrates the apparatus of the invention applied on the small intestines of a colostomy patient having the small intestines ending at the patient's anus.
[00160] FIGURE 15 is a schematic sectional view of a mechanically operable non-inflatable constriction device for use in accordance with the invention.
[00161] FIGURES 16 and 17 are cross-sectional views taken along the lines XVI-XVI and XVII-XVII, respectively, of FIGURE 15.
[00162] FIGURE 18 schematically shows an alternative design of the embodiment of FIGURE 15;
[00163] FIGURE 19 schematically illustrates a motor arrangement for the design according to FIGURE 18;
[00164] FIGURES 20 and 21 are schematic sectional views of two alternative designs of non-inflatable constriction devices of the invention.
[00165] FIGURES 22 and 23 illustrate a fully open and a reduced constriction opening, respectively, of the embodiment of FIGURE 21;
[00166] FIGURE 24 is a schematic view of a further alternative design of a non-inflatable constriction device of the invention.
[00167] FIGURES 25 and 26 illustrate a fully open and a reduced constriction opening, respectively, of the embodiment of FIGURE 24;
[00168] FIGURE 27 is a schematic view of another alternative design of a non-inflatable constriction device of the invention.
[00169] FIGURES 28 and 29 are schematic sectional views, respectively, of yet another alternative design of a non-inflatable constriction device of the invention.
[00170] FIGURE 30A is a schematic view of a hydraulically operable inflatable constriction device for use in accordance with the invention.
[00171] FIGURE 30B is the same embodiment shown in FIGURE 30A with the constriction device inflated.
[00172] FIGURES 31A, 31B, 31C and 31D are block diagrams illustrating four different principles for hydraulic operation of the constriction device shown in =
FIGURE 30A.
[00173] FIGURE 32 is a cross-sectional view of a reservoir having a variable volume controlled by a remote control motor.
SUBSTITUTE SHEET (RULE 26) [00174] FIGURES 33A and 33B are perspective views of a reverse servo in accordance with a particular embodiment of the hydraulic operation principle shown in FIGURE 31C.
[00175] FIGURE 34 is a schematic view of another hydraulically operable constriction device for use in accordance with the invention.
[00176] FIGURE 35A illustrates the constriction device of FIGURE 34 in a constricted state.
[00177] FIGURE 35B illustrates the constriction device of FIGURE 34 in a released state.
[00178] FIGURES 36A ¨ 36E schematically illustrate different operation stages of an embodiment of the invention, in which a constriction device and a stimulation device co-operate to move the fluid and/or other bodily matter in the lumen of a patient's organ.
[00179] FIGURE 37 is a schematic block diagram illustrating a general embodiment of the apparatus of the invention, in which energy is transferred to energy consuming components of the apparatus implanted in the patient.
[00180] FIGURES 38 to 49 are schematic block diagrams illustrating twelve embodiments, respectively, based on the general embodiment shown in FIGURE 37, wherein wireless energy is transmitted from outside a patient's body to energy consuming components of the apparatus implanted in the patient.
[00181] FIGURE 50 illustrates an energy-transforming device in the form of an electrical junction element for use in the apparatus of the present invention.
[00182] FIGURE 51 is a block diagram illustrating control components of an embodiment of the invention.
[00183] FIGURE 52 is a schematic view of exemplary circuitry of an embodiment of the invention, in which wireless energy is transformed into a current.
[00184] FIGURES 53A ¨ 53C schematically illustrate different operation stages of another embodiment of the invention of the type shown in FIGURE 2, in which a constriction device and a stimulation device co-operate to move the fluid and/or other bodily matter in the lumen of a patient's organ.
[00185] FIGURES 54A ¨ 54B schematically illustrate different operation stages of another embodiment of the invention of the type shown in FIGURES 36A ¨ 36E, in which a constriction device and a stimulation device co-operate to move the fluid and/or other bodily matter in the lumen of a patient's organ.
SUBSTITUTE SHEET (RULE 26) , 81596208 [00186] FIGURE 55A is a schematic view of another mechanically operable non-inflatable constriction device for use in accordance with the invention.
[00187] FIGURE 55B shows the constriction device of FIGURE 55A in a constricted state.
[00188] FIGURE 55C is an end view of the embodiment of FIGURE 55B.
[00189] FIGURE 56 is a schematic block diagram illustrating an arrangement for supplying an accurate amount of wireless energy used for the operation of the constriction/stimulation unit as described above.
[00190] FIGURE 57 schematically shows an embodiment of the system, in which the apparatus is operated with wire bound energy.
[00191] FIGURE 58 is a more detailed block diagram of an arrangement for controlling the transmission of wireless energy used for the operation of the constriction/stimulation unit as described above.
[00192] FIGURE 59 is a circuit for the arrangement shown in Fig. 19, according to a possible implementation example.
[00192a] According to one aspect of the present invention, there is provided an apparatus for controlling a flow of fluid and/or other bodily matter in a lumen formed by a tissue wall of a patient's organ, the apparatus comprising: an implantable constriction device for gently constricting at least one portion of the tissue wall to influence the flow in the lumen, a stimulation device for stimulating the constricted wall portion of the tissue wall as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the flow in the lumen, aa control device for controlling the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the flow in the lumen and wherin the control device is adapted to control the constriction and stimulation devices independently of each other, and simultaneously.
= 81596208 40a DETAILED DESCRIPTION OF THE INVENTION
[00193] Referring to the drawing figures, like reference numerals designate identical or corresponding elements throughout the several figures.
[00194] FIGURES 1A, 1B and 1C schematically illustrate different states of operation of a generally designed apparatus according to the present invention, when the apparatus is applied on a wall portion of a bodily organ designated BO. The apparatus includes a constriction device and a stimulation device, which are designated CSD, and a control device designated CD for controlling the constriction and stimulation devices CSD. FIGURE 1A shows the apparatus in an inactivation state, in which the constriction device does not constrict the organ BO and the stimulation device does not stimulate the organ BO. FIGURE 1B shows the apparatus in a constriction state, in which the control device CD controls the constriction device to gently constrict the wall portion of the organ BO to a constricted state, in which the blood circulation in the constricted wall portion is substantially unrestricted and the flow in the lumen of the wall portion is restricted.
shows the apparatus in a stimulation state, in which the control device CD
controls the stimulation device to stimulate different areas of the constricted wall portion, so that almost the entire wall portion of the organ BO contracts (thickens) and closes the lumen.
[00195] FIGURES 1D and 1E show how the stimulation of the constricted wall portion can be cyclically varied between a first stimulation mode, in which the left area of the wall portion (see FIGURE 1D) is stimulated, while the right area of the wall portion is not stimulated, and a second stimulation mode, in which the right area of the wall portion (see FIGURE 1E) is stimulated, while the left area of the wall portion is not stimulated, in order to maintain over time satisfactory blood circulation in the constricted wall portion.
[00196] It should be noted that the stimulation modes shown in FIGURES 1D
and 1E only constitute a principle example of how the constricted wall portion of the organ BO may be stimulated. Thus, more than two different areas of the constricted wall portion may be simultaneously stimulated in cycles or successively stimulated.
Also, groups of different areas of the constricted wall portion may be successively stimulated.
[00197] FIGURES IF, 1G and 1H illustrate different states of operation of a modification of the general embodiment shown in FIGURES 1A-1E, wherein the constriction and stimulation devices CSD include several separate constriction/stimulation elements, here three elements CSDE1, CSDE2 and CSDE3.
FIGURE IF shows how the element CSDE1 in a first state of operation is activated to both constrict and stimulate the organ BO, so that the lumen of the organ BO
is closed, whereas the other two elements CSDE2 and CSDE3 are inactivated.
FIGURE 1G shows how the element CSDE2 in a second following state of operation is activated, so that the lumen of the organ BO is closed, whereas the other two elements CSDE1 and CSDE3 are inactivated. FIGURE 1H shows how the element CSDE3 in a following third state of operation is activated, so that the lumen of the organ BO is closed, whereas the other two elements CSDE1 and CSDE2 are inactivated. By shifting between the first, second and third states of operation, either randomly or in accordance with a predetermined sequence, different portions of the organ can by temporarily constricted and stimulated while maintaining the lumen of the organ closed, whereby the risk of injuring the organ is minimized. It is also possible to activate the elements CSDE1-CSDE3 successively along the lumen of the organ to move fluids and/or other bodily matter in the lumen.
SUBSTITUTE SHEET (RULE 26) [00198] FIGURES 11, 1K and 1L illustrate an alternative mode of operation of the modification of the general embodiment. Thus, FIGURE 11 shows how the element CSDE1 in a first state of operation is activated to both constrict and stimulate the organ BO, so that the lumen of the organ BO is closed, whereas the other two elements CSDE2 and CSDE3 are activated to constrict but not stimulate the organ BO, so that the lumen of the organ BO is not completely closed where the elements CSDE2 and CSDE3 engage the organ BO. FIGURE 1K shows how the element CSDE2 in a second following state of operation is activated to both constrict and stimulate the organ BO, so that the lumen of the organ BO is closed, whereas the other two elements CSDE1 and CSDE3 are activated to constrict but not stimulate the organ BO, so that the lumen of the organ BO is not completely closed where the elements CSDE1 and CSDE3 engage the organ BO. FIGURE 1L shows how the element CSDE3 in a following third state of operation is activated to both constrict and stimulate the organ BO, so that the lumen of the organ BO is closed, whereas the other two elements CSDE1 and CSDE2 are activated to constrict but not stimulate the organ BO, so that the lumen of the organ BO is not completely closed where the elements CSDE1 and CSDE2 engage the organ BO. By shifting between the first, second and third states of operation, either randomly or in accordance with a predetermined sequence, different portions of the organ can by temporarily stimulated while maintaining the lumen of the organ closed, whereby the risk of injuring the organ is reduced. It is also possible to activate the stimulation of the elements CSDE1-CSDE3 successively along the lumen of the organ BO to move fluids and/or other bodily matter in the lumen.
[00199] FIGURES 2-4 show basic components of an embodiment of the apparatus according to the invention for controlling a flow of fluid and/or other bodily matter in a lumen formed by a tissue wall of a patient's organ. The apparatus comprises a tubular housing 1 with open ends, a constriction device 2 arranged in the housing 1, a stimulation device 3 integrated in the constriction device 2, and a control device 4 (indicated in FIGURE 4) for controlling the constriction and stimulation devices 2 and 3. The constriction device 2 has two elongate clamping elements 5, 6, which are radially movable in the tubular housing 1 towards and away from each other between retracted positions, see FIGURE 3, and clamping positions, see FIGURE 4. The stimulation device 3 includes a multiplicity of electrical elements 7 positioned on the clamping elements 5, 6, so that the electrical elements 7 on one of SUBSTITUTE SHEET (RULE 26) the clamping elements 5, 6 face the electrical elements 7 on the other clamping element. Thus, in this embodiment the constriction and stimulation devices form a constriction/stimulation unit, in which the constriction and stimulation devices are integrated in a single piece.
[00200] The constriction and stimulation devices may also be separate from each other. In this case, a structure may be provided for holding the electrical elements 7 in a fixed orientation relative to one another. Alternatively, the electrical elements 7 may include electrodes that are separately attached to the wall portion of the patient's organ.
[00201] FIGURES 5A - 5C illustrate in principle the function of the apparatus of FIGURE 2 when the apparatus is applied on a portion 8 of a tubular tissue wall of a patient's organ. Thus, FIGURE 5A shows the apparatus in a non-clamping state, in which the clamping elements 5, 6 are in their retracted positions and the wall portion 8 extends through the open ends of the housing 1 without being constricted by the clamping elements 5, 6. FIGURE 58 shows the apparatus in a clamping state, in which the clamping elements 5, 6 have been moved from their retracted positions to their clamping positions, in which the clamping elements 5, 6 gently constrict the wall portion 8 to a constricted state, in which the blood circulation in the constricted wall portion 8 is substantially unrestricted and the flow in the lumen of the wall portion 8 is restricted. FIGURE 5C shows the apparatus in a stimulation state, in which the clamping elements 5, 6 constrict the wall portion 8 and the electrical elements 7 of the stimulation device 3 electrically stimulate different areas of the wall portion 8, so that the wall portion 8 contracts (thickens) and closes the lumen.
[00202] When the apparatus is in its stimulation state, it is important to stimulate the different areas of the wall portion 8 in a manner so that they essentially maintains their natural physical properties over time to prevent the areas from being injured.
Consequently, the control device 4 controls the stimulation device 3 to intermittently stimulate each area of the wall portion 8 during successive time periods, wherein each time period is short enough to maintain over time satisfactory blood circulation in the area. Furthermore, the control device 4 controls the stimulation of the areas of the wall portion 8, so that each area that currently is not stimulated restores substantially normal blood circulation before it is stimulated again. To maintain over time the effect of stimulation, i.e., to keep the lumen closed by maintaining the wall portion 8 contracted, the control device 4 controls the stimulation device 3 to SUBSTITUTE SHEET (RULE 26) stimulate one or more of the areas at a time and to shift the stimulation from one area to another over time. The control device 4 may control the stimulation device 3 to cyclically propagate the stimulation of the areas along the tubular wall portion 8, for example, in accordance with a determined stimulation pattern. To achieve the desired reaction of the tissue wall during the stimulation thereof, the control device may control the stimulation device to, preferably cyclically, vary the intensity of the stimulation of the wall portion 8.
[00203] In the embodiment of FIGURES 2 - 4, the electrical elements 7 form a series of fourteen groups of electrical elements 7 extending longitudinally along each elongate clamping element 5 and 6, respectively, see FIGURE 2. The electrical elements 7 of each group of electrical elements 7 form a first path of four electrical elements 7 positioned in a row on clamping element 5 and extending tranverse thereto, and a second path of four electrical elements 7 positioned in a row on clamping element 6 and extending tranverse thereto. Thus, the two paths of electrical elements 7 extend on mutual sides of the patient's organ. The control device 4 controls the stimulation device 3 to successively energize the groups of electrical elements 7 in the series of groups in a direction opposite to or, alternatively, in the same direction as that of the flow in the lumen of the patient's organ. Of course, the number of electrical elements 7 of each path of electrical elements 7 can be greater or smaller than four, and several parallel rows electrical elements 7 can form each path of electrical elements 7.
[00204] FIGURES 6A - BC show another embodiment of the invention which includes a tubular housing 9 and three elongate clamping elements 10a, 10b, 10c, which are radially movable in the tubular housing 9 towards and away from a central axis thereof between retracted positions, see FIGURE 6A, and clamping positions, see FIGURE 6B. The three clamping elements 10a-10c are symmetrically disposed around the central axis of the housing 9. The stimulation device of this embodiment includes electrical elements 11 a, 11 b, 11c that form a series of groups of elements extending longitudinally along the elongate clamping elements 10a-10c, wherein the electrical elements 11a ¨ 11c of each group of electrical elements form a path of three electrical elements 11a, llb and 11c extending circumferentially around the central axis of the housing 9. The three electrical elements 11a ¨ 11 c of each group are positioned on the three clamping elements 10a-10c, respectively. Thus, the path of three electrical elements lla-11c extends around the patient's organ. Of course, SUBSTITUTE SHEET (RULE 26) the number of electrical elements 11a-11c of each path of electrical elements can be greater than three, and several parallel rows electrical elements 11a-11c can form each path of electrical elements.
[00205] FIGURES 7A and 7B show different steps of an electric stimulation mode performed by the apparatus of FIGURE 2 while the clamping elements 5, 6 of the apparatus are constricting a portion of a tubular tissue wall of a patient's organ 12 to restrict the flow in the lumen 13 of the organ 12. For the sake of clarity only the clamping elements 5, 6 of the constriction device 2 are shown in FIGURES 7A, 7B.
Thus, FIGURE 7A illustrates how energized electrical elements 7 of groups of electrical elements electrically stimulate a first portion 14 and a second portion 15 of the tubular wall to contract and close the lumen 13. FIGURE 7B illustrates how energized electrical elements 7 of other groups of electrical elements electrically stimulate a third portion 16 of the tubular wall different from the first and second portions to contract and close the lumen 13, while the electrical stimulation of the first and second portions 14, 15 of the tubular wall has been ceased, so that substantially normal blood circulation in the first and second portions is restored. In this manner, the electric stimulation of the constricted tubular wall is shifted over time from one portion of the tubular wall to another to insure recurrent restoration of blood circulation in the constricted tubular wall.
[00206] The control device 4 controls the stimulation device 3 to energize the electrical elements 7 with electric biphasic pulses, i.e., combined positive and negative pulses. The desired stimulation effect is achieved by varying different pulse parameters. Thus, the control device 4 controls the stimulation device 3 to vary the pulse amplitude (voltage), the off time period between successive pulses, the pulse duration and the pulse repetition frequency. The pulse current should be between 1 to 30mA. For neural stimulation, a pulse current of about 5mA and a pulse duration of about 30011s are suitable, whereas a pulse current of about 20mA and a pulse duration of about 301.ts are suitable for muscular stimulation. The pulse repetition frequency suitably is about 10Hz. For example, as illustrated in the Pulse/time diagram P/t of FIGURE 8A, a pulse combination including a negative pulse PS of short duration and high amplitude (voltage), and a positive pulse PL of long duration and low amplitude following the negative pulse may be cyclically repeated to form a pulse train of such pulse combinations. The energy content of the negative Pulse PS
should be substantially equal to the energy content of the positive pulse PL.
SUBSTITUTE SHEET (RULE 26) [00207] FIGURE 8B is a pulse/time diagram showing a modification of the electric stimulation shown in FIGURE 8A. Thus, the pulse combination of FIGURE
is mixed with a pulse train combination having a first relatively long pulse train PTL of high frequency/low amplitude pulses, appearing simultaneously with the positive pulse PL of the pulse combination of FIGURE 8A, and a second relatively short pulse train PTS of high frequency/low amplitude appearing simultaneously with the negative pulse PS of the pulse combination shown in FIGURE 8A. As a result, the high frequency/low amplitudes pulse trains PTL and PTS are superimposed on the positive and negative pulses PL and PS of FIGURE 8A, as illustrated in FIGURE
8B.
The pulse configuration of FIGURE 8B, and variations thereof, is beneficial to use in connection with the stimulation of particular human organs, in order to achieve the desired stimulation effect.
[00208] Preferably, the electric pulses form pulse trains, as illustrated in the Pulse/time diagrams P/t of FIGURES 9A, 9B, 9C and 9D. The Pulse/time diagram P/t of FIGURE 9A represents an individual area of the wall portion of the patient's tubular organ which is stimulated with a pulse train 18A. The pulse train 18A includes three initial negative pulses, each of which is of short duration and high amplitude (voltage), and one positive pulse of long duration and low amplitude following the negative pulses. After a delay to enable the area of the organ to restore substantially normal blood circulation, the pulse train 18A is repeated.
[00209] The Pulse/time diagram P/t of FIGURE 9B represents another individual area of the wall portion, which is stimulated with a pulse train 18B having the same configuration as the pulse train 18A. The pulse trains 18A and 18B
are shifted relative to each other, so that they partially overlap one another to ensure that the constricted wall portion always is stimulated to contract as desired.
[00210] The pulse/time diagrams P/t of FIGURES 10A and 10B represent two different areas of the wall portion, which are stimulated with cyclically repeated pulse trains 18C and 18D, respectively, having the same configuration. Each pulse train 180, 18D includes two initial negative pulses, each of which is of short duration and high amplitude (voltage), and one positive pulse of long duration and low amplitude following the two negative pulses. In this case, the pulse trains 180 and 18D
are shifted relative to each other, so that they do not overlap each other. Thus, the off time period between adjacent pulse trains 180 is longer than the duration of pulse SUBSTITUTE SHEET (RULE 26) train 18D and the off time period between adjacent pulse trains 18D is longer than the duration of pulse train 180.
[00211] The pulse trains 18A, 18B, 18C and 18D can be configured in many different ways. Thus, the control device 4 can control the stimulation device 2 to vary the length of each pulse train, the repetition frequency of the pulse trains, the number of pulses of each pulse train, and/or the off time periods between the pulse trains.
Typically, the control device 4 controls each off time period between the pulse trains to last long enough to restore substantially normal blood circulation in the area that just has been stimulated before that area again is stimulated with electric pulses.
[00212] FIGURES 11A and 11B show another embodiment of the invention that controls blood flow in a blood vessel 19, comprising a constriction device with two clamping elements 20a and 20b, a stimulation device in the form of two thermal stimulation elements 21a and 21b integrated in the clamping elements 20a, 20b, respectively, and a control device 4 for controlling the clamping elements 20a, 20b and stimulation elements 21a, 21b. The clamping elements 20a and 20b are movable towards and away from each other in the same manner as described above in connection with the embodiment according to FIGURES 5A-5C. The thermal stimulation elements 21a and 21b, which may include Pertier elements, are positioned on the clamping elements 20a, 20b, so that the thermal elements 21a are facing the thermal elements 21b. FIGURE 11A shows how the clamping elements 20a, 20b constrict the blood vessel 19, so that the blood flow is restricted.
FIGURE
11B shows how the control device 4 controls the thermal stimulation elements 21a, 21b to cool the wall of the blood vessel 19, so that the wall contracts and closes the blood vessel 19. To release the blood vessel 19, the control device 4 controls the thermal stimulation elements 21a, 21b to heat the wall of the blood vessel 19, so that the wall expands.
[00213] FIGURES 12A and 12B show hydraulic operation means suited for operating the constriction device of the embodiments described above.
Specifically, FIGURES 12A and 12B show the apparatus of FIGURE 2 provided with such means for hydraulic operation of the constriction device 2. (The stimulation device is not shown.) Thus, the housing 1 forms two hydraulic chambers 22a and 22b, in which the two clamping elements 5, 6 are slidable back and forth relative to the tubular tissue wall portion 8 of a patient's organ. The hydraulic operation means include an expandable reservoir 23, such as an elastic balloon, containing hydraulic fluid, SUBSTITUTE SHEET (RULE 26) conduits 24a and 24b between the reservoir 23 and the hydraulic chambers 22a, 22b, and a two-way pump 25 for pumping the hydraulic fluid in the conduits 24a, 24b.
The control device 4 controls the pump 25 to pump hydraulic fluid from the reservoir 23 to the chambers 22a, 22b to move the clamping elements 5, 6 against the wall portion 8, whereby the tubular wall portion 8 is constricted, see FIGURE 12B, and to pump hydraulic fluid from the chambers 22a, 22b to the reservoir 23 to move the clamping elements 5, 6 away from the wall portion 8, whereby the tubular wall 8 is released, see FIGURE 12A.
[00214] Alternatively, the embodiment of FIGURES 12A and 12B may be manually operated by applying suitable manually operable hydraulic means for distributing the hydraulic fluid between the expandable reservoir 23 and the hydraulic chambers 22a, 22b. In this case the pump 25 is omitted.
[00215] FIGURES 13A and 13B schematically show a mechanically operable embodiment of the invention, comprising an open ended tubular housing 26 applied on the tubular tissue wall portion 8 of a patient's organ, a constriction device 27 arranged in the housing 26 and a control device 4 for controlling the constriction device 27. A stimulation device (not shown) as described above is also provided in the housing 26. The constriction device 27 includes a clamping element 28, which is radially movable in the tubular housing 26 towards and away from the tubular wall portion 8 between a retracted position, see FIGURE 13A, and a clamping position, see FIGURE 13B, in which the clamping element 28 gently constricts the tubular wall portion 8. Mechanical operation means for mechanically operating the clamping element 28 includes an electric motor 29 attached to the housing 26 and a telescopic device 30, which is driven by the motor 29 and operatively connected to the clamping element 28. The control device 4 controls the electric motor 29 to expand the telescopic device 30 to move the clamping element 28 against the wall portion 8, whereby the tubular wall portion 8 is constricted, see FIGURE 13B, and controls the motor 29 to retract the telescopic device 30 to move the clamping element 28 away from the wall portion 8, whereby the wall portion 8 is released, see FIGURE
13A.
[00216] Alternatively, the motor 29 may be omitted and the telescopic device 30 be modified for manual operation, as shown in FIGURE 13C. Thus, a spring 30a may be provided acting to keep the telescopic device 30 expanded to force the clamping element 28 against the wall portion 8. The mechanical operation means may include a subcutaneously implanted lever mechanism 29a that is operatively connected to SUBSTITUTE SHEET (RULE 26) the telescopic device 30. The patient may push the lever mechanism 29a through the patient's skin 29b to pull the telescopic device 30 against the action of the spring 30a to the retracted position of the telescopic device 30, as indicated in phantom lines.
When the patient releases the lever mechanism 29a, the spring 30a expands the telescopic device 30, whereby clamping element 28 is forced against the wall portion 8.
[00217] The mechanical operation means as described above in connection with FIGURES 13A, 13B and 13C may also be implemented in the embodiments according to FIGURES 1-11.
[00218] FIGURE 14A illustrates the embodiment of FIGURE 2 applied on the small intestines 31 of a colostomy patient having a stoma in the abdomen. The clamping elements 5, 6 of the constriction device 2 constrict the small intestines 31 and the stimulation device 3 is energized to close the intestinal passageway.
(For the sake of clarity, the housing is not shown and the clamping elements 5, 6 are exaggerated.) In this embodiment, a control device includes an external control unit in the form of a hand-held wireless remote control 32, and an implanted internal control unit 33, which may include a microprocessor, for controlling the constriction and stimulation devices. The remote control 32 is operable by the patient to control the internal control unit 33 to switch on and off the constriction device and/or the stimulation device. Alternatively, however, the remote control 32 may be replaced by a subcutaneously implanted push button that is manually switched by the patient between "on" and"off . Such a manually operable push button may also be provided in combination with the remote control 32 as an emergency button to allow the patient to stop the operation of the apparatus in case of emergency or malfunction.
[00219] The internal control unit 33 controls an implanted operation device 34 to move the clamping elements 5, 6. An implanted source of energy 35, such as a rechargeable battery, powers the operation device 34. The internal control unit 33, which may be implanted subcutaneously or in the abdomen, also works as en energy receiver, i.e., for transforming wireless energy into electric energy and charging the implanted source of energy 35 (rechargeable battery) with the electric energy.
[00220] An implanted sensor 36 senses a physical parameter of the patient, such as the pressure in the intestines, or a parameter that relates to the pressure in the intestines, wherein the internal control unit 33 controls the constriction device 2 and/or the stimulation device 3 in response to signals from the sensor 36. In this SUBSTITUTE SHEET (RULE 26) embodiment the sensor 36 is a pressure sensor, wherein the internal control unit 33 controls the constriction device and/or stimulation device to change the constriction of the patient's intestines 31 in response to the pressure sensor 36 sensing a predetermined value of measured pressure. For example, the control unit 33 may control the constriction device and/or stimulation device to increase the constriction of the patient's intestines 31 in response to the pressure sensor sensing an increased pressure. Alternatively or in combination, the remote control 32 controls the constriction device and/or stimulation device in response to signals from the sensor 36, in the same manner as the internal control unit 33.
[00221] The remote control 32 may be equipped with means for producing an indication, such as a sound signal or displayed information, in response to signals from the sensor 36. When the patient's attention is taken by such an indication indicating an increased pressure exceeding a threshold value, he or she may use the remote control to control the constriction device and stimulation device to pump intestinal contents through the patient's stoma.
[00222] FIGURE 14B shows an embodiment which is similar to the embodiment of FIGURE 14A except that the constriction device is applied on the small intestines of a colostomy patient having the small intestines surgically connected to the patient's anus.
[00223] Of course, the constriction device 2 shown in FIGURES 14A and 14B
may be replaced by any one of the constriction devices described in the various embodiments of the present invention, where applicable.
[00224] FIGURES 15-17 show a mechanically operable constriction device having an elongated constriction member in the form of a circular resilient core 37 with two overlapping end portions 38, 39. The core 37 defines a substantially circular restriction opening and is enclosed in an elastic soft hose 40 except at a releasable and lockable joint 41 of the core 37, which when released enables application of the core 37 with its hose 40 around a portion of a tubular tissue wall of a patient's organ.
The materials of all of these elements are bio-compatible so that the patient' body will not reject them. An operation device 42 for mechanically operating the longitudinal extension of the core 37 to change the size of the restriction opening comprises a drive wheel 43 in frictional engagement with the overlapping end portions 38, 39 of the core 37. The drive wheel 43 is journalled on a holder 44 placed in the hose 40 and provided with two counter pressure rollers 45, 46 pressing the respective end SUBSTITUTE SHEET (RULE 26) portions 38, 39 of the core 37 against the drive wheel 43 to increase the frictional engagement there between. An electric motor 47 of the operation device is connected to the drive wheel 43 via a long flexible drive shaft 48, and is moulded together with a remote controlled power supply unit 49 in a body 50 of silicone rubber. The length of the flexible drive shaft 48 is selected so that the body 50 can be placed in a desired position in the patient's body, suitably in the abdomen.
[00225] The power supply unit 49 can be controlled to power the electric motor 47 to turn the drive wheel 43 in one direction to reduce the diameter of the core 37, so that the wall portion is constricted, or to turn the drive wheel 43 in the opposite direction to increase the diameter of the core 37, so that the wall portion is released.
[00226] In accordance with a first alternative, a rack gear may be formed on one of the end portions 38, 39 of the core 37 and the drive wheel 43 may be replaced by a drive gear wheel connected to the other end portion of the core 37 and in mesh with the rack gear.
[00227] In accordance with a second alternative, the operation device 42 may be designed as a worm-driven hose clamp, i. e., one of the end portions 38, 39 of the core 37 may be provided with threads and the other end portion of the core 37 may be provided with a worm, the threads of which interacts with the threads of said one end portion of the core 37. The threads of such a worm may also interact with threads provided on both end portions 38, 39 of the core 37. In this alternative, the electric motor 47 turns the worm in one direction to reduce the diameter of the core 37, so that the wall portion is constricted, or turn the worm in the opposite direction to increase the diameter of the core 37, so that the wall portion is released in one direction to reduce the diameter of the core 37, so that the wall portion is constricted, or turns the clamping screw in the opposite direction to increase the diameter of the core 37, so that the wall portion is released.
[00228] FIGURE 18 shows a constriction device which is identical to the embodiment of FIGURES 15-17, except that the motor 47 is encapsulated in the hose 40 so that it is fixed to the core 37 and has a short drive shaft 51, and that the motor 47 is positioned relative to the core 37, such that the drive shaft 51 extends substantially tangentially to the circular core 37. There is an angular gearing 52 connecting the drive shaft 51 to the drive wheel 43.
[00229] FIGURE 19 shows a suitable alternative arrangement for the motor 47 in the embodiment of FIGURE 18, comprising a first clamping member 53 secured to SUBSTITUTE SHEET (RULE 26) one end portion of the core 37 and a second clamping member 54 secured to the other end portion 39 of the core 37. The motor 47 is secured to the first clamping member 53 and is operatively connected to a worm gear 55 via a gear transmission 56. The worm gear 55 is journalled at its opposite ends on holders 57 and 58, which are rigidly secured to the clamping member 53 and the motor 47, respectively.
The second clamping member 54 has a pinion in mesh with the worm gear 55. When the motor 47 is powered, the worm gear 55 rotates, and will thereby pull the end portion 39 of the core 37 in one or the opposite longitudinal direction, so that the diameter of the substantially circular core 37 is either increased or decreased. The motor 47, worm gear 55, gear transmission 56 and second clamping member 54 constitute a servo system of the type that transfers a weak force acting on a moving element having a long stroke into a strong force acting on another moving element having a short stroke.
[00230] FIGURE 20 shows a constriction device including a plurality of arcuate lamellae 59 arranged like the conventional adjustable aperture mechanism of a camera. A motor 60 operates the lamellae 59 to change the size of a restriction opening defined by the lamellae 59.
[00231] FIGURES 21-23 show a constriction device including two semi-circular elements 61 and 62, which are hinged together such that the semi-circular elements 61, 62 are swingable relative to each other between a fully open state in which they substantially form a circle, as illustrated in FIGURE 22, and an angular state, in which the size of the restriction opening defined by the semi-circular elements 61, 62 is reduced, as illustrated in FIGURE 23. A motor 63 operates the semi-circular elements 61, 62 to swing them relative to each other.
[00232] FIGURES 24-26 show a constriction device including an elastic belt forming a circle and having a substantially oval cross-section. A motor 67 operates the belt 64 to turn around the longitudinal extension thereof between a fully open state, in which the inner broader side of the belt 64 forms a substantially cylindrical surface, as illustrated in FIGURE 25, and a reduced open state, in which the inner broader side of the belt 64 forms a substantially conical surface, as illustrated in FIGURE 26.
[00233] FIGURE 27 shows a constriction device 68 having two rigid articulated clamping elements 69 positioned on opposite sides of a portion of a tubular tissue wall 70 of a patient's organ. An operation device 71 turns the clamping elements 69 SUBSTITUTE SHEET (RULE 26) toward each other to clamp the wall portion 70 between the clamping elements 69 to thereby contract the wall portion, and turns the clamping elements 69 away from each other to release the wall portion from the clamping elements 69.
[002341 FIGURES 28 and 29 show an embodiment of the apparatus of the invention comprising a constriction device 300 having three bending members 301, 302 and 303 displaced relative to one another in a row along a portion of a tubular tissue wall 304 of a patient's organ and positioned alternately on opposite sides of the tubular wall 304. (Alternatively, each member 301, 302 and 303 may take the shape of an hour-glass.) An operation device (not shown) moves the two outer members 301, 303 laterally against the tubular wall 304 in one direction and the intermediate member 302 against the tubular wall 304 in the opposite direction to bend the tubular wall 304, to thereby constrict the tubular wall portion 304, as illustrated in FIGURE 29. To release the wall portion 304 the operation device moves the members 301-303 away from the tubular wall portion 304 to the position shown in FIGURE 28.
[00235] FIGURES 30A and 30B show a hydraulically operable elongated constriction device in the form of a band 72 having an expandable/contractible cavity 73, which is in fluid communication with an adjustable reservoir 74 containing hydraulic fluid. FIGURE 30A illustrates when the band is in a non-constriction state, whereas FIGURE 30B illustrates when the band is in a constriction state, in which the cavity 73 is expanded by hydraulic fluid supplied by the reservoir 74.
[00236] FIGURES 31A, 31B, 31C and 31D are block diagrams of four differently operated hydraulic constriction devices. FIGURE 31A shows the band 72 of FIGURE
30A, the cavity 73 of which is in fluid communication with a reservoir 75.
FIGURE
31B shows the embodiment of FIGURE 30A, in which the cavity 73 of the band 72 is in fluid communication with the reservoir 74 via an operation device in the form of a two-way pump 76. FIGURE 31C shows an operation device in the form of a reverse servo system with a first closed system controlling a second system. The reverse servo system comprises an adjustable fluid supply reservoir 77 and an adjustable servo reservoir 78. The servo reservoir 78 controls a larger adjustable reservoir 79 which in connection with the band 72 applied around a portion of tubular tissue wall of a patient's organ varies the volume of the cavity 73 of the band 72, which in turn varies the constriction of the wall portion. FIGURE 31D shows an embodiment identical to the embodiment of FIGURE 31C, except that the larger reservoir 79 is SUBSTITUTE SHEET (RULE 26) omitted. Instead, the servo reservoir 78 is in fluid communication with the cavity of the band 72.
[00237] In all of the above embodiments according to FIGURES 12A through 30B, stimulation devices may be provided to form constriction/stimulation units, in which the stimulation devices include a multiplicity of electrical elements 7 (indicated in FIGURES 12A ¨ 15, 18, 20¨ 23, 26¨ 31B) positioned on the constriction devices.
[00238] FIGURE 32 is a cross-sectional view of a fluid supply device including a bellows reservoir 80 defining a chamber 81, the size of which is variable by an operation device comprising a remote controlled electric motor 82. The reservoir 80 and the motor 82 are placed in a housing 83. Moving a large wall 84 varies the chamber 81. The wall 84 is secured to a nut 85, which is threaded on a rotatable spindle 86. The spindle 86 is rotated by the motor 82. A battery 89 placed in the housing 83 powers the motor 82. A signal receiver 90 for controlling the motor 82 is also placed in the housing 83. Alternatively, the battery 89 and the signal receiver 90 may be mounted in a separate place. The motor 82 may also be powered with energy transferred from transmitted signals.
[00239] Where applicable, the fluid supply device of FIGURE 32 may be used for supplying hydraulic fluid for the operation of the constriction devices described in this specification. For example, the fluid supply device of FIGURE 32 may be substituted for the reservoir 74 in the embodiment according to FIGURE 30A.
[00240] FIGURES 33A and 33B show a reverse servo including a rectangular housing 91 and an intermediate wall 92, which is movable in the housing 91. A
relatively large, substantially cylindrical bellows reservoir 93 is arranged in the housing 91 and is joined to the movable intermediate wall 92. Another cylindrical bellows reservoir 94, which is substantially smaller than reservoir 93, is arranged in the housing 91 at the other side of the intermediate wall 92 and is also joined to the wall 92. The small bellows reservoir 94 has a fluid supply pipe 95 and the large bellows reservoir 93 has a fluid supply pipe 96.
[00241] Referring to FIGURE 33A, when a small amount of hydraulic fluid is conducted through the supply pipe 95 into the small bellows reservoir 94, the small bellows reservoir 94 expands and pushes the movable intermediate wall 92 towards the large bellows reservoir 93. As a result, the large bellows reservoir 93 is contracted by the intermediate wall 92, whereby a large amount of hydraulic fluid is SUBSTITUTE SHEET (RULE 26) forced out of the large bellows reservoir 93 through the supply pipe 96, as shown in FIGURE 33B.
[00242] For example, the reverse servo of FIGURES 33A and 33B may be used in the embodiment of FIGURE 31C, wherein the small bellows reservoir 94 corresponds to the small servo reservoir 78 and the large bellows reservoir 93 corresponds to the large reservoir 79. Also, the reverse servo of FIGURES 33A
and 33B may be used in the embodiment of FIGURE 30A and 30B, wherein the small bellows reservoir 94 is connected to the adjustable reservoir 74, and the large bellows reservoir 93 is connected to the cavity 73 of the band 72.
[00243] FIGURE
34 schematically shows a hydraulically operable constriction device 97 of the apparatus of the invention, which is similar to the embodiment shown in FIGURE 30A, except that the hydraulic system is designed differently.
Thus, the constriction device 97 includes a relatively small inflatable cavity 98, which is in fluid communication with a reservoir 99 containing hydraulic fluid, and a relatively large cavity 100, which is displaceable by small cavity 98. Small cavity 98 is adapted to displace large cavity 100 to constrict the patient's tubular wall portion when small cavity 98 is inflated and to displace large cavity 100 to release the wall portion when small cavity 98 is deflated. Thus, a relatively small addition of hydraulic fluid from reservoir 99 to small cavity 98 causes a relatively large increase in the constriction of the wall portion.
[00244] Large cavity 100 is defined by a contraction element in the form of a big balloon 101, which may be connected to an injection port (not shown) for calibration of the volume of large cavity 100. Adding fluid to or withdrawing fluid from the injection port with the aid of a syringe calibrates the volume of balloon 101.
Small cavity 98 is defined by a small bellows 102 attached to an annular frame 103 of constriction device 97 and at the opposite end is attached to balloon 101.
[00245] FIGURES
35A and 35B schematically illustrate the operation of constriction device 97, when annular frame 103 is applied around the tubular wall portion of the patient's organ. Referring to FIGURE 35A, when small cavity 98 is deflated bellows 102 pulls balloon 101 inwardly into annular frame 103, so that constriction device 97 constricts the wall portion. Referring to FIGURE 35B, when small cavity 98 is inflated bellows 102 pulls balloon 101 out of annular frame 103, so that constriction device 97 releases the wall portion.
SUBSTITUTE SHEET (RULE 26) [00246] As mentioned above, the constriction device and stimulation device can co-operate to actively move the fluid and/or other bodily matter in the lumen of a patient's organ. This can be achieved using the constriction/stimulation unit shown in FIGURE 2. Thus, in accordance with a first cooperation option, the clamping elements 5, 6 of the constriction device constricts the wall portion 8 without completely closing the lumen, whereby the flow in the lumen is restricted, and the control device 4 controls the electrical elements 7 to progressively stimulate the constricted wall portion in the downstream or upstream direction of the lumen to cause progressive contraction of the wall portion 8 to move the fluid and/or other bodily matter in the lumen.
[00247] In accordance with a second cooperation option, the constriction device constricts the wall portion so that the flow in the lumen is restricted, and the control device 4 controls a few electrical elements 7 at one end of the elongate clamping elements 5, 6 to stimulate the constricted wall portion 8 to close the lumen either at an upstream end or a downstream end of the wall portion 8. With the lumen closed in this manner, the control device 4 controls the constriction device to increase the constriction of the wall portion, whereby the fluid and/or other bodily matter in the lumen is moved downstream or upstream of the wall portion 8.
[00248] In another embodiment of the invention for performing the second cooperation option, the constriction device constricts the wall portion so that the flow in the lumen is restricted, and the control device 4 controls the stimulation device to stimulate the constricted wall portion while the constriction device varies the constriction of the different areas of the wall portion, such that the wall portion is progressively constricted in the downstream or upstream direction of the lumen.
FIGURES 36A ¨ 36E show different operation stages of such an alternative embodiment, which comprises a constriction device 104 including two elongate constriction elements 105, 106 having convex surfaces 107, 108 that abut a length of the wall portion 8 on mutual sides thereof, and a multiplicity of electrical elements 7 (such as electrodes) that are positioned on the convex surfaces 107, 108. The control device 4 controls the electrical elements 7 during operation of the constriction device 104 and controls the elongate constriction elements 105, 106 to move relative to the tubular wall portion 8 so that the constriction elements 105, 106 progressively constrict the wall portion 8, as appears from FIGURES 36A to 36D.
SUBSTITUTE SHEET (RULE 26) [00249] Thus, in an initial position of the constriction elements 105, 106 shown in FIGURE 36A, the wall portion is not constricted by the constriction elements 105, 106 and the electrical elements 7 are not energized. Starting from this initial position, the control device 4 controls the constriction elements 105, 106 to swing the left ends of the constriction elements 105, 106 toward the wall portion (indicated by arrows) to constrict the tubular wall portion 8, see FIGURE 36B, while energizing the electrical elements 7, so that the electrical elements 7 that contact the wall portion 8 contract the latter. FIGURE 36 C shows how the lumen of the tubular wall portion 8 is completely closed by the thickened wall portion 8. Then, as shown in FIGURE
360, the control device 4 controls the constriction elements 105, 106 to move so that their right ends are moving towards each other (indicated by arrows), while the convex surfaces 107, 108 of the constriction elements 105, 106 are rolling on each other with the contracted wall portion 8 between them, see FIGURE 36D. As a result, the bodily matter in the lumen of the organ is forced to the right (indicated by a white arrow).
When the constriction elements 105, 106 have rolled on each other to the position shown in FIGURE 36E, the control device 4 controls the right ends of the constriction elements 105, 106 to move away from each other (indicated by arrows in FIGURE
36E) to the initial position shown in FIGURE 36A. The operation stages described according to FIGURES 36A to 36E can be cyclically repeated a number of times until the desired amount of bodily matter has been moved in the lumen of the organ in a peristaltic manner.
[00250] Alternatively, only one of the constriction elements 105, 106 can be provided with a convex surface, whereas the other constriction element has a plane surface that abuts the wall portion. It is also possible to use a single constriction element with a convex surface that presses the tubular portion 8 of the organ against a bone of the patient.
[00251] In the embodiment according to FIGURES 36A to 36E, the control device 4 may control the electrical elements 7 to progressively stimulate the constricted wall portion 8 to cause progressive contraction thereof in harmony with the movement of the elongate constriction elements 105, 106, as the convex surfaces 107, 108 of the constriction elements 105, 106 are rolling on each other.
[00252] .FIGURE 37 schematically shows a general embodiment of the apparatus of the invention, in which energy is transferred to energy consuming components of the apparatus implanted in the patient. The apparatus of FIGURE
SUBSTITUTE SHEET (RULE 26) comprises an implanted constriction/stimulation unit 110, which is operable to gently constrict a portion of a tubular tissue wall of a patient's organ and to stimulate different areas of the constricted portion to cause contraction of the wall portion. The constriction device of the constriction/stimulation unit 110 is capable of performing a reversible function, i.e., to constrict and release the wall portion, so that the constriction/stimulation unit 110 works as an artificial sphincter.
[00253] A source of energy 111 is adapted to supply energy consuming components of the constriction/stimulation unit 110 with energy via a power supply line 112. A wireless remote control or a subcutaneously implanted switch operable by the patient to switch on or off the supply of energy from the source of energy may be provided. The source of energy may be an implantable permanent or rechargeable battery, or be included in an external energy-transmission device, which may be operable directly by the patient or be controlled by a remote control operable by the patient to transmit wireless energy to the energy consuming components of the constriction/stimulation unit. Alternatively, the source of energy may comprise a combination of an implantable rechargeable battery, an external energy-transmission device and an implantable energy-transforming device for transforming wireless energy transmitted by the external energy-transmission device into electric energy for the charge of the implantable rechargeable battery.
[00254] FIGURE 38 shows a special embodiment of the general embodiment of FIGURE 37 having some parts implanted in a patient and other parts located outside the patient's body. Thus, in FIGURE 38 all parts placed to the right of the patient's skin 109 are implanted and all parts placed to the left of the skin 109 are located outside the patient's body. An implanted energy-transforming device 111A of the apparatus is adapted to supply energy consuming components of the constriction/stimulation unit 110 with energy via the power supply line 112.
An external energy-transmission device 113 of the apparatus includes a wireless remote control transmitting a wireless signal, which is received by a signal receiver incorporated in the implanted energy-transforming device 111A. The implanted energy-transforming device 111A transforms energy from the signal into electric energy, which is supplied via the power supply line 112 to the constriction/stimulation unit 110.
[00255] The apparatus of FIGURE 38 may also include an implanted rechargeable battery for energizing energy consuming implanted components of the SUBSTITUTE SHEET (RULE 26) apparatus. In this case, the implanted energy-transforming device 111A also charges the battery with electric energy, as the energy-transforming device transforms energy from the signal into the electric energy.
[00256] A reversing device in the form of an electric switch 114, such as a microprocessor, is implanted in the patient for reversing the constriction device of the constriction/stimulation unit 110. The wireless remote control of the external energy-transmission device 113 transmits a wireless signal that carries energy and the implanted energy-transforming device 111A transforms the wireless energy into a current for operating the switch 114. When the polarity of the current is shifted by the energy-transforming-device 111A the switch 114 reverses the function performed by the constriction device of the constriction/stimulation unit 110.
[00257] FIGURE 39 shows an embodiment of the invention including the energy-transforming device 111A, the constriction/stimulation unit 110 and an implanted operation device in the form of a motor 115 for operating the constriction device of the constriction/stimulation unit 110. The motor 115 is powered with energy from the energy-transforming device 111A, as the remote control of the external energy-transmission device113 transmits a wireless signal to the receiver of the energy-transforming device 111A.
[00258] FIGURE 40 shows an embodiment of the invention including the energy-transforming device 111A, the constriction/stimulation unit 110 and an implanted assembly 116 including a motor/pump unit 117 and a fluid reservoir 118. In this case the constriction device of the constriction/stimulation unit 110 is hydraulically operated, i.e., hydraulic fluid is pumped by the motor/pump unit from the reservoir 118 to the constriction/stimulation unit 110 to constrict the wall portion, and hydraulic fluid is pumped by the motor/pump unit 117 back from the constriction/stimulation unit 110 to the reservoir 118 to release the wall portion. The implanted energy-transforming device 111A transforms wireless energy into a current, for powering the motor/pump unit 117.
[00259] FIGURE 41 shows an embodiment of the invention comprising the external energy-transmission device 113.that controls the control unit 122 to reverse the motor 115 when needed, the constriction/stimulation unit 110, the constriction device of which is hydraulically operated, and the implanted energy-transforming device 111A, and further comprising an implanted hydraulic fluid reservoir 119, an implanted motor/pump unit 120, an implanted reversing device in the form of a SUBSTITUTE SHEET (RULE 26) hydraulic valve shifting device 121 and a separate external wireless remote control 111B. The motor of the motor/pump unit 120 is an electric motor. In response to a control signal from the wireless remote control of the external energy-transmission device 113, the implanted energy-transforming device 111A powers the motor/pump unit 120 with energy from the energy carried by the control signal, whereby the motor/pump unit 120 distributes hydraulic fluid between the reservoir 119 and the constriction device of the constriction/stimulation unit 110. The remote control 111B
controls the shifting device 121 to shift the hydraulic fluid flow direction between one direction in which the fluid is pumped by the motor/pump unit 120 from the reservoir 119 to the constriction device of the constriction/stimulation unit 110 to constrict the wall portion, and another opposite direction in which the fluid is pumped by the motor/pump unit 120 back from the constriction device of the constriction/stimulation unit 110 to the reservoir 119 to release the wall portion.
[00260] FIGURE 42 shows an embodiment of the invention including the energy-transforming device 111A and the constriction/stimulation unit 110. A
control unit 122, an accumulator 123 and a capacitor 124 are also implanted in the patient. A
separate external wireless remote control 111B controls the control unit 122.
The control unit 122 controls the energy-transforming device 111A to store electric energy in the accumulator 123, which supplies energy to the constriction/stimulation unit 110.
In response to a control signal from the wireless remote control 111B, the control unit 122 either releases electric energy from the accumulator 123 and transfers the released energy via power lines, or directly transfers electric energy from the energy-transforming device 111A via the capacitor 124, which stabilises the electric current, for the operation of the constriction/stimulation unit 110.
[00261] In accordance with one alternative, the capacitor 124 in the embodiment of FIGURE 42 may be omitted. In accordance with another alternative, the accumulator 123 in this embodiment may be omitted.
[00262] FIGURE 43 shows an embodiment of the invention including the energy-transforming device 111A, the constriction/stimulation unit 110. A
battery 125 for supplying energy for the operation of the constriction/stimulation unit 110 and an electric switch 126 for switching the operation of the constriction/stimulation unit 110 are also implanted in the patient. The switch 126 is operated by the energy supplied by the energy-transforming device 111A to switch from an off mode, in which the SUBSTITUTE SHEET (RULE 26) battery 125 is not in use, to an on mode, in which the battery 125 supplies energy for the operation of the constriction/stimulation unit 110.
[00263] FIGURE 44 shows an embodiment of the invention identical to that of FIGURE 43, except that a control unit 122 also is implanted in the patient. A
separate external wireless remote control 111B controls the control unit 122. In this case, the switch 126 is operated by the energy supplied by the energy-transforming device 111A to switch from an off mode, in which the wireless remote control 111B is prevented from controlling the control unit 122 and the battery 125 is not in use, to a standby mode, in which the remote control 111B is permitted to control the control unit 122 to release electric energy from the battery 125 for the operation of the constriction/stimulation unit 110.
[00264] FIGURE 45 shows an embodiment of the invention identical to that of FIGURE 44, except that the accumulator 123 is substituted for the battery 125 and the implanted components are interconnected differently. In this case, the accumulator 123 stores energy from the energy-transforming device 111A. In response to a control signal from the wireless remote control 111B, the implanted control unit 122 controls the switch 126 to switch from an off mode, in which the accumulator 123 is not in use, to an on mode, in which the accumulator 123 supplies energy for the operation of the constriction/stimulation unit 110.
[00265] FIGURE 46 shows an embodiment of the invention identical to that of FIGURE 45, except that the battery 125 also is implanted in the patient, and the implanted components are interconnected differently. In response to a control signal from the wireless remote control 111B, the implanted control unit 122 controls the accumulator 123, which may be a capacitor, to deliver energy for operating the switch 126 to switch from an off mode, in which the battery 125 is not in use, to an on mode, in which the battery 125 supplies electric energy for the operation of the constriction/stimulation unit 110.
[00266] Alternatively, the switch 126 may be operated by energy supplied by the accumulator 123 to switch from an off mode, in which the wireless remote control 111B is prevented from controlling the battery 125 to supply electric energy and the battery 125 is not in use, to a standby mode, in which the wireless remote control 111B is permitted to control the battery 125 to supply electric energy for the operation of the constriction/stimulation unit 110.
SUBSTITUTE SHEET (RULE 26) [00267] FIGURE 47 shows an embodiment of the invention identical to that of FIGURE 43, except that a motor 115, a mechanical reversing device in the form of a gearbox 127 and a control unit 122 for controlling the gearbox 127 also are implanted in the patient. A separate external wireless remote control 111B controls the implanted control unit 122 to control the gearbox 127 to reverse the function performed by the constriction device (mechanically operated) of the constriction/stimulation unit 110.
[00268] FIGURE 48 shows an embodiment of the invention identical to that of FIGURE 46, except that the implanted components are interconnected differently.
Thus, in this case, the battery 125 powers the control unit 122 when the accumulator 123, suitably a capacitor, activates the switch 126 to switch to an on mode.
When the switch 126 is in its on mode the control unit 122 is permitted to control the battery 125 to supply, or not supply, energy for the operation of the constriction/stimulation unit 110.
[00269] FIGURE 49 shows an embodiment of the invention identical to that of FIGURE 39, except that a gearbox 127 that connects the motor 115 to the constriction/stimulation unit 110, and a control unit 122 that controls the energy-transforming device 111A to power the motor 115 also are implanted in the patient.
There is a separate external wireless remote control 111B that controls the control unit 122 to reverse the motor 115 when needed.
[00270] Optionally, the accumulator 123 shown in FIGURE 42 may be provided in the embodiment of FIGURE 49, wherein the implanted control unit 122 controls the energy-transforming device 111A to store the transformed energy in the accumulator 123. In response to a control signal from the wireless remote control 111B, the control unit 122 controls the accumulator 123 to supply energy for the operation of the constriction/stimulation unit 110.
[00271] Those skilled in the art will realise that the above various embodiments according to FIGURES 38-49 could be combined in many different ways. For example, the energy operated switch 114 could be incorporated in any of the embodiments of FIGURES 39, 42-49, the hydraulic shifting device 121 could be incorporated in the embodiment of FIGURE 40, and the gearbox 127 could be incorporated in the embodiment of FIGURE 39. The switch 114 may be of a type that includes electronic components, for example a microprocessor, or a FGPA (Field Programmable Gate Array) designed for switching. Alternatively, however, the energy SUBSTITUTE SHEET (RULE 26) operated switch 114 may be replaced by a subcutaneously implanted push button that is manually switched by the patient between "on" and"off".
[00272]
Alternatively, a permanent or rechargeable battery may be substituted for the energy-transforming devices 111A of the embodiments shown in FIGURES
38-49.
[00273] FIGURE
50 shows the energy-transforming device in the form of an electrical junction element 128 for use in any of the above embodiments according to FIGURES 37-49. The element 128 is a flat p-n junction element comprising a p-type semiconductor layer 129 and an n-type semiconductor layer 130 sandwiched together. A light bulb 131 is electrically connected to opposite sides of the element 128 to illustrate how the generated current is obtained. The output of current from such a p-n junction element 128 is correlated to the temperature. See the formula below.
I = 10 (exp(qVikT)-1) Where I is the external current flow, is the reverse saturation current, q is the fundamental electronic charge of 1.602 x 10-19 coulombs, V is the applied voltage, k is the Boltzmann constant, and T is the absolute temperature.
[00274] Under large negative applied voltage (reverse bias), the exponential term becomes negligible compared to 1.0, and I is approximately -10. 10 is strongly dependent on the temperature of the junction and hence on the intrinsic-carrier concentration. 10 is larger for materials with smaller bandgaps than for those with larger bandgaps. The rectifier action of the diode, that is, its restriction of current flow to only one direction, is in this particular embodiment the key to the operation of the p-n junction element 128.
[00275] The alternative way to design a p-n junction element is to deposit a thin layer of semiconductor onto a supporting material which does not absorb the kind of energy utilised in the respective embodiments. For use with wirelessly transmitted energy in terms of light waves, glass could be a suitable material. Various materials may be used in the semiconductor layers, such as, but not limited to, cadmium SUBSTITUTE SHEET (RULE 26) telluride, copper-indium-diselenide and silicon. It is also possible to use a multilayer structure with several layers of p and n-type materials to improve efficiency.
[00276] The electric energy generated by the p-n junction element 128 could be of the same type as generated by solar cells, in which the negative and positive fields create a direct current. Alternatively, the negative and positive semiconductor layers may change polarity following the transmitted waves, thereby generating the alternating current.
[00277] The p-n junction element 128 is designed to make it suited for implantation. Thus, all the external surfaces of the element 128 in contact with the human body are made of a biocompatible material. The p-n junction semiconductors are designed to operate optimally at a body temperature of 37 C because the current output, which should be more than 1 IAA, is significantly dependent upon such temperature, as shown above. Since both the skin and subcutis absorb energy, the relation between the sensitivity or working area of the element 128 and the intensity or strength of the wireless energy-transmission is considered. The p-n junction element 128 preferably is designed flat and small. Alternatively, if the element 128 is made in larger sizes it should be flexible, in order to adapt to the patient's body movements. The volume of the element 128 should be kept less than 2000 cm3.
[00278] FIGURE 51 shows basic parts of a remote control of the apparatus of the invention for controlling the constriction/stimulation unit 110. In this case, the stimulation device of the constriction/stimulation unit stimulates the wall portion with electric pulses. The remote control is based on wireless transmission of electromagnetic wave signals, often of high frequencies in the order of 100 kHz - 1 gHz, through the skin 132 of the patient. In FIGURE 51, all parts placed to the left of the skin 132 are located outside the patient's body and all parts placed to the right of the skin 132 are implanted.
[00279] An external signal-transmission device 133 is to be positioned close to a signal-receiving device 134 implanted close to the skin 132. As an alternative, the signal-receiving device 134 may be placed for example inside the abdomen of the patient. The signal-receiving device 134 comprises a coil, approximately 1-100 mm, preferably 25 mm in diameter, wound with a very thin wire and tuned with a capacitor to a specific high frequency. A small coil is chosen if it is to be implanted under the skin of the patient and a large coil is chosen if it is to be implanted in the abdomen of the patient. The signal transmission device 133 comprises a coil having about the SUBSTITUTE SHEET (RULE 26) same size as the coil of the signal-receiving device 134 but wound with a thick wire that can handle the larger currents that is necessary. The coil of the signal transmission device 133 is tuned to the same specific high frequency as the coil of the signal-receiving device 134.
[00280] The signal-transmission device 133 is adapted to send digital information via the power amplifier and signal-receiving device 134 to an implanted control unit 135. To avoid that accidental random high frequency fields trigger control commands, digital signal codes are used. A conventional keypad placed on the signal transmission device 133 is used to order the signal transmission device 133 to send digital signals for the control of the constriction/stimulation unit. The signal transmission device 133 starts a command by generating a high frequency signal.
After a short time, when the signal has energized the implanted parts of the control system, commands are sent to operate the constriction device of the constriction/stimulation unit 110 in predefined steps. The commands are sent as digital packets in the form illustrated below.
Start pattern, Command, Count, Checksum, 8 bits 8 bits 8 bits 8 bits [00281] The commands are sent continuously during a rather long time period (e.g., about 30 seconds or more). When a new constriction or release step is desired, the Count byte is increased by one to allow the implanted control unit 135 to decode and understand that another step is demanded by the signal transmission device 133. If any part of the digital packet is erroneous, its content is simply ignored.
[00282] Through a line 136, an implanted energizer unit 137 draws energy from the high frequency electromagnetic wave signals received by the signal-receiving device 134. The energizer unit 137 stores the energy in a source of energy, such as a large capacitor, powers the control unit 135 and powers the constriction/stimulation unit 110 via a line 138.
[00283] The control unit 135 comprises a demodulator and a microprocessor.
The demodulator demodulates digital signals sent from the signal transmission device 133. The microprocessor receives the digital packet, decodes it and sends a SUBSTITUTE SHEET (RULE 26) control signal via a signal line 139 to control the constriction device of the constriction/stimulation unit 110 to either constrict or release the wall portion of the patient's organ depending on the received command code.
[00284] FIGURE 52 shows a circuitry of an embodiment of the invention, in which wireless energy is transformed into a current. External components of the circuitry include a microprocessor 140, a signal generator 141 and a power amplifier 142 connected thereto. The microprocessor 140 is adapted to switch the signal generator 141 on/off and to modulate signals generated by the signal generator with digital commands. The power amplifier 142 amplifies the signals and sends them to an external signal-transmitting antenna coil 143. The antenna coil 143 is connected in parallel with a capacitor 144 to form a resonant circuit tuned to the frequency generated by the signal generator 141.
[00285] Implanted components of the circuitry include a signal receiving antenna coil 145 and a capacitor 146 forming together a resonant circuit that is tuned to the same frequency as the transmitting antenna coil 143. The signal receiving antenna coil 145 induces a current from the received high frequency electromagnetic waves and a rectifying diode 147 rectifies the induced current, which charges a storage capacitor 148. The storage capacitor 148 powers a motor 149 for driving the constriction device of the constriction/stimulation unit 110. A coil 150 connected between the antenna coil 145 and the diode 147 prevents the capacitor 148 and the diode 147 from loading the circuit of the signal-receiving antenna 145 at higher frequencies. Thus, the coil 150 makes it possible to charge the capacitor 148 and to transmit digital information using amplitude modulation.
[00286] A capacitor 151 and a resistor 152 connected in parallel and a diode 153 form a detector used to detect amplitude modulated digital information. A
filter circuit is formed by a resistor 154 connected in series with a resistor 155 connected in series with a capacitor 156 connected in series with the resistor 154 via ground, and a capacitor 157, one terminal of which is connected between the resistors 154,155 and the other terminal of which is connected between the diode 153 and the circuit formed by the capacitor 151 and resistor 152. The filter circuit is used to filter out undesired low and high frequencies. The detected and filtered signals are fed to an implanted microprocessor 158 that decodes the digital information and controls the motor 149 via an H-bridge 159 comprising transistors 160, 161, 162 and 163. The motor 149 can be driven in two opposite directions by the H-bridge 159.
SUBSTITUTE SHEET (RULE 26) [00287] The microprocessor 158 also monitors the amount of stored energy in the storage capacitor 148. Before sending signals to activate the motor 149, the microprocessor 158 checks whether the energy stored in the storage capacitor 148 is enough. If the stored energy is not enough to perform the requested operation, the microprocessor 158 waits for the received signals to charge the storage capacitor 148 before activating the motor 149.
[00288] Alternatively, the energy stored in the storage capacitor 148 may only be used for powering a switch, and the energy for powering the motor 149 may be obtained from another implanted energy source of relatively high capacity, for example a battery. In this case the switch is adapted to connect the battery to the motor 149 in an on mode when the switch is powered by the storage capacitor and to keep the battery disconnected from the motor 149 in a standby mode when the switch is not powered.
[00289] FIGURES 53A ¨ 53C show an embodiment of the invention, which is similar to the embodiment of FIGURE 2, except that the constriction/stimulation unit, here denoted by reference numeral 200, is provided with additional clamping elements. The embodiment of FIGURES 53A ¨ 53C is suited for actively moving the fluid and/or other bodily matter in the lumen of a patient's organ. Thus, the constriction/stimulation unit 200 also includes a first pair of short clamping elements 201 and 202, and a second pair of short clamping elements 203 and 204, wherein the first and second pairs of clamping elements are positioned at mutual sides of the elongate clamping elements 5, 6. The two short clamping elements 201, 202 of the first pair are radially movable towards and away from each other between retracted positions (FIGURE 53A) and clamping positions (FIGURES 53B and 530), and the two short clamping elements 203, 204 of the second pair are radially movable towards and away from each other between retracted positions (FIGURE 530) and clamping positions (FIGURES 53A and 53B). The stimulation device 3 also includes electrical elements 7 positioned on the short clamping elements 201 - 204, so that the electrical elements 7 on one of the short clamping elements 201 and 203, respectively, of each pair of short elements face the electrical elements 7 on the other short clamping element 202 and 204, respectively, of each pair of short elements.
[00290] The constriction/stimulation unit 200 is applied on a wall portion 8 of a tubular tissue wall of a patient's organ, so that the short clamping elements 201, 202 SUBSTITUTE SHEET (RULE 26) are positioned at an upstream end of the wall portion 8, whereas the short clamping elements 203, 204 202 are positioned at a downstream end of the wall portion 8. In FIGURES 53A to 53C the upstream end of the wall portion 8 is to the left and the downstream end of the wall portion 8 is to the right.
[00291] The control device 4 controls the pair of short clamping elements 202, the pair of elongate clamping elements 5, 6 and the pair of short elements 203, 204 to constrict and release the wall portion 8 independently of one another.
The control device also controls the electrical elements 7 on a clamping element that is constricting the wall portion to stimulate the constricted wall portion 8 with electric pulses to cause contraction of the wall portion 8, so that the lumen of the wall portion 8 is closed.
[00292] FIGURES 53A ¨ 53C illustrate how the control device 4 controls the operation of the constriction/stimulation unit 200 to cyclically move fluid and/or other bodily matter downstream in the lumen of the wall portion 8. Thus, in FIGURE
the short clamping elements 201, 202 and the elongate clamping elements 5, 6 are in their retracted positions, whereas the short clamping elements 203, 204 are in their clamping positions while the electrical elements 7 on elements 203, 204 electrically stimulate the wall portion 8. The electrical stimulation causes the wall portion 8 at the elements 203, 204 to thicken, whereby the lumen is closed. FIGURE 53B
illustrates how also the short clamping elements 201, 202 have been moved radially inwardly to their clamping positions, while the electrical elements 7 on elements 201, 202 electrically stimulate the wall portion 8, whereby a volume of bodily matter is trapped in the lumen between the upstream and downstream ends of the wall portion 8.
FIGURE 53C illustrates how initially the short clamping elements 203, 204 have been moved radially outwardly to their retracted positions, and then the elongate clamping elements 5, 6 have been moved radially inwardly to their clamping positions while the electrical elements 7 on elements 5, 6 electrically stimulate the wall portion 8. As a result, the bodily matter in the lumen between the upstream and downstream ends of the wall portion 8 has been moved downstream in the lumen Then, the control device 4 controls the constriction/stimulation unit 200 to assume the state shown in FIGURE
53A, whereby bodily matter may flow into and fill the lumen between the upstream and downstream ends of the wall portion 8, so that the cycle of the operation is completed.
SUBSTITUTE SHEET (RULE 26) [00293] Alternatively, the operation cycle of the constriction/stimulation unit 200 described above may be reversed, in order to move bodily matter upstream in the lumen. In this case, the control device 4 controls the short clamping elements 203, 204 to constrict the wall portion 8 at the downstream end thereof to restrict the flow in the lumen and controls the electric elements 7 to stimulate the constricted wall portion 8 with electric pulses at the downstream end to close the lumen. With the lumen closed at the downstream end of the constricted wall portion 8 and the short clamping elements 201, 202 in their retracted positions, as shown in FIGURE
53A, the control device 4 controls the elongate clamping elements 5, 6 to constrict the wall portion 8 between the upstream and downstream ends thereof. As a result, the fluid and/or other bodily matter contained in the wall portion 8 between the upstream and downstream ends thereof is moved upstream in the lumen.
[00294] Although FIGURES 53A ¨ 53C disclose pairs of clamping elements, it should be noted that it is conceivable to design the constriction/stimulation unit 200 with only a single short clamping element 201, a single elongate clamping element 5 and a single short clamping element 203. In this case the bottom of the tubular wall portion 8 is supported by stationary elements of the constriction/stimulation unit 200 opposite to the clamping elements 201, 5, and 203.
[00295] FIGURES 54A and 54B schematically show another embodiment of the invention, in which a constriction/stimulation unit 205 is designed for actively moving the fluid and/or other bodily matter in the lumen of a patient's tubular organ. The constriction device 206 of the constriction/stimulation unit 205 includes a rotor 207, which carries three cylindrical constriction elements 208A, 208B and 208C
positioned equidistantly from the axis 209 of the rotor 207. The constriction elements 208C may be designed as rollers. Each cylindrical element 208A-208C is provided with electrical elements 7. A stationary elongate support element 210 is positioned spaced from but close to the rotor 207 and has a part cylindrical surface 211 concentric with the axis 209 of the rotor 207. The constriction/stimulation unit 205 is applied on a patient's tubular organ 212, so that the organ 212 extends between the support element 210 and the rotor 207.
[00296] The control device 4 controls the rotor 207 of the constriction device to rotate, such that the constriction elements 208A-208C successively constrict wall portions of a series of wall portions of the tubular organ 212 against the elongate support element 210. The electrical elements 7 of the constriction elements SUBSTITUTE SHEET (RULE 26) 208C stimulate the constricted wall portions with electric pulses so that the wall portions thicken and close the lumen of the organ 212. FIGURE 54A illustrates how the constriction element 208A has started to constrict the wall of the organ 212 and how the lumen of the organ 212 is closed with the aid of the electrical elements 7 on the constriction element 208A, whereas the constriction element 208B is about to release the organ 212. FIGURE 54B illustrates how the constriction element has advanced about halfway along the elongate support element 210 and moved the bodily matter in the lumen in a direction indicated by an arrow. The constriction element 208B has released the organ 212, whereas the constriction element 208C
is about to engage the organ 212. Thus, the control device 4 controls the rotor 207 to cyclically move the constriction elements 208A-2080, one after the other, along the elongate support element 210, while constricting the wall portions of the organ 212, so that the bodily matter in the organ 212 is moved in a peristaltic manner.
[00297] FIGURES 55A, 55B and 55C show another mechanically operable constriction device 213 for use in the apparatus of the invention. Referring to FIGURE 55A, the constriction device 213 includes a first ring-shaped holder applied on a tubular organ 8 of a patient and a second ring-shaped holder 215 also applied on the organ 8 spaced apart from holder 214. There are elastic strings (here twelve strings) that extend in parallel along the tubular organ 8 and interconnect the two holders 213, 214 without contacting the organ 8. FIGURE
illustrate an inactivated state of the constriction device 213 in which the organ 8 is not constricted.
[00298] Referring to FIGURES 55B and 55C, when organ 8 is to be constricted the ring-shaped holders 213 and 214 are rotated by an operation means (not shown) in opposite directions, whereby the elastic strings 216 constrict the organ 8 in a manner that appears from FIGURES 55B and 55C. For the sake of clarity, only five strings 216 are shown in FIGURE 55B.
[00299] In accordance with the present invention, electrodes for electrically stimulating the organ 8 to cause contraction of the wall of the organ 8 are attached to the strings 216 (not shown in FIGURES 55A-55C).
[00300] FIGURE 56 schematically illustrates an arrangement of the apparatus that is capable of sending information from inside the patient's body to the outside thereof to give information related to at least one functional parameter of the apparatus, and/or related to a physical parameter of the patient, in order to supply an SUBSTITUTE SHEET (RULE 26) accurate amount of energy to an implanted internal energy receiver 302 connected to energy consuming components of an implanted constriction/stimulation unit 301 of the apparatus of the invention. Such an energy receiver 302 may include a source of energy and/or an energy-transforming device. Briefly described, wireless energy is transmitted from an external source of energy 304a located outside the patient and is received by the internal energy receiver 302 located inside the patient. The internal energy receiver is adapted to directly or indirectly supply received energy to the energy consuming components of the constriction/stimulation unit 301 via a switch 326. An energy balance is determined between the energy received by the internal energy receiver 302 and the energy used for the constriction/stimulation unit 301, and the transmission of wireless energy is then controlled based on the determined energy balance. The energy balance thus provides an accurate indication of the correct amount of energy needed, which is sufficient to operate the constriction/stimulation unit 301 properly, but without causing undue temperature rise.
[00301] In FIGURE 56 the patient's skin is indicated by a vertical line 305. Here, the energy receiver comprises an energy-transforming device 302 located inside the patient, preferably just beneath the patient's skin 305. Generally speaking, the implanted energy-transforming device 302 may be placed in the abdomen, thorax, muscle fascia (e.g. in the abdominal wall), subcutaneously, or at any other suitable location. The implanted energy-transforming device 302 is adapted to receive wireless energy E transmitted from the external source of energy 304a provided in an external energy-transmission device 304 located outside the patient's skin 305 in the vicinity of the implanted energy-transforming device 302.
[00302] As is well known in the art, the wireless energy E may generally be transferred by means of any suitable Transcutaneous Energy Transfer (TET) device, such as a device including a primary coil arranged in the external source of energy 304a and an adjacent secondary coil arranged in the implanted energy-transforming device 302. When an electric current is fed through the primary coil, energy in the form of a voltage is induced in the secondary coil which can be used to power the implanted energy consuming components of the apparatus, e.g. after storing the incoming energy in an implanted source of energy, such as a rechargeable battery or a capacitor. However, the present invention is generally not limited to any particular SUBSTITUTE SHEET (RULE 26) energy transfer technique, TET devices or energy sources, and any kind of wireless energy may be used.
[00303] The amount of energy received by the implanted energy receiver may be compared with the energy used by the implanted components of the apparatus.
The term "energy used" is then understood to include also energy stored by implanted components of the apparatus. A control device includes an external control unit 304b that controls the external source of energy 304a based on the determined energy balance to regulate the amount of transferred energy. In order to transfer the correct amount of energy, the energy balance and the required amount of energy is determined by means of a determination device including an implanted internal control unit 315 connected between the switch 326 and the constriction/stimulation unit 301. The internal control unit 315 may thus be arranged to receive various measurements obtained by suitable sensors or the like, not shown, measuring certain characteristics of the constriction/stimulation unit 301, somehow reflecting the required amount of energy needed for proper operation of the constriction/stimulation unit 301. Moreover, the current condition of the patient may also be detected by means of suitable measuring devices or sensors, in order to provide parameters reflecting the patient's condition. Hence, such characteristics and/or parameters may be related to the current state of the constriction/stimulation unit 301, such as power consumption, operational mode and temperature, as well as the patient's condition reflected by parametyers such as: body temperature, blood pressure, heartbeats and breathing. Other kinds of physical parameters of the patient and functional parameters of the device are described elsewhere.
00304] Furthermore, a source of energy in the form of an accumulator 316 may optionally be connected to the implanted energy-transforming device 302 via the control unit 315 for accumulating received energy for later use by the constriction/stimulation unit 301. Alternatively or additionally, characteristics of such an accumulator, also reflecting the required amount of energy, may be measured as well. The accumulator may be replaced by a rechargeable battery, and the measured characteristics may be related to the current state of the battery, any electrical parameter such as energy consumption voltage, temperature, etc. In order to provide sufficient voltage and current to the constriction/stimulation unit 301, and also to avoid excessive heating, it is clearly understood that the battery should be charged optimally by receiving a correct amount of energy from the implanted energy-SUBSTITUTE SHEET (RULE 26) transforming device 302, i.e. not too little or too much. The accumulator may also be a capacitor with corresponding characteristics.
[00306] For example, battery characteristics may be measured on a regular basis to determine the current state of the battery, which then may be stored as state information in a suitable storage means in the internal control unit 315.
Thus, whenever new measurements are made, the stored battery state information can be updated accordingly. In this way, the state of the battery can be "calibrated"
by transferring a correct amount of energy, so as to maintain the battery in an optimal condition.
[00306] Thus, the internal control unit 315 of the determination device is adapted to determine the energy balance and/or the currently required amount of energy, (either energy per time unit or accumulated energy) based on measurements made by the above-mentioned sensors or measuring devices of the apparatus, or the patient, or an implanted source of energy if used, or any combination thereof.
The internal control unit 315 is further connected to an internal signal transmitter 327, arranged to transmit a control signal reflecting the determined required amount of energy, to an external signal receiver 304c connected to the external control unit 304b. The amount of energy transmitted from the external source of energy 304a may then be regulated in response to the received control signal.
[00307] Alternatively, the determination device may include the external control unit 304b. In this alternative, sensor measurements can be transmitted directly to the external control unit 304b wherein the energy balance and/or the currently required amount of energy can be determined by the external control unit 304b, thus integrating the above-described function of the internal control unit 315 in the external control unit 304b. In that case, the internal control unit 315 can be omitted and the sensor measurements are supplied directly to the internal signal transmitter which sends the measurements over to the external signal receiver 304c and the external control unit 304b. The energy balance and the currently required amount of energy can then be determined by the external control unit 304b based on those sensor measurements.
[00308] Hence, the present solution according to the arrangement of FIGURE
56 employs the feed back of information indicating the required energy, which is more efficient than previous s'olutions because it is based on the actual use of energy that is compared to the received energy, e.g. with respect to the amount of energy, SUBSTITUTE SHEET (RULE 26) the energy difference, or the energy receiving rate as compared to the energy rate used by implanted energy consuming components of the apparatus. The apparatus may use the received energy either for consuming or for storing the energy in an implanted source of energy or the like. The different parameters discussed above would thus be used if relevant and needed and then as a tool for determining the actual energy balance. However, such parameters may also be needed per se for any actions taken internally to specifically operate the apparatus.
[00309] The internal signal transmitter 327 and the external signal receiver 304c may be implemented as separate units using suitable signal transfer means, such as radio, IR (Infrared) or ultrasonic signals. Alternatively, the internal signal transmitter 327 and the external signal receiver 304c may be integrated in the implanted energy-transforming device 302 and the external source of energy 304a, respectively, so as to convey control signals in a reverse direction relative to the energy transfer, basically using the same transmission technique. The control signals may be modulated with respect to frequency, phase or amplitude.
[00310] Thus, the feedback information may be transferred either by a separate communication system including receivers and transmitters or may be integrated in the energy system. In accordance with the present invention, such an integrated information feedback and energy system comprises an implantable internal energy receiver for receiving wireless energy, the energy receiver having an internal first coil and a first electronic circuit connected to the first coil, and an external energy transmitter for transmitting wireless energy, the energy transmitter having an external second coil and a second electronic circuit connected to the second coil. The external second coil of the energy transmitter transmits wireless energy which is received by the first coil of the energy receiver. This system further comprises a power switch for switching the connection of the internal first coil to the first electronic circuit on and off, such that feedback information related to the charging of the first coil is received by the external energy transmitter in the form of an impedance variation in the load of the external second coil, when the power switch switches the connection of the internal first coil to the first electronic circuit on and off. In implementing this system in the arrangement of Fig. 17, the switch 326 is either separate and controlled by the internal control unit 315, or integrated in the internal control unit 315. It should be understood that the switch 326 should be interpreted in its broadest embodiment.
SUBSTITUTE SHEET (RULE 26) This means a transistor, MCU, MCPU, ASIC FPGA or a DA converter or any other electronic component or circuit that may switch the power on and off.
[00311] To conclude, the energy supply arrangement illustrated in FIGURE 56 may operate basically in the following manner. The energy balance is first determined by the internal control unit 315 of the determination device. A control signal reflecting the required amount of energy is also created by the internal control unit 315, and the control signal is transmitted from the internal signal transmitter 327 to the external signal receiver 304c. Alternatively, the energy balance can be determined by the external control unit 304b instead depending on the implementation, as mentioned above. In that case, the control signal may carry measurement results from various sensors. The amount of energy emitted from the external source of energy 304a can then be regulated by the external control unit 304b, based on the determined energy balance, e.g. in response to the received control signal. This process may be repeated intermittently at certain intervals during ongoing energy transfer, or may be executed on a more or less continuous basis during the energy transfer.
[00312] The amount of transferred energy can generally be regulated by adjusting various transmission parameters in the external source of energy 304a, such as voltage, current, amplitude, wave frequency and pulse characteristics.This system may also be used to obtain information about the coupling factors between the coils in a TET system even to calibrate the system both to find an optimal place for the external coil in relation to the internal coil and to optimize energy transfer.
Simply comparing in this case the amount of energy transferred with the amount of energy received. For example if the external coil is moved the coupling factor may vary and correctly displayed movements could cause the external coil to find the optimal place for energy transfer. Preferably, the external coil is adapted to calibrate the amount of transferred energy to achieve the feedback information in the determination device, before the coupling factor is maximized.
[00313] This coupling factor information may also be used as a feedback during energy transfer. In such a case, the energy system of the present invention comprises an implantable internal energy receiver for receiving wireless energy, the energy receiver having an internal first coil and a first electronic circuit connected to the first coil, and an external energy transmitter for transmitting wireless energy, the energy transmitter having an external second coil and a second electronic circuit connected to the second coil. The external second coil of the energy transmitter SUBSTITUTE SHEET (RULE 26) transmits wireless energy which is received by the first coil of the energy receiver.
This system further comprises a feedback device for communicating out the amount of energy received in the first coil as a feedback information, and wherein the second electronic circuit includes a determination device for receiving the feedback information and for comparing the amount of transferred energy by the second coil with the feedback information related to the amount of energy received in the first coil to obtain the coupling factor between the first and second coils. The energy transmitter may regulate the transmitted energy in response to the obtained coupling factor.
[00314] With reference to FIGURE 57, although wireless transfer of energy for operating the apparatus has been described above to enable non-invasive operation, it will be appreciated that the apparatus can be operated with wire bound energy as well. Such an example is shown in FIGURE 57, wherein an external switch 326 is interconnected between the external source of energy 304a and an operation device, such as an electric motor 307 operating the constriction/stimulation unit 301.
An external control unit 304b controls the operation of the external switch 326 to effect proper operation of the constriction/stimulation unit 301.
[00315] FIGURE 58 illustrates different embodiments for how received energy can be supplied to and used by the constriction/stimulation unit 301. Similar to the example of FIGURE 56, an internal energy receiver 302 receives wireless energy E
from an external source of energy 304a which is controlled by a transmission control unit 304b. The internal energy receiver 302 may comprise a constant voltage circuit, indicated as a dashed box "constant V" in FIGURE 58, for supplying energy at constant voltage to the constriction/stimulation unit 301. The internal energy receiver 302 may further comprise a constant current circuit, indicated as a dashed box "constant C" in the figure, for supplying energy at constant current to the constriction/stimulation unit 301.
[00316] The constriction/stimulation unit 301 comprises an energy consuming part 301a, which may be a motor, pump, restriction device, or any other medical appliance that requires energy for its electrical operation. The constriction/stimulation unit 301 may further comprise an energy storage device 301b for storing energy supplied from the internal energy receiver 302. Thus, the supplied energy may be directly consumed by the energy consuming part 301a, or stored by the energy storage device 301b, or the supplied energy may be partly consumed and partly SUBSTITUTE SHEET (RULE 26) stored. The constriction/stimulation unit 301 may further comprise an energy stabilizing unit 301c for stabilizing the energy supplied from the internal energy receiver 302. Thus, the energy may be supplied in a fluctuating manner such that it may be necessary to stabilize the energy before consumed or stored.
[00317] The energy supplied from the internal energy receiver 302 may further be accumulated and/or stabilized by a separate energy stabilizing unit 328 located outside the constriction/stimulation unit 301, before being consumed and/or stored by the constriction/stimulation unit 301. Alternatively, the energy stabilizing unit 328 may be integrated in the internal energy receiver 302. In either case, the energy stabilizing unit 328 may comprise a constant voltage circuit and/or a constant current circuit.
[00318] It should be noted that FIGURE 56 and FIGURE 58 illustrate some possible but non-limiting implementation options regarding how the various shown functional components and elements can be arranged and connected to each other.
However, the skilled person will readily appreciate that many variations and modifications can be made within the scope of the present invention.
[00319] FIGURE 59 schematically shows an energy balance measuring circuit of one of the proposed designs of the apparatus for controlling transmission of wireless energy, or energy balance. The circuit has an output signal centered on 2.5V
and proportionally related to the energy imbalance. The derivative of this signal shows if the value goes up and down and how fast such a change takes place. If the amount of received energy is lower than the energy used by implanted components of the apparatus, more energy is transferred and thus charged into the source of energy. The output signal from the circuit is typically fed to an ND converter and converted into a digital format. The digital information can then be sent to the external energy-transmission device allowing it to adjust the level of the transmitted energy.
Another possibility is to have a completely analog system that uses comparators comparing the energy balance level with certain maximum and minimum thresholds sending information to external energy-transmission device if the balance drifts out of the max/min window.
[00320] The schematic FIGURE 59 shows a circuit implementation for a system that transfers energy to the implanted energy components of the apparatus of the present invention from outside of the patient's body using inductive energy transfer.
An inductive energy transfer system typically uses an external transmitting coil and SUBSTITUTE SHEET (RULE 26) an internal receiving coil. The receiving coil, L1, is included in the schematic FIGURE
59; the transmitting parts of the system are excluded.
[00321] The implementation of the general concept of energy balance and the way the information is transmitted to the external energy transmitter can of course be implemented in numerous different ways. The schematic FIGURE 20 and the above described method of evaluating and transmitting the information should only be regarded as examples of how to implement the control system.
CIRCUIT DETAILS
[00322] In FIGURE 59 the symbols Y1, Y2, Y3 and so on symbolize test points within the circuit. The components in the diagram and their respective values are values that work in this particular implementation which of course is only one of an infinite number of possible design solutions.
[00323] Energy to power the circuit is received by the energy receiving coil L1.
Energy to implanted components is transmitted in this particular case at a frequency of 25 kHz. The energy balance output signal is present at test point Yl.
[00324] The embodiments described in connection with FIGURES 56, 58 and 59 identify a general method for controlling transmission of wireless energy to implanted energy consuming components of the apparatus of the present invention.
Such a method will be defined in general terms in the following.
[00325] A method is thus provided for controlling transmission of wireless energy supplied to implanted energy consuming components of an apparatus as described above. The wireless energy E is transmitted from an external source of energy located outside the patient and is received by an internal energy receiver located inside the patient, the internal energy receiver being connected to the implanted energy consuming components of the apparatus for directly or indirectly supplying received energy thereto. An energy balance is determined between the energy received by the internal energy receiver and the energy used for the operation of the implanted parts of the apparatus. The transmission of wireless energy E
from the external source of energy is then controlled based on the determined energy balance.
[00326] The wireless energy may be transmitted inductively from a primary coil in the external source of energy to a secondary coil in the internal energy receiver. A
SUBSTITUTE SHEET (RULE 26) change in the energy balance may be detected to control the transmission of wireless energy based on the detected energy balance change. A difference may also be detected between energy received by the internal energy receiver and energy used for the operation of the implanted parts of the apparatus, to control the transmission of wireless energy based on the detected energy difference.
[00327] When controlling the energy transmission, the amount of transmitted wireless energy may be decreased if the detected energy balance change implies that the energy balance is increasing, or vice versa. The decrease/increase of energy transmission may further correspond to a detected change rate.
[00328] The amount of transmitted wireless energy may further be decreased if the detected energy difference implies that the received energy is greater than the used energy, or vice versa. The decrease/increase of energy transmission may then correspond to the magnitude of the detected energy difference.
[00329] As mentioned above, the energy used for the operation of the implanted parts of the apparatus be consumed to operate the implanted parts of the apparatus and/or stored in at least one implanted energy storage device of the apparatus.
[00330] When electrical and/or physical parameters of the implanted parts of the apparatus and/or physical parameters of the patient are determined, the energy may be transmitted for consumption and storage according to a transmission rate per time unit which is determined based on said parameters. The total amount of transmitted energy may also be determined based on said parameters.
[00331] When a difference is detected between the total amount of energy received by the internal energy receiver and the total amount of consumed and/or stored energy, and the detected difference is related to the integral over time of at least one measured electrical parameter related to said energy balance, the integral may be determined for a monitored voltage and/or current related to the energy balance.
[00332] When the derivative is determined over time of a measured electrical parameter related to the amount of consumed and/or stored energy, the derivative may be determined for a monitored voltage and/or current related to the energy balance.
[00333] The transmission of wireless energy from the external source of energy may be controlled by applying to the external source of energy electrical pulses from a first electric circuit to transmit the wireless energy, the electrical pulses having SUBSTITUTE SHEET (RULE 26) leading and trailing edges, varying the lengths of first time intervals between successive leading and trailing edges of the electrical pulses and/or the lengths of second time intervals between successive trailing and leading edges of the electrical pulses, and transmitting wireless energy, the transmitted energy generated from the electrical pulses having a varied power, the varying of the power depending on the lengths of the first and/or second time intervals.
[00334] In that case, the frequency of the electrical pulses may be substantially constant when varying the first and/or second time intervals. When applying electrical pulses, the electrical pulses may remain unchanged, except for varying the first and/or second time intervals. The amplitude of the electrical pulses may be substantially constant when varying the first and/or second time intervals.
Further, the electrical pulses may be varied by only varying the lengths of first time intervals between successive leading and trailing edges of the electrical pulses.
[00335] A train of two or more electrical pulses may be supplied in a row, wherein when applying the train of pulses, the train having a first electrical pulse at the start of the pulse train and having a second electrical pulse at the end of the pulse train, two or more pulse trains may be supplied in a row, wherein the lengths of the second time intervals between successive trailing edge of the second electrical pulse in a first pulse train and leading edge of the first electrical pulse of a second pulse train are varied [00336] When applying the electrical pulses, the electrical pulses may have a substantially constant current and a substantially constant voltage. The electrical pulses may also have a substantially constant current and a substantially constant voltage. Further, the electrical pulses may also have a substantially constant frequency. The electrical pulses within a pulse train may likewise have a substantially constant frequency.
[00337] The circuit formed by the first electric circuit and the external source of energy may have a first characteristic time period or first time constant, and when effectively varying the transmitted energy, such frequency time period may be in the range of the first characteristic time period or time constant or shorter.
[00338] The embodiments described in connection with FIGURES 56, 58 and 59 also identify general features for controlling transmission of wireless energy to implanted energy consuming components of the apparatus of the present invention.
Such features of the apparatus will be defined in general terms in the following.
SUBSTITUTE SHEET (RULE 26) [00339] In its broadest sense, the apparatus comprises a control device for controlling the transmission of wireless energy from an energy-transmission device, and an implantable internal energy receiver for receiving the transmitted wireless energy, the internal energy receiver being connected to implantable energy consuming components of the apparatus for directly or indirectly supplying received energy thereto. The apparatus further comprises a determination device adapted to determine an energy balance between the energy received by the internal energy receiver and the energy used for the implantable energy consuming components of the apparatus, wherein the control device controls the transmission of wireless energy from the external energy-transmission device, based on the energy balance determined by the determination device.
[00340] Further, the apparatus of the invention may comprise any of the following features:
[00341] - A primary coil in the external source of energy adapted to transmit the wireless energy inductively to a secondary coil in the internal energy receiver.
[00342] - The determination device is adapted to detect a change in the energy balance, and the control device controls the transmission of wireless energy based on the detected energy balance change.
[00343] - The determination device is adapted to detect a difference between energy received by the internal energy receiver and energy used for the implantable energy consuming components of the apparatus, and the control device controls the transmission of wireless energy based on the detected energy difference.
[00344] - The control device controls the external energy-transmission device to decrease the amount of transmitted wireless energy if the detected energy balance change implies that the energy balance is increasing, or vice versa, wherein the decrease/increase of energy transmission corresponds to a detected change rate.
[00345] - The control device controls the external energy-transmission device to decrease the amount of transmitted wireless energy if the detected energy difference implies that the received energy is greater than the used energy, or vice versa, wherein the decrease/increase of energy transmission corresponds to the magnitude of said detected energy difference.
[00346] - The energy used for implanted parts of the apparatus is consumed to operate the implanted parts, and/or stored in at least one energy storage device of the apparatus.
SUBSTITUTE SHEET (RULE 26) [00347] - Where electrical and/or physical parameters of the apparatus and/or physical parameters of the patient are determined, the energy-transmission device transmits the energy for consumption and storage according to a transmission rate per time unit which is determined by the determination device based on said parameters. The determination device also determines the total amount of transmitted energy based on said parameters.
[00348] - When a difference is detected between the total amount of energy received by the internal energy receiver and the total amount of consumed and/or stored energy, and the detected difference is related to the integral over time of at least one measured electrical parameter related to the energy balance, the determination device determines the integral for a monitored voltage and/or current related to the energy balance.
[00349] - When the derivative is determined over time of a measured electrical parameter related to the amount of consumed and/or stored energy, the determination device determines the derivative for a monitored voltage and/or current related to the energy balance.
[00350] - The energy-transmission device comprises a coil placed externally to the human body, and an electric circuit is provided to power the external coil with electrical pulses to transmit the wireless energy. The electrical pulses have leading and trailing edges, and the electric circuit is adapted to vary first time intervals between successive leading and trailing edges and/or second time intervals between successive trailing and leading edges of the electrical pulses to vary the power of the transmitted wireless energy. As a result, the energy receiver receiving the transmitted wireless energy has a varied power.
[00351] - The electric circuit is adapted to deliver the electrical pulses to remain unchanged except varying the first and/or second time intervals.
[00352] - The electric circuit has a time constant and is adapted to vary the first and second time intervals only in the range of the first time constant, so that when the lengths of the first and/or second time intervals are varied, the transmitted power over the coil is varied.
[00353] - The electric circuit is adapted to deliver the electrical pulses to be varied by only varying the lengths of first time intervals between successive leading and trailing edges of the electrical pulses.
SUBSTITUTE SHEET (RULE 26) . 81596208 [00354] - The electric circuit is adapted to supplying a train of two or more electrical pulses in a row, said train having a first electrical pulse at the start of the pulse train and having a second electrical pulse at the end of the pulse train, and [00355] - the lengths of the second time intervals between successive trailing edge of the second electrical pulse in a first pulse train and leading edge of the first electrical pulse of a second pulse train are varied by the first electronic circuit.
[00356] - The electric circuit is adapted to provide the electrical pulses as pulses having a substantially constant height and/or amplitude and/or intensity and/or voltage and/or current and/or frequency.
[00357] - The electric circuit has a time constant, and is adapted to vary the first and second time intervals only in the range of the first time constant, so that when the lengths of the first and/or second time intervals are varied, the transmitted power over the first coil are varied.
[00358] - The electric circuit is adapted to provide the electrical pulses varying the lengths of the first and/or the second time intervals only within a range that includes the first time constant or that is located relatively close to the first time constant, compared to the magnitude of the first time constant.
[00359] While the invention has been described in connection with what is presently considered to be the most practical and preferred embodiment, it is to be understood that the invention is not to be limited to the disclosed embodiment, but on the contrary, is intended to cover various modifications and equivalent arrangements included within the scope of the appended claims.
Claims (1523)
1. An apparatus for controlling a flow of fluid and/or other bodily matter in a lumen formed by a tissue wall of a patient's organ, the apparatus comprising:
an implantable constriction device for gently constricting at least one portion of the tissue wall to influence the flow in the lumen, a stimulation device for stimulating the constricted wall portion of the tissue wall as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the flow in the lumen, a control device for controlling the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the flow in the lumen and wherein the control device is adapted to control the constriction and stimulation devices independently of each other, and simultaneously.
an implantable constriction device for gently constricting at least one portion of the tissue wall to influence the flow in the lumen, a stimulation device for stimulating the constricted wall portion of the tissue wall as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the flow in the lumen, a control device for controlling the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the flow in the lumen and wherein the control device is adapted to control the constriction and stimulation devices independently of each other, and simultaneously.
2. The apparatus according to claim 1, wherein said constriction device is adapted to constrict the wall portion to at least restrict the flow in the lumen, and said control device controls said stimulation device to cause contraction of the constricted wall portion, so that the flow in the lumen is at least further restricted.
3. The apparatus according to claim 2, wherein the constriction device is adapted to constrict the wall portion to a constricted state in which the blood circulation in the constricted wall portion is substantially unrestricted and the flow in the lumen is at least restricted, and the control device controls the stimulation device to cause contraction of the wall portion, so that the flow in the lumen is at least further restricted when the wall portion is kept by the constriction device in the constricted state.
4. The apparatus according to claim 1, wherein the control device controls the constriction device to adjust the constriction of the patient's wall portion.
5. The apparatus according to claim 4, wherein the control device controls the stimulation device to stimulate the wall portion, while the control device controls the constriction device to change the constriction of the wall portion.
6. The apparatus according to claim 4, wherein the control device is adapted to calibrate the constriction device by controlling the stimulation device to stimulate the wall portion while controlling the constriction device to adjust the constriction of the wall portion until the desired restriction of the flow in the lumen is obtained.
7. The apparatus according to claim 4, wherein the control device controls the stimulation device not to stimulate the wall portion while the control device controls the constriction device to change the constriction of the wall portion.
8. The apparatus according to claim 4, wherein the control device controls the constriction device to constrict the wall portion, such that the flow in the lumen is restricted but not stopped, and controls the stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the lumen is further restricted but not stopped.
9. The apparatus according to claim 8, wherein the control device controls the stimulation device to adjust the intensity of the stimulation of the wall portion in response to a sensed physical parameter of the patient.
10. The apparatus according to claim 8, wherein the control device controls the stimulation device to adjust the intensity of the stimulation of the wall portion in response to a sensed functional parameter of the apparatus.
11. The apparatus according to claim 8, wherein the control device controls the stimulation device in a first mode to stimulate the constricted wall portion to further restrict but not stop the flow in the lumen and controls the stimulation device in a second mode to cease the stimulation of the wall portion to increase the flow in the lumen.
12. The apparatus according to claim 11, wherein the control device in the second mode controls the stimulation device to cease the stimulation of the wall portion and controls the constriction device to release the wall portion to restore the flow in the lumen.
13. The apparatus according to claim 4, wherein said control device controls said constriction device to constrict the wall portion, such that the flow in the lumen is restricted but not stopped, and controls said stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the lumen is stopped.
14. The apparatus according to claim 13, wherein the control device controls the stimulation device in a first mode to stimulate the constricted wall portion to stop the flow in the lumen and controls the stimulation device in a second mode to cease the stimulation of the wall portion to allow flow in the lumen.
15. The apparatus according to claim 14, wherein the control device in the second mode controls the stimulation device to cease the stimulation of the wall portion and controls the constriction device to release the wall portion to restore the flow in the lumen.
16. The apparatus according to claim 13, wherein the control device controls the stimulation device to adjust the intensity of the stimulation of the wall portion in response to a sensed physical parameter of the patient.
17. The apparatus according to claim 13, wherein the control device controls the stimulation device to adjust the intensity of the stimulation of the wall portion in response to a sensed functional parameter of the apparatus.
18. The apparatus according to claim 16, wherein the control device controls the stimulation device to increase the intensity of the stimulation of the wall portion, such that the flow in the lumen remains stopped when a pressure increase occurs in the lumen.
19. The apparatus according to claim 18, further comprising a sensor for sensing a physical parameter of the patient's body that relates to the pressure in the lumen, wherein the control device controls the stimulation device in response to signals from the sensor.
20. The apparatus according to claim 19, wherein the physical parameter is a pressure in the patient's body and the sensor is a pressure sensor.
21. The apparatus according to claim 4, wherein said control device controls said constriction device to constrict the wall portion, such that the flow in the lumen is substantially stopped, and controls said stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the lumen is completely stopped.
22. The apparatus according to claim 21, wherein the control device controls the stimulation device in a first mode to stimulate the constricted wall portion to completely stop the flow in the lumen and controls the stimulation device in a second mode to cease the stimulation of the wall portion to allow flow in the lumen.
23. The apparatus according to claim 22, wherein the control device in the second mode controls the stimulation device to cease the stimulation of the wall portion and controls the constriction device to release the wall portion to restore the flow in the lumen.
24. The apparatus according to claim 21, wherein the control device controls the stimulation device to adjust the intensity of the stimulation of the wall portion in response to a sensed physical parameter of the patient.
25. The apparatus according to claim 21, wherein the control device controls the stimulation device to adjust the intensity of the stimulation of the wall portion in response to a sensed functional parameter of the apparatus.
26. The apparatus according to claim 24, wherein the control device controls the stimulation device to increase the intensity of the stimulation of the wall portion in response to a sensed pressure increase in the lumen, such that the flow in the lumen remains stopped.
27. The apparatus according to claim 26, further comprising a sensor for sensing a physical parameter of the patient's body that relates to the pressure in the lumen, wherein the control device controls the stimulation device in response to signals from the sensor.
28. The apparatus according to claim 27, wherein the physical parameter is a pressure in the patient's body and the sensor is a pressure sensor.
29. The apparatus according to claim 4, wherein the control device controls the constriction device to constrict the wall portion, such that the flow in the lumen is stopped.
30. The apparatus according to claim 29, wherein the control device controls the constriction device in a first mode to constrict the constricted wall portion to stop the flow in the lumen and controls the constriction device in a second mode to cease the constriction of the wall portion to restore flow in the lumen.
31. The apparatus according to claim 29, wherein the control device controls the stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the lumen remains stopped when a pressure increase occurs in the lumen.
32. The apparatus according to claim 31, further comprising a sensor for sensing a physical parameter of the patient's body that relates to the pressure in the lumen, wherein the control device controls the stimulation device in response to signals from the sensor.
33. The apparatus according to claim 32, wherein the physical parameter is a pressure in the patient's body and the sensor is a pressure sensor.
34. The apparatus according to claim 4, wherein the control device controls the constriction device and/or the stimulation device from outside the patient's body.
35. The apparatus according to claim 34, wherein the control device is operable by the patient.
36. The apparatus according to claim 37, wherein the control device comprises a manually operable switch for switching on and off the constriction device and/or stimulation device, the switch being adapted for subcutaneous implantation in the patient to be manually operated from outside the patient's body.
37. The apparatus according to claim 35, wherein the control device comprises a hand-held wireless remote control operable by the patient to switch on and off the constriction device and/or stimulation device.
38. The apparatus according to claim 34, wherein the control device wirelessly controls the constriction device and/or stimulation device.
39. The apparatus according to claim 38, wherein the control device wirelessly controls the constriction device in a non-magnetic manner.
40. The apparatus according to claim 1, wherein the constriction device is designed to normally keep the patient's wall portion in a constricted state, in which the blood circulation in the constricted wall portion is substantially unrestricted and the flow in the lumen is at least restricted.
41. The apparatus according to claim 40, wherein the control device controls the stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that the outlet opening is reduced to further restrict but not stop the flow in the lumen.
42. The apparatus according to claim 41, wherein the control device controls the stimulation device to adjust the intensity of the stimulation of the wall portion in response to a sensed physical parameter of the patient or functional parameter of the apparatus.
43. The apparatus according to claim 41, wherein the control device controls the stimulation device in a first mode to stimulate the constricted wall portion to further restrict the flow in the lumen and controls the stimulation device in a second mode to cease the stimulation of the wall portion to increase the flow in the lumen.
44. The apparatus according to claim 40, wherein the control device controls the stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the lumen is stopped.
45. The apparatus according to claim 44, wherein the control device controls the stimulation device to adjust the intensity of the stimulation of the wall portion in response to a sensed physical parameter of the patient or functional parameter of the apparatus.
46. The apparatus according to claim 45, wherein the control device controls the stimulation device to increase the intensity of the stimulation, such that the flow in the lumen remains stopped when a pressure increase occurs in the lumen.
47. The apparatus according to claim 46, further comprising a sensor for sensing a physical parameter of the patient that relates to the pressure in the lumen, wherein the control device controls the stimulation device in response to signals from the sensor.
48. The apparatus according to claim 47, wherein the physical parameter is a pressure in the patient's body and the sensor is a pressure sensor.
49. The apparatus according to claim 44, wherein the control device controls the stimulation device in a first mode to stimulate the constricted wall portion to stop the flow in the lumen and controls the stimulation device in a second mode to cease the stimulation of the wall portion to allow flow in the lumen.
50. The apparatus according to claim 40, wherein the control device controls the stimulation device from outside the patient's body.
51. The apparatus according to claim 50, wherein the control device is operable by the patient.
52. The apparatus according to claim 51, wherein the control device comprises a manually operable switch for switching on and off the stimulation device, the switch being adapted for subcutaneous implantation in the patient to be manually operated from outside the patient's body.
53. The apparatus according to claim 51, wherein the control device comprises a hand-held wireless remote control operable by the patient to switch on and off the stimulation device.
54. The apparatus according to claim 50, wherein the control device wirelessly controls the stimulation device.
55. The apparatus according to claim 1, wherein the control device controls the stimulation device to intermittently and individually stimulate different areas of the wall portion, such that at least two of the areas are stimulated at different points of time.
56. The apparatus according to claim 55, wherein the control device controls the stimulation device to intermittently stimulate each area of the different areas of the wall portion during successive time periods, each time period being short enough to maintain over time satisfactory blood circulation in the area until the lapse of the time period.
57. The apparatus according to claim 55, wherein the control device controls the stimulation device to intermittently stimulate the areas of the wall portion, such that an area of the wall portion that currently is not stimulated has time to restore substantially normal blood circulation before the stimulation device stimulates the area again.
58. The apparatus according to claim 1, wherein the control device controls the stimulation device to stimulate one or more different areas of the wall portion at a time.
59. The apparatus according to claim 58, wherein the control device controls the stimulation device to sequentially stimulate the different areas of the wall portion.
60. The apparatus according to claim 58, wherein the control device controls the stimulation device to shift over time the stimulation from one area to another.
61. The apparatus according to claim 60, wherein the control device controls the stimulation device to cyclically propagate the stimulation of the areas along the wall portion in the same or opposite direction of the flow in the patient's lumen.
62. The apparatus according to claim 61, wherein the control device controls the stimulation device to propagate the stimulation of the areas in accordance with a determined stimulation pattern.
63. The apparatus according to claim 1, wherein the control device controls the stimulation device to vary the intensity of the stimulation of the wall portion.
64. The apparatus according to claim 63, wherein the control device controls the stimulation device to cyclically vary the intensity of the stimulation of the wall portion.
65. The apparatus according to claim 1, wherein the control device controls the stimulation device to intermittently and individually stimulate different areas of the wall portion with pulses.
66. The apparatus according to claim 65, wherein the control device controls the stimulation device to intermittently stimulate the areas with the pulses.
67. The apparatus according to claim 65, wherein the pulses form pulse trains.
68. The apparatus according to claim 67, wherein at least a first area and a second area of the areas of the wall portion are repeatedly stimulated with a first pulse train and a second pulse train, respectively, such that the first and second pulse trains over time are shifted relative to each other.
69. The apparatus according to claim 68, wherein the first area is stimulated with the first pulse train while the second area is not stimulated with the second pulse train, and vice versa.
70. The apparatus according to claim 68, wherein the first and second pulse trains are shifted relative to each other such that the first and second pulse trains at least partially overlap each other.
71. The apparatus according to claim 67, wherein the control device controls the stimulation device to vary the amplitudes of the pulses of the pulse trains.
72. The apparatus according to claim 67, wherein the control device controls the stimulation device to vary the off time periods between the individual pulses of each pulse train.
73. The apparatus according to claim 67, wherein the control device controls the stimulation device to vary the width of each pulse of the pulse trains.
74. The apparatus according to claim 67, wherein the control device controls the stimulation device to vary the frequency of the pulses of the pulse trains.
75. The apparatus according to claim 67, wherein the control device controls the stimulation device to vary the off time periods between the pulse trains.
76. The apparatus according to claim 75, wherein the control device controls the stimulation device to keep each off time period between the pulse trains long enough to restore substantially normal blood circulation in each area when the area is not stimulated during the off time periods.
77. The apparatus according to claim 67, wherein the control device controls the stimulation device to vary the length of each pulse train.
78. The apparatus according to claim 67, wherein the control device controls the stimulation device to vary the frequency of the pulse trains.
79. The apparatus according to claim 67, wherein the control device controls the stimulation device to vary the number of pulses of each pulse train.
80. The apparatus according to claim 1, wherein the stimulation device intermittently and individually electrically stimulates different areas of the patient's wall portion.
81. The apparatus according to claim 80, wherein the stimulation device stimulates the areas of the patient's wall portion with electric pulses.
82. The apparatus according to claim 81, wherein the wall portion includes muscle fibers and the stimulation device stimulates the wall portion including the muscle fibers with electric pulses, to cause contraction of the muscle fibres to contract the wall portion.
83. The apparatus according to claim 80, wherein the stimulation device comprises at least one electrical element for engaging the wall portion and for stimulating the wall portion with electric pulses.
84. The apparatus according to claim 83, wherein the stimulation device comprises a plurality of electrical elements.
85. The apparatus according to claim 84, wherein the electrical elements are placed in a fixed orientation relative to one another.
86. The apparatus according to claim 85, wherein the stimulation device comprises a structure holding the electrical elements in the fixed orientation.
87. The apparatus according to claim 86, wherein the electrical elements form an elongate pattern of electrical elements, and the structure is applicable on the patient's organ such that the elongate pattern of electrical elements extends along the wall portion of the organ in the direction of the flow in the lumen and the elements abut the respective areas of the wall portion.
88. The apparatus according to claim 86, wherein the structure is integrated in the constriction device.
89. The apparatus according to claim 86, wherein the structure is separate from the constriction device.
90. The apparatus according to claim 84, wherein the control device controls the stimulation device to electrically energize the electrical elements.
91. The apparatus according to claim 90, wherein the control device controls the stimulation device to cyclically energize each element with electric pulses.
92. The apparatus according to claim 91, wherein the control device controls the stimulation device to energize the electrical elements, such that a number or groups of the electrical elements are energized at the same time.
93. The apparatus according to claim 91, wherein the control device controls the stimulation device to energize the electrical elements, such that the electrical elements are energized one at a time in sequence or groups of the electrical elements are sequentially energized, either randomly or in accordance with a predetermined pattern.
94. The apparatus according to claim 91, wherein the electrical elements form an elongate pattern of electrical elements, and the elements are applicable on the patient's wall such that the elongate pattern of electrical elements extends along the wall portion of the organ in the direction of the flow in the lumen and the elements abut the respective areas of the wall portion.
95. The apparatus according to claim 94, wherein the control device controls the stimulation device to successively energize the electrical elements longitudinally along the elongate pattern of electrical elements.
96. The apparatus according to claim 95, wherein the control device controls the stimulation device to successively energize the electrical elements along the elongate pattern of electrical elements in a direction opposite to, or in the same direction as, that of the flow in the lumen, when the stimulation device is applied on the patient's organ.
97. The apparatus according to claim 95, wherein the control device controls the stimulation device to successively energize the electrical elements from a position substantially at the center of the constricted wall portion towards both ends of the elongate pattern of electrical elements, when the stimulation device is applied on the patient's organ.
98. The apparatus according to claim 95, wherein the control device controls the stimulation device to energize the electrical elements, such that electrical elements currently energized form at least one group of adjacent energized electrical elements.
99. The apparatus according to claim 98, wherein the elements in the group of energized electrical elements form a path of energized electrical elements.
100. The apparatus according to claim 99, wherein the path of energized electrical elements extends at least in part around the patient's organ, when the stimulation device is applied on the organ.
101. The apparatus according to claim 100, wherein the path of energized electrical elements extends completely around the patient's organ, when the stimulation device is applied on the organ.
102. The apparatus according to claim 98, wherein the elements in the group of energized electrical elements form two paths of energized electrical elements extending opposite to each other, when the stimulation device is applied on the patient's organ.
103. The apparatus according to claim 102, wherein the two paths of energized electrical elements extend on mutual sides of the patient's organ and at least substantially transverse to the direction of flow in the patient's lumen, when the stimulation device is applied on the organ.
104. The apparatus according to claim 90, wherein the electrical elements form a plurality of groups of elements, the groups forming a series of groups extending along the patient's organ in the direction of flow in the patient's lumen, when the stimulation device is applied on the organ.
105. The apparatus according to claim 104, wherein the control device controls the stimulation device to successively energize the groups of electrical elements in the series of groups in a direction opposite to, or in the same direction as, that of the flow in the lumen, when the stimulation device is applied on the patient's organ.
106. The apparatus according to claim 104, wherein the control device controls the stimulation device to successively energize the groups of electrical elements in the series of groups from a position substantially at the center of the constricted wall portion in a direction opposite to, and in the same direction as, that of the flow in the lumen, when the stimulation device is applied on the patient's organ.
107. The apparatus according to claim 104, wherein the electrical elements of each group of electrical elements form a path of elements extending at least in part around the patient's organ, when the stimulation device is applied on the organ.
108. The apparatus according to claim 107, wherein the path of electrical elements of each group of elements extends completely around the patient's organ, when the stimulation device is applied on the organ.
109. The apparatus according to claim 104, wherein the electrical elements of each group of electrical elements form two paths of elements extending on mutual sides of the patient's organ, when the stimulation device is applied on the organ.
110. The apparatus according to claim 109, wherein the two paths of electrical elements of each group of elements extend at least substantially transverse to the direction of flow in the lumen, when the stimulation device is applied on the patient's organ.
111. The apparatus according to claim 1, wherein the stimulation device thermally stimulates the wall portion.
112. The apparatus according to claim 111, wherein said control device controls said stimulation device to cool the constricted wall portion to cause contraction of the wall portion.
113. The apparatus according to claim 112, wherein said constriction device is adapted to constrict the wall portion to at least restrict the flow in the lumen, and said control device controls said stimulation device to cool the constricted wall portion to cause contraction thereof, such that the flow in the lumen is at least further restricted.
114. The apparatus according to claim 113, wherein the control device controls the stimulation device to cool the wall portion to cause contraction thereof, such that the flow in the lumen is further restricted but not stopped.
115. The apparatus according to claim 113, wherein the control device controls the stimulation device to cool the wall portion to cause contraction thereof, such that the flow in the lumen is stopped.
116. The apparatus according to claim 111, wherein the control device controls the stimulation device to heat the wall portion, when the wall portion is constricted and contracted, to cause expansion of the wall portion.
117. The apparatus according to claim 111, wherein the wall portion includes a blood vessel and said control device controls said stimulation device to cool the blood vessel to cause contraction thereof, or to heat the blood vessel to cause expansion thereof.
118. The apparatus according to claim 111, wherein the control device controls the constriction device and/or the stimulation device from outside the patient's body.
119. The apparatus according to claim 1, wherein the control device comprises an internal control unit implantable in the patient for controlling the constriction device and/or stimulation device.
120. The apparatus according to claim 119, wherein the internal control unit is programmable.
121. The apparatus according to claim 120, wherein the control device comprises an external control unit intended to be outside the patient's body for controlling the constriction device and/or stimulation device.
122. The apparatus according to claim 121, wherein the internal control unit is programmable by the external control unit.
123. The apparatus according to claim 121, wherein the internal control unit is programmable for controlling the constriction device and/or stimulation device over time.
124. The apparatus according to claim 123, wherein the internal control unit controls the constriction device over time in accordance with an activity schedule program.
125. The apparatus according to claim 121, wherein the internal control unit comprises a microprocessor.
126. The apparatus according to claim 1, further comprising at least one implantable sensor, wherein the control device controls the constriction device and/or the stimulation device in response to signals from the sensor.
127. The apparatus according to claim 126, wherein the sensor directly or indirectly senses at least one physical parameter of the patient.
128. The apparatus according to claim 127, wherein the sensor directly or indirectly senses at least one functional parameter of a medical implant.
129. The apparatus according to claim 127, wherein the sensor comprises a pressure sensor for sensing as the physical parameter a pressure in the patient's body.
130. The apparatus according to claim 129, wherein the control device controls the constriction device and/or stimulation device to change the constriction of the patient's wall portion in response to the pressure sensor sensing a predetermined value of measured pressure.
131. The apparatus according to claim 126, wherein the control device comprises an implantable internal control unit directly controlling the constriction device and/or stimulation device in response to signals from the sensor.
132. The apparatus according to claim 126, wherein the control device comprises an external control unit outside the patient's body for controlling the constriction device and/or stimulation device in response to signals from the sensor.
133. The apparatus according to claim 127, wherein the control device produces an indication in response to the signals from the sensor.
134. The apparatus according to claim 133, wherein the indication comprises a sound signal or displayed information.
135. The apparatus according to claim 1, wherein the constriction device and stimulation device co-operate to move the fluid and/or other bodily matter in the lumen.
136. The apparatus according to claim 135, wherein the constriction device is adapted to constrict the wall portion to restrict the flow in the lumen, and the control device controls the stimulation device to progressively stimulate the constricted wall portion to cause progressive contraction of the wall portion to move the fluid and/or other bodily matter in the lumen.
137. The apparatus according to claim 135, wherein the control device controls the stimulation device to progressively stimulate the constricted wall portion in the downstream or upstream direction of the lumen.
138. The apparatus according to claim 135, wherein the constriction device is adapted to constrict the wall portion to restrict the flow in the lumen, and the control device controls the stimulation device to stimulate the constricted wall portion to close the lumen either at an upstream end or a downstream end of the wall portion and simultaneously controls the constriction device to increase the constriction of the wall portion to move the fluid and/or other bodily matter in the lumen.
139. The apparatus according to claim 135, wherein the control device controls the constriction device to vary the constriction of the wall portion and simultaneously controls the stimulation device to progressively stimulate the constricted wall portion to cause progressive contraction of the wall portion to move the fluid and/or other bodily matter in the lumen.
140. The apparatus according to claim 139, wherein the control device controls the stimulation device to progressively stimulate the constricted wall portion in the downstream or upstream direction of the lumen.
141. The apparatus according to claim 134, wherein the control device controls the stimulation device to stimulate the wall portion and simultaneously controls the constriction device to vary the constriction of different areas of the wall portion such that the wall portion is progressively constricted in the downstream or upstream direction of the lumen.
142. The apparatus according to claim 141, wherein the control device controls the stimulation device to progressively stimulate the constricted wall portion to cause progressive contraction thereof in harmony with the progressive constriction of the wall portion performed by the constriction device.
143. The apparatus according to claim 141, wherein the constriction device comprises at least one elongated constriction element extending along the wall portion, and the control device controls the elongated constriction element to progressively constrict the wall portion in the downstream or upstream direction of the lumen.
144. The apparatus according to claim 143, wherein the elongated constriction element comprises contact surfaces dimensioned to contact a length of the wall portion, when the constriction device constricts the wall portion, and the stimulation device comprises a plurality of stimulation elements distributed along the contact surfaces, such that the stimulation elements stimulate the different areas of the wall portion along the length of the wall portion, when the control device controls the stimulation device to stimulate the wall portion.
145. The apparatus according to claim 135, wherein said constriction device is adapted to constrict any one of a series of wall portions of the tissue wall to at least restrict the flow in the lumen, said stimulation device stimulates the wall portion constricted by said constriction device to close the lumen, and said control device controls said constriction device to successively constrict the wall portions of the series of wall portions to move the fluid and/or other bodily matter in the lumen in a peristaltic manner.
146. The apparatus according to claim 145, wherein the constriction device comprises at least one constriction element that is moveable along the organ to successively constrict the wall portions of the series of wall portions of the organ, and the stimulation device comprises at least one stimulation element positioned on the constriction element for stimulating the wall portion constricted by the constriction element to close the lumen.
147. The apparatus according to claim 146, wherein the control device controls the constriction device to cyclically move the constriction element along the wall portions of the series of wall portions.
148. The apparatus according to claim 146, wherein the constriction device comprises a plurality of constriction elements, each of which is moveable along the organ to successively constrict the wall portions of the series of wall portions of the organ, and the stimulation device comprises stimulation elements positioned on the constriction elements for stimulating the wall portions constricted by the constriction elements to close the lumen.
149. The apparatus according to claim 148, wherein the control device controls the constriction device to cyclically move the constriction elements one after the other along the wall portions of the series of wall portions of the organ.
150. The apparatus according to claim 149, wherein the constriction device comprises a rotor carrying the constriction elements, and the control device controls the rotor to rotate such that each constriction element cyclically constricts the wall portions of the series of wall portions of the organ.
151. The apparatus according to claim 150, wherein each constriction element comprises a roller for rolling on the organ to constrict the latter.
152. The apparatus according to claim 135, wherein the constriction device comprises a first constriction element for constricting the wall portion of the organ at an upstream end thereof, a second constriction element for constricting the wall portion at a downstream end thereof, and a third constriction element for constricting the wall portion between the upstream and downstream ends thereof, and the control device controls the first, second and third constriction elements to constrict and release the wall portions independently of one another.
153. The apparatus according to claim 152, wherein the control device controls the first or second constriction element to constrict the wall portion at the upstream or downstream end thereof to close the lumen and controls the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, whereby the fluid or other bodily matter contained in the wall portion between the upstream and downstream ends thereof is moved downstream or upstream in the lumen.
154. The apparatus according to claim 153, wherein the control device controls the stimulation device to stimulate the wall portion between the upstream and downstream ends thereof, when the third constriction element constricts the wall portion.
155. The apparatus according to claim 152, wherein the control device controls the first constriction element to constrict the wall portion at the upstream end thereof to restrict the flow in the lumen and controls the stimulation device to stimulate the constricted wall portion at the upstream end to close the lumen.
156. The apparatus according to claim 155, wherein the control device controls the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, whereby the fluid and/or other bodily matter contained in the wall portion between the upstream and downstream ends thereof is moved downstream in the lumen.
157. The apparatus according to claim 156, wherein the control device controls the second constriction element to constrict the wall portion at the downstream end thereof to restrict the flow in the lumen and controls the stimulation device to stimulate the constricted wall portion at the downstream end to close the lumen.
158. The apparatus according to claim 157, wherein the control device controls the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, whereby the fluid and/or other bodily matter contained in the wall portion between the upstream and downstream ends thereof is moved upstream in the lumen.
159. The apparatus according to claim 135, wherein the stimulation device is adapted to stimulate the wall portion with electric pulses.
160. The apparatus according to claim 1, wherein the constriction device is adjustable, and further comprising an operation device for operating the adjustable constriction device to change the constriction of the patient's wall portion of the organ.
161. The apparatus according to claim 160, wherein the operation device mechanically operates the constriction device.
162. The apparatus according to claim 160, wherein the operation device hydraulically operates the constriction device.
163. The apparatus according to claim 160, wherein the operation device operates the constriction device in a non-magnetic and/or non-manual manner.
164. The apparatus according to claim 160, wherein the operation device comprises an electrically powered operation device.
165. The apparatus according to claim 161, wherein the operation device comprises a motor.
166. The apparatus according to claim 161, wherein the operation device comprises a servo system.
167. The apparatus according to claim 161, wherein the constriction device comprises at least two elongated clamping elements extending along the organ in the direction of flow in the patient's lumen on different sides of the organ, and the operation device operates the clamping elements to clamp the wall portion between the clamping elements to constrict the wall portion.
168. The apparatus according to claim 162, wherein the operation device comprises hydraulic means for hydraulically adjusting the constriction device and a reverse servo operatively connected to the hydraulic means.
169. The apparatus according to claim 160, wherein the constriction device comprises a non-inflatable mechanical constriction device and the operation device comprises hydraulic means that hydraulically adjusts the mechanical constriction device.
170. The apparatus according to claim 1, wherein the control device controls the constriction device to close the lumen, either at an upstream end or a downstream end of the wall portion, and controls the constriction device to constrict the remaining part of the wall portion to move the fluid and/or other bodily matter in the lumen.
171. The apparatus according to claim 170, wherein the control device controls the stimulation device to stimulate the wall portion as the constriction device constricts the remaining part of the wall portion.
172. The apparatus according to claim 1, wherein the constriction device is adapted to constrict the wall portion to restrict but not stop the flow in the lumen, and the control device controls the stimulation device to stimulate the wall portion constricted by the constriction device to close the lumen, either at an upstream end or a downstream end of the wall portion, and simultaneously controls the constriction device to increase the constriction of the wall portion to move the fluid and/or other bodily matter in the lumen.
173. The apparatus according to claim 1, wherein the constriction device is adapted to constrict the wall portion to restrict or vary the flow in the lumen, and the control device controls the stimulation device to progressively stimulate the constricted wall portion, in the downstream or upstream direction of the lumen, to cause progressive contraction of the wall portion to move the fluid and/or other bodily matter in the lumen.
174. The apparatus according to claim 1, wherein the control device controls the constriction device to vary the constriction of different areas of the wall portion, such that the wall portion is progressively constricted in the downstream or upstream direction of the lumen to move the fluid and/or other bodily matter in the lumen.
175. The apparatus according to claim 174, wherein the constriction device comprises at least one elongated constriction element that extends along the wall portion, and the control device controls the elongated constriction element to progressively constrict the wall portion in the downstream or upstream direction of the lumen.
176. The apparatus according to claim 174, wherein the control device controls the stimulation device to progressively stimulate the constricted wall portion to cause progressive contraction thereof in harmony with the progressive constriction of the wall portion performed by the constriction device.
177. The apparatus according to claim 176, wherein the constriction device comprises at least one elongated constriction element, and the control device controls the elongated constriction element to progressively constrict the wall portion in the downstream or upstream direction of the lumen.
178. The apparatus according to claim 177, wherein the elongated constriction element comprises contact surfaces dimensioned to contact a length of the wall portion, when the constriction device constricts the wall portion, and the stimulation device comprises a plurality of stimulation elements distributed along the contact surfaces, such that the stimulation elements stimulate the different areas of the wall portion along the length of the wall portion, when the control device controls the stimulation device to stimulate the wall portion.
179. The apparatus according to claim 1, wherein the constriction device is adapted to constrict any one of a series of wall portions of the tissue wall of the organ to at least restrict the flow in the lumen.
180. The apparatus according to claim 179, wherein the control device controls the constriction device to successively constrict the wall portions of the series of wall portions to move the fluid and/or other bodily matter in the lumen in a peristaltic manner.
181. The apparatus according to claim 179, wherein the constriction device comprises at least one constriction element moveable along the wall of the organ to successively constrict the wall portions of the series of wall portions, and the control device controls the constriction device to cyclically move the constriction element along the wall portions of the series of wall portions.
182. The apparatus according to claim 180, wherein the constriction device comprises a plurality of constriction elements, each of which is moveable along the wall of the organ to successively constrict the wall portions of the series of wall portions, wherein the control device controls the constriction device to cyclically move the constriction elements one after the other along the wall portions of the series of wall portions.
183. The apparatus according to claim 182, wherein the constriction device includes a rotor carrying the constriction elements, and the control device controls the rotor to rotate, such that each constriction element cyclically constricts the wall portions of the series of wall portions.
184. The apparatus according to claim 183, wherein each constriction element comprises a roller for rolling on the wall of the organ to constrict the latter.
185. The apparatus according to claim 180, wherein the stimulation device stimulates the wall portion of the series of wall portions which is constricted by the constriction device, to close the lumen.
186. The apparatus according to claim 181, wherein the stimulation device comprises at least one stimulation element positioned on the constriction element for stimulating the wall portion constricted by the constriction element to close the lumen.
187. The apparatus according to claim 182, wherein the stimulation device comprises stimulation elements positioned on the constriction elements for stimulating the wall portions constricted by the constriction elements to close the lumen.
188. The apparatus according to claim 1, wherein the constriction device comprises a first constriction element for constricting the wall portion at an upstream end thereof, a second constriction element for constricting the wall portion at a downstream end thereof, and a third constriction element for constricting the wall portion between the upstream and downstream ends thereof.
189. The apparatus according to claim 188, wherein the control device controls the first, second and third constriction elements to constrict and release the wall portion independently of one another.
190. The apparatus according to claim 189, wherein the control device controls the first or second constriction element to constrict the wall portion at the upstream or downstream end thereof to close the lumen, and controls the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, whereby the fluid and/or other bodily matter contained in the wall portion between the upstream and downstream ends thereof is moved downstream or upstream in the lumen.
191. The apparatus according to claim 190, wherein the control device controls the stimulation device to stimulate the wall portion between the upstream and downstream ends thereof, when the third constriction element constricts the wall portion.
192. The apparatus according to claim 189, wherein the control device controls the first constriction element to constrict the wall portion at the upstream end thereof to restrict the flow in the lumen and controls the stimulation device to stimulate the constricted wall portion at the upstream end to close the lumen.
193. The apparatus according to claim 192, wherein the control device controls the third constriction element to constrict the wall portion between the upstream and downstream ends thereof to move the fluid and/or other bodily matter contained in the wall portion between the upstream and downstream ends thereof downstream in the lumen.
194. The apparatus according to claim 193, wherein the control device controls the stimulation device to simultaneously stimulate the wall portion as the latter is constricted by the third constriction element.
195. The apparatus according to claim 190, wherein the control device controls the second constriction element to constrict the wall portion at the downstream end thereof to restrict the flow in the lumen and controls the stimulation device to stimulate the constricted wall portion at the downstream end to close the lumen.
196. The apparatus according to claim 195, wherein the control device controls the third constriction element to constrict the wall portion between the upstream and downstream ends thereof to move the fluid and/or other bodily matter contained in the wall portion between the upstream and downstream ends thereof upstream in the lumen.
197. The apparatus according to claim 196, wherein the control device controls the stimulation device to simultaneously stimulate the wall portion as the latter is constricted by the third constriction element.
198. The apparatus according to claim 135, wherein the constriction device comprises a plurality of separate constriction elements adapted to constrict any wall portions of a series of wall portions, respectively, of the organ.
199. The apparatus according to claim 198 wherein the control device controls the constriction device to activate the constriction elements in random or in accordance with a predetermined sequence.
200. The apparatus according to claim 198, wherein the control device controls the constriction device to activate the constriction elements one after the other, so that the wall portions of the series of wall portions are successively constricted along the organ to move the fluid and/or other bodily matter in the lumen.
201. The apparatus according to claim 198, wherein the stimulation device comprises stimulation elements positioned on the constriction elements.
202. The apparatus according to claim 201, wherein the control device controls the stimulation device to activate the stimulation elements to stimulate any wall portions of the series of wall portions constricted by the constriction elements.
203. The apparatus according to claim 202, wherein the control device controls the constriction device to activate the constriction elements to constrict the wall portions of the series of wall portions without completely closing the lumen, and controls the stimulation device to activate the stimulation elements to stimulate the constricted wall portions one after the other, so that the wall portions of the series of wall portions are successively contracted along the organ to move the fluid and/or other bodily matter in the lumen.
204. The apparatus according to claim 202, wherein the control device controls the constriction device to activate the constriction elements to constrict all of the wall portions of the series of wall portions, and controls the stimulation device to activate the stimulation elements to stimulate any constricted wall portions in random or in accordance with a predetermined sequence to close the organ's lumen.
205. An apparatus according to claim 1, wherein the constriction and stimulation devices form an operable constriction/stimulation unit, a source of energy, and a control device operable from outside the patient's body to control the source of energy to release energy for use in connection with the operation of the constriction/stimulation unit.
206. The apparatus according to claim 205, wherein the source of energy is implantable in the patient's body.
207. The apparatus according to claim 206, wherein the source of energy comprises a battery.
208. The apparatus according to claim 205, wherein the source of energy is external to the patient's body and the control device controls the external source of energy to release wireless energy, further comprising an energy-transmission device for transmitting the released wireless energy from outside the patient's body to inside the patient's body.
209. The apparatus according to claim 208, wherein the energy-transmission device is adapted to transmit the wireless energy in pulses or digital pulses, or a combination of pulses and digital pulses.
210. The apparatus according to claim 208, wherein the wireless energy comprises electromagnetic energy.
211. The apparatus according to claim 208, wherein the wireless energy comprises an electric, an electromagnetic or a magnetic field, or a combination thereof, or electromagnetic waves.
212. The apparatus according to claim 208, wherein the energy-transmission device transmits wireless energy for direct use in connection with the operation of the constriction/stimulation unit, as the wireless energy is being transmitted.
213. The apparatus according to claim 212, further comprising an implantable electric motor or pump for operating the constriction device, wherein the motor or pump is directly powered by wireless energy in the form of a magnetic or an electromagnetic field.
214. The apparatus according to claim 213, wherein the motor or pump comprises coils, and the magnetic or electromagnetic field influences the coils to generate a current for driving the motor or pump.
215. The apparatus according to claim 213, wherein the motor or pump comprises materials influenced by magnetic fields, and the magnetic or electromagnetic field influences the materials to create kinetic energy for driving the motor or pump.
216. The apparatus according to claim 213, wherein the motor or pump comprises permanent magnets, and the magnetic or electromagnetic field influences the magnets to create kinetic energy for driving the motor or pump.
217. The apparatus according to claim 208, wherein the energy-transmission device transmits energy of a first form and the constriction/stimulation unit is operable in response to energy of a second form, and further comprising an energy-transforming device implantable in the patient for transforming the energy of the first form wirelessly transmitted by the energy-transmission device into the energy of the second form.
218. The apparatus according to claim 217, wherein the energy of the second form is different from the energy of the first form.
219. The apparatus according to claim 217, wherein the energy-transforming device comprises at least one element having a positive region and a negative region, when exposed to the energy of the first form transmitted by the energy-transmission device the element is capable of creating an energy field between the positive and negative regions, and the energy field produces the energy of the second form.
220. The apparatus according to claim 219, wherein the element comprises an electrical junction element, and the electrical junction element is capable of inducing an electric field between the positive and negative regions when exposed to the energy of the first form transmitted by the energy-transmission device, whereby the energy of the second form comprises electric energy.
221. The apparatus according to claim 219, wherein the energy-transforming device comprises at least one semiconductor.
222. The apparatus according to claim 221, wherein the semiconductor comprises at least one element having a positive region and a negative region, when exposed to the energy of the first form transmitted by the energy-transmission device, the element is capable of creating an energy field between the positive and negative regions, and the energy field produces the energy of the second form.
223. The apparatus according to claim 218, wherein the energy-transforming device transforms the energy of the first form directly or indirectly into the energy of the second form.
224. The apparatus according to claim 223, further comprising an implantable motor or pump for operating the constriction device, wherein the motor or pump is powered by the energy of the second form.
225. The apparatus according to claim 224, wherein the constriction device is operable to perform at least one reversible function and the motor is capable of reversing the function.
226. The apparatus according to claim 224, wherein the control device shifts polarity of the energy of the second form to reverse the motor.
227. The apparatus according to claim 224, wherein the energy-transforming device directly powers the motor or pump with the transformed energy, as the energy of the second form is being transformed from the energy of the first form.
228. The apparatus according to claim 223, wherein the wireless energy of the first form comprises sound waves and the energy of the second form comprises electric energy.
229. The apparatus according to claim 228, wherein the energy-transforming device comprises a piezo-electric element for transforming sound waves into electric energy.
230. The apparatus according to claim 217, further comprising an internal source of energy implantable in the patient for supplying energy for the operation of the constriction/stimulation unit.
231. The apparatus according to claim 229, wherein the internal source of energy comprises a battery.
232. The apparatus according to claim 229, wherein the internal source of energy stores the energy of the second form supplied by the energy-transforming device.
233. The apparatus according to claim 232, wherein the internal source of energy comprises an accumulator.
234. The apparatus according to claim 233, wherein the accumulator comprises at least one capacitor or at least one rechargeable battery, or a combination of at least one capacitor and at least one rechargeable battery.
235. The apparatus according to claim 230, further comprising an implantable switch operable to switch from an off mode, in which the internal source of energy is not in use, to an on mode, in which the internal source of energy supplies energy for the operation of the constriction/stimulation unit.
236. The apparatus according to claim 235, wherein the switch is operable by the energy of the first form transmitted by the energy-transmission device.
237. The apparatus according to claim 235, wherein the switch is operable by the energy of the second form supplied by the energy-transforming device.
238. The apparatus according to claim 217, further comprising an implantable stabiliser for stabilising the energy of the second form.
239. The apparatus according to claim 238, wherein the energy of the second form comprises electric current and the stabiliser comprises at least one capacitor.
240. The apparatus according to claim 217, wherein the energy-transforming device directly operates the constriction/stimulation unit with the energy of the second form in a non-magnetic, non-thermal or non-mechanical manner.
241. The apparatus according to claim 208, wherein the energy-transmission device transmits energy by at least one wireless signal.
242. The apparatus according to claim 241, wherein the signal comprises a wave signal.
243. The apparatus according to claim 242, wherein the wave signal comprises an electromagnetic wave signal including one of an infrared light signal, a visible light signal, an ultra violet light signal, a laser signal, a micro wave signal, a radio wave signal, an x-ray radiation signal, and a gamma radiation signal.
244. The apparatus according to claim 242, wherein the wave signal comprises a sound or ultrasound wave signal.
245. The apparatus according to claim 241, wherein the signal comprises a digital or analogue signal, or a combination of a digital and analogue signal.
246. The apparatus according to claim 217, wherein the energy-transforming device transforms the energy of the first form into a direct current or pulsating direct current, or a combination of a direct current and pulsating direct current.
247. The apparatus according to claim 217, wherein the energy-transforming device transforms the energy of the first form into an alternating current or a combination of a direct and alternating current.
248. The apparatus according to claim 217, wherein one of the energy of the first form and the energy of the second form comprises magnetic energy, kinetic energy, sound energy, chemical energy, radiant energy, electromagnetic energy, photo energy, nuclear energy or thermal energy.
249. The apparatus according to claim 217, wherein one of the energy of the first form and the energy of the second form is non-magnetic, non-kinetic, non-chemical, non-sonic, non-nuclear or non-thermal.
250. The apparatus according to claim 205, further comprising implantable electrical components including at least one voltage level guard.
251. The apparatus according to claim 205, further comprising implantable electrical components including at least one constant current guard.
252. The apparatus according to claim 217, wherein the energy-transmission device functions different from the energy-transforming device.
253. The apparatus according to claim 217, wherein the energy-transmission device functions similar to the energy-transforming device.
254. The apparatus according to claim 217, wherein the energy-transforming device is designed to be implanted subcutaneously or in the abdomen, thorax or cephalic region of the patient.
255. The apparatus according to claim 217, wherein the energy-transforming device is designed to be implanted in an orifice of the patient's body and under the mucosa or intramuscularly outside the mucosa of the orifice.
256. The apparatus according to claim 205, wherein the control device controls the constriction/stimulation unit.
257. The apparatus according to claim 256, wherein the control device comprises a microprocessor.
258. The apparatus according to claim 205, wherein the control device is operable by the patient.
259. The apparatus according to claim 205, wherein the control device comprises a manually or magnetically operable switch for switching on and off the constriction/stimulation unit, the switch being adapted for subcutaneous implantation in the patient.
260. The apparatus according to claim 258, wherein the control device comprises a hand-held wireless remote control operable by the patient to control the constriction/stimulation unit to adjust the stimulation intensity and/or adjust the constriction of the wall portion.
261. The apparatus according to claim 205, wherein the control device comprises a remote control for controlling the constriction/stimulation unit from outside the patient's body.
262. The apparatus according to claim 261, wherein the remote control comprises a wireless remote control.
263. The apparatus according to claim 262, wherein the wireless remote control comprises at least one external signal transmitter or transceiver and at least one internal signal receiver or transceiver implantable in the patient.
264. The apparatus according to claim 262, wherein the wireless remote control is adapted to transmit at least one wireless control signal for controlling the constriction/stimulation unit.
265. The apparatus according to claim 264, wherein the control signal comprises a frequency, amplitude, phase modulated signal or a combination thereof.
266. The apparatus according to claim 264, wherein the control signal comprises an analogue or a digital signal, or a combination of an analogue and digital signal.
267. The apparatus according to claim 266, wherein the remote control transmits a carrier signal for carrying the control signal.
268. The apparatus according to claim 267, wherein the carrier signal comprises digital, analogue or a combination of digital and analogue signals.
269. The apparatus according to claim 268, wherein the signals comprise wave signals.
270. The apparatus according to claim 264, wherein the control signal comprises a wave signal comprising one of a sound wave signal, an ultrasound wave signal, an electromagnetic wave signal, an infrared light signal, a visible light signal, an ultra violet light signal, a laser light signal, a micro wave signal, a radio wave signal, an x-ray radiation signal and a gamma radiation signal.
271. The apparatus according to claim 264, wherein the control signal comprises an electric or magnetic field, or a combined electric and magnetic field.
272. The apparatus according to claim 266, wherein the remote control transmits an electromagnetic carrier wave signal for carrying the digital or analogue control signal.
273. The apparatus according to claim 205, further comprising an external data communicator and an implantable internal data communicator communicating with the external data communicator, wherein the internal communicator feeds data related to the constriction/stimulation unit back to the external data communicator or the external data communicator feeds data to the internal data communicator.
274. The apparatus according to claim 205, further comprising at least one implantable sensor, wherein the control device is adapted to control the constriction/stimulation unit in response to signals from the sensor.
275. The apparatus according to claim 274, wherein the sensor is adapted to directly or indirectly sense at least one physical parameter of the patient.
276. The apparatus according to claim 274, wherein the sensor is adapted to directly or indirectly sense at least one functional parameter of a medical implant.
277. The apparatus according to claim 275, wherein the sensor comprises a pressure sensor for directly or indirectly sensing the pressure against the constriction device.
278. The apparatus according to claim 277, wherein the control device is adapted to control the constriction/stimulation unit to change the constriction of the patient's wall portion in response to the pressure sensor sensing a predetermined value.
279. The apparatus according to claim 274, wherein the control device comprises an internal control unit implanted in the patient and directly controlling the constriction/stimulation unit in response to signals from the sensor.
280. The apparatus according to claim 274, wherein the control device comprises an external control unit outside the patient's body controlling the constriction/stimulation unit in response to signals from the sensor.
281. The apparatus according to claim 274, wherein the control device comprises an implantable internal control unit that directly controls the constriction/stimulation unit in response to signals from the sensor.
282. The apparatus according to claim 274, wherein the control device comprises an external control unit outside the patient's body for controlling the constriction/stimulation unit in response to signals from the sensor.
283. The apparatus according to claim 275, wherein the control device is adapted to produce an indication in response to the sensor sensing the physical parameter.
284. The apparatus according to claim 283, wherein the indication comprises a sound signal or displayed information.
285. The apparatus according to claim 205, further comprising an implantable operation device adapted to operate the constriction/stimulation unit.
286. The apparatus according to claim 285, further comprising a magnet for activating the operation device.
287. The apparatus according to claim 286, wherein the magnet is adapted to activate the operation device from outside the patient's body.
288. The apparatus according to claim 286, wherein the operation device comprises a motor.
289. The apparatus according to claim 288, wherein the motor is powered by energy released from the source of energy.
290. The apparatus according to claim 288, further comprising an implantable gearbox, wherein the motor is operatively connected to the constriction device of the constriction/stimulation unit via the gearbox.
291. The apparatus according to claim 205, wherein the constriction device is operable to perform a reversible function.
292. The apparatus according to claim 291, further comprising a reversing device implantable in the patient for reversing the function performed by the constriction device.
293. The apparatus according to claim 292, wherein the control device controls the reversing device to reverse the function performed by the constriction device.
294. The apparatus according to claim 292, wherein the reversing device comprises hydraulic means including a valve for shifting the flow direction of a liquid flow in the hydraulic means.
295. The apparatus according to claim 225, wherein the reversing device comprises a mechanical reversing device.
296. The apparatus according to claim 292, wherein the mechanical reversing device comprises a gearbox.
297. The apparatus according to claim 292, wherein the reversing device comprises a switch.
298. The apparatus according to claim 230, further comprising a sensor or measuring device sensing or measuring a functional parameter correlated to the transfer of energy for charging the internal source of energy, and a feedback device for sending feedback information from inside the patient's body to the outside thereof, the feedback information being related to the functional parameter sensed by the sensor or measured by the measuring device.
299. The apparatus according to claim 205, further comprising a feedback device for sending feedback information from inside the patient's body to the outside thereof, the feedback information being related to at least one of a physical parameter of the patient and a functional parameter related to the constriction/stimulation unit.
300. The apparatus according to claim 206, further comprising a sensor and/or a measuring device, wherein the control device comprises an implantable internal control unit for controlling the constriction/stimulation unit in response to information being related to at least one of a physical parameter of the patient sensed by the sensor or measured by the measuring device and a functional parameter related to the constriction/stimulation unit sensed by the sensor or measured by the measuring device.
301. The apparatus according to claim 300, wherein the physical parameter is a pressure or a motility movement.
302. The apparatus according to claim 208, further comprising an implantable internal energy receiver for receiving the transmitted wireless energy, the internal energy receiver being connected to implantable energy consuming components of the apparatus for directly or indirectly supplying received energy thereto, the apparatus further comprising a determination device adapted to determine an energy balance between the energy received by the internal energy receiver and the energy used for the implantable energy consuming components of the apparatus, wherein the control device controls the transmission of wireless energy from the external energy-transmission device, based on the energy balance determined by the determination device.
303. The apparatus according to claim 302, wherein the determination device is adapted to detect a change in the energy balance, and the control device controls the transmission of wireless energy based on the detected energy balance change.
304. The apparatus according to claim 302, wherein the determination device is adapted to detect a difference between energy received by the internal energy receiver and energy used for the implantable energy consuming components of the apparatus, and the control device controls the transmission of wireless energy based on the detected energy difference.
305. The apparatus according to claim 208, wherein the energy-transmission device comprises a coil placed externally to the human body, further comprising an implantable energy receiver to be placed internally in the human body and an electric circuit connected to power the external coil with electrical pulses to transmit the wireless energy, the electrical pulses having leading and trailing edges, the electric circuit adapted to vary first time intervals between successive leading and trailing edges and/or second time intervals between successive trailing and leading edges of the electrical pulses to vary the power of the transmitted wireless energy, the energy receiver receiving the transmitted wireless energy having a varied power.
306. The apparatus according to claim 305, wherein the electric circuit is adapted to deliver the electrical pulses to remain unchanged except varying the first and/or second time intervals.
307. The apparatus according to claim 305, wherein the electric circuit has a time constant and is adapted to vary the first and second time intervals only in the range of the first time constant, so that when the lengths of the first and/or second time intervals are varied, the transmitted power over the coil is varied.
308. The apparatus according to claim 299, further comprising an implantable internal energy receiver for receiving wireless energy, the energy receiver having an internal first coil and a first electronic circuit connected to the first coil, and an external energy transmitter for transmitting wireless energy, the energy transmitter having an external second coil and a second electronic circuit connected to the second coil, wherein the external second coil of the energy transmitter transmits wireless energy which is received by the first coil of the energy receiver, the system further comprising a power switch for switching the connection of the internal first coil to the first electronic circuit on and off, such that feedback information related to the charging of the first coil is received by the external energy transmitter in the form of an impedance variation in the load of the external second coil, when the power switch switches the connection of the internal first coil to the first electronic circuit on and off.
309. The apparatus according to claim 299, further comprising an implantable internal energy receiver for receiving wireless energy, the energy receiver having an internal first coil and a first electronic circuit connected to the first coil, and an external energy transmitter for transmitting wireless energy, the energy transmitter having an external second coil and a second electronic circuit connected to the second coil, wherein the external second coil of the energy transmitter transmits wireless energy which is received by the first coil of the energy receiver, the system further comprising a feedback device for communicating out the amount of energy received in the first coil as a feedback information, and wherein the second electronic circuit includes a determination device for receiving the feedback information and for comparing the amount of transferred energy by the second coil with the feedback information related to the amount of energy received in the first coil to obtain the coupling factors between the first and second coils.
310. The apparatus according to claim 309, wherein the energy transmitter regulates the transmitted energy in response to the obtained coupling factor.
311. The apparatus according to claim 309, wherein external second coil is adapted to be moved in relation to the internal first coil to establish the optimal placement of the second coil, in which the coupling factor is maximized.
312. The apparatus according to claim 311, wherein the external second coil is adapted to calibrate the amount of transferred energy to achieve the feedback information in the determination device, before the coupling factor is maximized.
313. An apparatus according to claim 1, for controlling the food flow through the stomach of a patient, the apparatus, wherein the implantable constriction device is adapted to gently constrict at least one portion of the tissue wall of the patient's stomach to influence the food flow in the stomach, the stimulation device is adapted to stimulate the wall portion of the tissue wall, and the control device is adapted to control said stimulation device to stimulate the wall portion, as said constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the food flow in the stomach.
314. An apparatus according to claim 1, for controlling the flow of intestinal contents in the intestines of a patient, wherein the implantable constriction device is adapted to gently constrict at least one portion of the tissue wall of the patient's intestines to influence the flow of intestinal contents in the intestines, the stimulation device is adapted to stimulate the wall portion of the tissue wall, and the control device is adapted to control said stimulation device to stimulate the wall portion, as said constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the flow of intestinal contents in the intestines.
315. The apparatus according to claim 314, wherein the control device controls said stimulation device to intermittently and individually stimulate different areas of the wall portion.
316. An apparatus according to claim 1, for controlling the flow of urine in the urethra or urine bladder of a patient, wherein implantable constriction device for gently constricting at least one portion of the tissue wall of the patient's urethra or urine bladder to influence the urine flow in the urethra or urine bladder, a stimulation device for stimulating the wall portion of the tissue wall, and a control device for controlling said stimulation device to stimulate the wall portion, as said constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the urine flow in the urethra or urine bladder.
317. The apparatus according to claim 316, wherein the control device controls said stimulation device to intermittently and individually stimulate different areas of the wall portion.
318. An apparatus according to claim 1 for treatment of male sexual impotence, wherein the constriction device is implantable in a male impotent patient for gently constricting at least one penile portion of the patient's normal penile tissue or the prolongation thereof to restrict the blood flow leaving the penis, wherein the implantable stimulation device is adapted to stimulating the penile portion, and the control device is adapted to control said stimulation device to stimulate the penile portion, as said constriction device constricts the penile portion, to cause contraction of the penile portion to further restrict the blood flow leaving the penis to achieve erection.
319. The apparatus according to claim 318, wherein the control device controls said stimulation device to intermittently and individually stimulate different areas of the penile portion.
320. An apparatus according to claim 1 for the treatment of male sexual impotence treatment, wherein the a stimulation device implantable in a male impotent patient is adapted to stimulate at least one penile portion of the patient's normal penile tissue or the prolongation thereof, and the control device is adpated to control said stimulation device to stimulate the penile portion to cause contraction thereof to restrict the blood flow leaving the penis to achieve erection.
321. The apparatus according to claim 320, wherein the control device controls said stimulation device to intermittently and individually stimulate different areas of the penile portion.
322. An apparatus according to claim 1 for controlling the blood flow in a blood vessel of a patient, wherein the implantable constriction device is adapted to gently constrict at least one portion of the tissue wall of the blood vessel to influence the blood flow in the blood vessel, the stimulation device is adapted to stimulate the tissue wall portion, and the control device is adapted to control said stimulation device to stimulate the tissue wall portion, as said constriction device constricts the tissue wall portion, to cause contraction of the tissue wall portion to further influence the blood flow in the blood vessel.
323. The apparatus according to claim 322, wherein the control device controls said stimulation device to intermittently and individually stimulate different areas of the tissue wall portion.
324. An apparatus according to claim 1 for controlling the flow of eggs into the uterus of a female, wherein the implantable constriction device is adapted to constrict each one of the female's uterine tubes to restrict the passageway thereof, and the control device is adapted to control said constriction device to constrict the uterine tube such that an egg appearing in the passageway of the uterine tube is prevented from entering the uterine cavity, and to release the uterine tube such that an egg existing in the passageway of the uterine tube is allowed to enter the uterine cavity.
325. The apparatus according to claim 324, wherein the constriction device is for gently constricting at least one portion of the tissue wall of the uterine tube to restrict the passageway thereof, wherein the implantable stimulation device is adapted to stimulate the tissue wall portion, and wherein the control device is adapted to control said stimulation device to stimulate the tissue wall portion, as said constriction device constricts the tissue wall portion, to cause contraction of the tissue wall portion to further restrict the passageway of the uterine tube.
326. The apparatus according to claim 325, wherein said control device controls said stimulation device to to intermittently and individually stimulate different areas of the tissue wall portion of the uterine tube.
327. An apparatus according to claim 1 for controlling the flow of eggs into the uterus of a female, wherein the implantable constriction device is adapted to gently constrict at least one portion of the tissue wall of each one of the female's uterine tubes to restrict the passageway thereof, the stimulation device is adapted to stimulate the tissue wall portion of the uterine tube, and the control device is adapted to control said stimulation device to stimulate the tissue wall portion, as said constriction device constricts the tissue wall portion, to cause contraction of the tissue wall portion to further restrict the passageway of the uterine tube to prevent an egg existing in the uterine tube from entering the uterine cavity.
328. The apparatus according to claim 327, wherein said control device controls the stimulation device to intermittently and individually stimulate different areas of the tissue wall portion of the uterine tube.
329. An apparatus according to claim 1 for controlling the flow of eggs into the uterus of a female, wherein the implantable stimulation device is adapted to stimulate a portion of the tissue wall of each one of the female's uterine tubes, and the control device is adapted to control said stimulation device to stimulate the tissue wall portion of the uterine tube to cause contraction of the tissue wall portion, such that the passageway of the uterine tube is restricted to prevent an egg appearing in the uterine tube from entering the uterine cavity, and to cease stimulating the tissue wall portion of the uterine tube to allow an egg existing in the passageway of the uterine tube to enter the uterine cavity.
330. The apparatus according to claim 329, wherein said control device controls said stimulation device to to intermittently and individually stimulate different areas of the tissue wall portion of the uterine tube.
331. An apparatus according to claim 1 for controlling the flow of gallstones in a patient suffering from gallstone trouble, wherein the implantable stimulation device is adapted to stimulate a portion of the tissue wall of the patient's cystic, hepatic or bile duct, and a control device for controlling said stimulation device to progressively stimulate the tissue wall portion to cause progressive contraction of the tissue wall portion to move one or more gallstones appearing in the duct in the direction towards the duodenum.
332. A flow control apparatus for controlling a flow of fluid and/or other matter in a fluid conduit formed by a conduit wall, the apparatus comprising:
an energizing device configured to influence the flow in the conduit, the energizing device including a stimulation device configured to stimulate a wall portion of the conduit wall, and a control device operable to control the stimulation device to stimulate the wall portion to cause contraction of the wall portion to influence the flow in the conduit.
an energizing device configured to influence the flow in the conduit, the energizing device including a stimulation device configured to stimulate a wall portion of the conduit wall, and a control device operable to control the stimulation device to stimulate the wall portion to cause contraction of the wall portion to influence the flow in the conduit.
333. The apparatus according to claim 332, wherein the energizing device is configured to influence a flow of fluid and/or other bodily matter in a lumen formed by a tissue wall of a patient's organ, the energizing device further including an implantable constriction device configured to gently constrict at least one portion of the tissue wall to influence the flow in the lumen, and wherein the control device is operable to control the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the flow in the lumen.
334. The apparatus according to claim 333, wherein the constriction device is configured to constrict the wall portion to a constricted state in which the blood circulation in the constricted wall portion is substantially unrestricted and the flow in the lumen is at least restricted, and the control device is operable to control the stimulation device to cause contraction of the wall portion, so that the flow in the lumen is at least further restricted when the wall portion is kept by the constriction device in the constricted state.
335. The apparatus according to claim 333, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's wall portion, and the control device is operable to control the constriction and stimulation devices independently of each other.
336. The apparatus according to claim 333, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's wall portion, and - the control device is operable to control the stimulation device to stimulate or not to stimulate the wall portion, while the control device controls the constriction device to adjust the constriction of the wall portion, and - the control device is adapted to calibrate the constriction device by controlling the stimulation device to stimulate the wall portion while controlling the constriction device to adjust the constriction of the wall portion until the desired restriction of the flow in the lumen is obtained.
337. The apparatus according to claim 333, wherein the control device is operable to control the constriction device to adjust the constriction of the wall portion, such that the flow in the lumen is restricted but not stopped, and is operable - to control the stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the lumen is further restricted but not stopped, or - to control the stimulation device in a first mode to stimulate the constricted wall portion to stop the flow in the lumen and to control the stimulation device in a second mode to cease the stimulation of the wall portion to allow flow in the lumen.
338. The apparatus according to claim 333, wherein the control device is operable to control the constriction device to adjust the constriction of the wall portion, such that the flow in the lumen is substantially stopped, and to control the stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the lumen is completely stopped, and wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted wall portion to completely stop the flow in the lumen, and to control the stimulation device in a second mode to cease the stimulation of the wall portion to allow flow in the lumen, or to control in the second mode the stimulation device to cease the stimulation of the wall portion and the constriction device to release the wall portion to restore the flow in the lumen.
339. The apparatus according to claim 334, wherein the control device is operable to control the constriction device in a first mode to constrict the constricted wall portion to stop the flow in the lumen and to control the constriction device in a second mode to cease the constriction of the wall portion to restore flow in the lumen.
340. The apparatus according to claim 333, wherein the control device comprises a manually operable switch for switching on and off the constriction device and/or stimulation device, the switch being adapted for subcutaneous implantation in the patient to be manually operated from outside the patient's body.
341. The apparatus according to claim 333, wherein the constriction device is designed to normally keep the patient's wall portion in a constricted state, in which the blood circulation in the constricted wall portion is substantially unrestricted and the flow in the lumen is at least restricted, wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted wall portion to cause contraction thereof to further restrict but not stop the flow in the lumen, or to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the lumen is stopped, and wherein the control device is operable to control the stimulation device in a second mode to cease the stimulation of the wall portion to increase the flow in the lumen.
342. The apparatus according to claim 333, wherein the control device is operable to control the stimulation device to adjust the intensity of the stimulation of the wall portion in response to a sensed physical parameter of the patient or functional parameter of the apparatus.
343. The apparatus according to claim 333, wherein the control device is operable to control the stimulation device to increase the intensity of the stimulation in response to a sensed parameter related to an increase of pressure in the lumen, such that the flow in the lumen remains stopped, further comprising a sensor configured to sense a physical parameter of the patient that relates to the pressure in the lumen, the control device controlling the stimulation device in response to signals from the sensor, the physical parameter being related to a pressure in the patient's body and the sensor being a pressure related sensor.
344. The apparatus according to claim 333, wherein the control device is operable to control the stimulation device to intermittently and individually stimulate different areas of the wall portion, such that at least two of the areas are stimulated at different points of time, and wherein the control device is operable to control the stimulation device to intermittently stimulate each area of the different areas of the wall portion during successive time periods, each time period being short enough to maintain over time satisfactory blood circulation in the area until the lapse of the time period, or the areas of the wall portion, such that an area of the wall portion that currently is not stimulated has time to restore substantially normal blood circulation before the stimulation device stimulates the area again.
345. The apparatus according to claim 333, wherein the control device is operable to control the stimulation device to stimulate different areas of the wall portion at a time by sequentially stimulating the different areas of the wall portion, or by shifting over time the stimulation from one area to another, or by shifting over time the stimulation from one area to another such that both areas are temporarily stimulated at the same time during the stimulation shift.
346. The apparatus according to claim 333, wherein the control device is operable to control the stimulation device to intermittently and individually electrically stimulate different areas of the patient's wall portion with electric pulses, and wherein the stimulation device comprises at least one electrical element for engaging the wall portion and for stimulating the wall portion with electric pulses.
347. The apparatus according to claim 346, wherein the pulses form pulse trains, and wherein the control device is operable to control the stimulation device to vary at least one of the following pulse parameters: the off time periods between the individual pulses of each pulse train, the off time periods between the pulse trains, the width of each pulse of the pulse trains, the length of each pulse train, the pulse amplitudes of the pulses of the pulse trains, the frequency of the pulses of the pulse trains, the frequency of the pulse trains, and the number of pulses of each pulse train, wherein at least a first area and a second area of the areas of the wall portion are repeatedly stimulated with a first pulse train of the pulse trains and a second pulse train of the pulse trains, respectively, such that the first and second pulse trains over time are shifted relative to each other, and wherein the first area is stimulated with the first pulse train while the second area is not stimulated with the second pulse train, and vice versa, or the first and second pulse trains are shifted relative to each other such that the first and second pulse trains at least partially overlap each other.
348. The apparatus according to claim 346, wherein the wall portion includes muscle fibers and the stimulation device is configured to stimulate the wall portion including the muscle fibers with the electric pulses, to cause contraction of the muscle fibres to contract the wall portion.
349. The apparatus according to claim 346, wherein the stimulation device comprises a plurality of electrical elements and a structure holding the electrical elements in a the fixed orientation relative to one another, the structure being integrated in or separate from the constriction device, and wherein the electrical elements form an elongate pattern of electrical elements and the structure is applicable on the patient's organ such that the elongate pattern of electrical elements extends along the wall portion of the organ in the direction of the flow in the lumen and the elements abut the respective areas of the wall portion.
350. The apparatus according to claim 346, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to electrically energize the electrical elements, preferably to cyclically energize each element with electric pulses, and wherein the control device is operable to control the stimulation device to energize the electrical elements, such that a number or groups of the electrical elements are energized at the same time or such that the electrical elements are energized one at a time in sequence or groups of the electrical elements are sequentially energized, either randomly or in accordance with a predetermined pattern.
351. The apparatus according to claim 346, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form an elongate pattern of electrical elements, wherein the elements are applicable on the patient's wall such that the elongate pattern of electrical elements extends along the wall portion of the organ in the direction of the flow in the lumen and the elements abut the respective areas of the wall portion, and wherein the control device is operable to control the stimulation device - to successively energize the electrical elements longitudinally along the elongate pattern of electrical elements, or - to successively energize the electrical elements along the elongate pattern of electrical elements in a direction opposite to, or in the same direction as, that of the flow in the lumen, when the stimulation device is applied on the patient's organ, or - to successively energize the electrical elements from a position substantially at the center of the constricted wall portion towards both ends of the elongate pattern of electrical elements, when the stimulation device is applied on the patient's organ.
352. The apparatus according to claim 346, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to energize the electrical elements, such that electrical elements currently energized form at least one group of adjacent energized electrical elements, wherein the elements in the group of energized electrical elements form a path of energized electrical elements, and wherein the path of energized electrical elements extends along the patient's organ, or at least in part or completely around the patient's organ, when the stimulation device is applied on the organ.
353. The apparatus according to claim 346, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form a plurality of groups of elements, the groups forming a series of groups extending along the patient's organ in the direction of flow in the patient's lumen, when the stimulation device is applied on the organ, the electrical elements of each group of electrical elements forming a path of elements extending along the patient's organ, or at least in part or completely around the patient's organ, and wherein the control device is operable to control the stimulation device - to successively energize the groups of electrical elements in the series of groups in a direction opposite to, or in the same direction as, that of the flow in the lumen, when the stimulation device is applied on the patient's organ, or - to successively energize the groups of electrical elements in the series of groups from a position substantially at the center of the constricted wall portion in a direction opposite to and in the same direction as that of the flow in the lumen, when the stimulation device is applied on the patient's organ.
354. The apparatus according to claim 333, wherein the stimulation device is configured to thermally stimulate the wall portion, either by cooling the constricted wall portion to cause contraction of the wall portion or by heating the wall portion, when the wall portion is constricted and contracted, to cause expansion of the wall portion, and wherein the constriction device is configured to constrict the wall portion to at least restrict the flow in the lumen, and the control device is operable to control the stimulation device to cool the constricted wall portion to cause contraction thereof, such that the flow in the lumen is at least further restricted but not stopped, or further restricted and stopped.
355. The apparatus according to claim 333, wherein the tissue wall portion of the organ extends between an upstream end and a downstream end of the wall portion with respect to the direction of the flow in the lumen, and wherein the control device is operable to control at least one of the constriction and stimulation devices to affect the wall portion such that the fluid and/or other bodily matter is actively moved in the lumen.
356. The apparatus according to claim 333, wherein the constriction device is configured to constrict the entire wall portion between the upstream and downstream ends thereof to restrict the flow in the lumen, and the control device is operable to control the stimulation device to progressively stimulate the constricted wall portion in the downstream or upstream direction of the lumen to cause progressive contraction of the wall portion to move the fluid and/or other bodily matter in the lumen, or to control the stimulation device to stimulate the constricted wall portion to close the lumen either at the upstream end or the downstream end of the wall portion and to simultaneously control the constriction device to increase the constriction of the entire wall portion to move the fluid and/or other bodily matter in the lumen.
357. The apparatus according to claim 333, wherein the control device is operable to control the constriction device to vary the constriction of the wall portion and to simultaneously control the stimulation device to progressively stimulate the constricted wall portion in the downstream or upstream direction of the lumen to cause progressive contraction of the wall portion to move the fluid and/or other bodily matter in the lumen.
358. The apparatus according to claim 333, wherein the control device is operable to control the stimulation device to stimulate the wall portion and to simultaneously control the constriction device to vary the constriction of different areas of the wall portion such that the wall portion is progressively constricted in the downstream or upstream direction of the lumen, and wherein the control device is operable to control the stimulation device to progressively stimulate the constricted wall portion to cause progressive contraction thereof in harmony with the progressive constriction of the wall portion performed by the constriction device, or the control device is operable to control an elongated constriction element of the constriction device extending along the wall portion to progressively constrict the wall portion in the downstream or upstream direction of the lumen, wherein the elongated constriction element comprises contact surfaces dimensioned to contact a length of the wall portion, when the constriction device constricts the wall portion, and the stimulation device comprises a plurality of stimulation elements distributed along the contact surfaces, such that the stimulation elements stimulate the different areas of the wall portion along the length of the wall portion, when the control device controls the stimulation device to stimulate the wall portion.
359. The apparatus according to claim 333, wherein the constriction device is configured to constrict any one of a series of wall portions of the tissue wall to at least restrict the flow in the lumen, the stimulation device is configured to stimulate the wall portion constricted by the constriction device to close the lumen, and the control device is operable to control the constriction device to successively constrict the wall portions of the series of wall portions to move the fluid and/or other bodily matter in the lumen in a peristaltic manner, and wherein the constriction device comprises at least one constriction element that is moveable along the organ to successively constrict the wall portions of the series of wall portions of the organ, and the stimulation device comprises at least one stimulation element positioned on the constriction element for stimulating the wall portion constricted by the constriction element to close the lumen.
360. The apparatus according to claim 359, wherein the control device is operable to control the constriction device to cyclically move the constriction element along the wall portions of the series of wall portions.
361. The apparatus according to claim 359, wherein the constriction device comprises a plurality of constriction elements, each of which is moveable along the organ to successively constrict the wall portions of the series of wall portions of the organ, wherein the stimulation device comprises stimulation elements positioned on the constriction elements for stimulating the wall portions constricted by the constriction elements to close the lumen, wherein the control device is operable to control the constriction device to cyclically move the constriction elements one after the other along the wall portions of the series of wall portions of the organ, wherein the constriction device comprises a rotor carrying the constriction elements, and the control device is operable to control the rotor to rotate such that each constriction element cyclically constricts the wall portions of the series of wall portions of the organ, and wherein each constriction element comprises a roller for rolling on the organ to constrict the latter.
362. The apparatus according to claim 333, wherein the constriction device comprises a first constriction element for constricting the wall portion of the organ at the upstream end thereof, a second constriction element for constricting the wall portion at the downstream end thereof, and a third constriction element for constricting the wall portion between the upstream and downstream ends thereof, and the control device is operable to control the first, second and third constriction elements to constrict and release the wall portions independently of one another, and wherein the control device is operable to control the first or second constriction element to constrict the wall portion at the upstream or downstream end thereof to close the lumen and to control the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, whereby the fluid or other bodily matter contained in the wall portion between the upstream and downstream ends thereof is moved downstream or upstream in the lumen, the control device controlling the stimulation device to stimulate the wall portion between the upstream and downstream ends thereof, when the third constriction element constricts the wall portion, or the control device is operable to control the first constriction element to constrict the wall portion at the upstream end thereof to restrict the flow in the lumen and to control the stimulation device to stimulate the constricted wall portion at the upstream end to close the lumen, and wherein the control device is operable to control the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, whereby the fluid and/or other bodily matter contained in the wall portion between the upstream and downstream ends thereof is moved downstream in the lumen, or the control device is operable to control the second constriction element to constrict the wall portion at the downstream end thereof to restrict the flow in the lumen and to control the stimulation device to stimulate the constricted wall portion at the downstream end to close the lumen, and the control device is operable to control the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, whereby the fluid and/or other bodily matter contained in the wall portion between the upstream and downstream ends thereof is moved upstream in the lumen.
363. The apparatus according to claim 333, wherein the constriction device is adjustable, and further comprising an operation device for operating the adjustable constriction device to change the constriction of the patient's wall portion of the organ wherein the operation device mechanically or hydraulically operates the constriction device.
364. The apparatus according to claim 363, wherein the operation device mechanically operates the constriction device, and the constriction device comprises at least two elongated clamping elements extending along the organ in the direction of flow in the patient's lumen on different sides of the organ, and the operation device operates the clamping elements to clamp the wall portion between the clamping elements to constrict the wall portion.
365. The apparatus according to claim 333, wherein the control device is operable to control the constriction device to close the lumen, either at an upstream end or a downstream end of the wall portion, and to control the constriction device to constrict the remaining part of the wall portion to move the fluid and/or other bodily matter in the lumen, and wherein the control device is operable to control the stimulation device to stimulate the wall portion as the constriction device constricts the remaining part of the wall portion.
366. The apparatus according to claim 333, wherein the constriction device is configured to constrict the wall portion to restrict but not stop the flow in the lumen, and the control device is operable to control the stimulation device to stimulate the wall portion constricted by the constriction device to close the lumen, either at an upstream end or a downstream end of the wall portion, and to simultaneously control the constriction device to increase the constriction of the wall portion to move the fluid and/or other bodily matter in the lumen.
367. The apparatus according to claim 333, wherein the constriction device comprises a plurality of separate constriction elements adapted to constrict any wall portions of a series of wall portions, respectively, of the organ, and the control device is operable to control the constriction device to activate the constriction elements in random or in accordance with a predetermined sequence.
368. The apparatus according to claim 367, wherein the stimulation device comprises stimulation elements positioned on the constriction elements, and wherein the control device is operable to control the stimulation device to activate the stimulation elements to stimulate any wall portions of the series of wall portions constricted by the constriction elements.
369. The apparatus according to claim 368, wherein the control device is operable to control the constriction device to activate the constriction elements to constrict the wall portions of the series of wall portions without completely closing the lumen, and to control the stimulation device to activate the stimulation elements to stimulate the constricted wall portions one after the other, so that the wall portions of the series of wall portions are successively contracted along the organ to move the fluid and/or other bodily matter in the lumen, or to constrict all of the wall portions of the series of wall portions, and to control the stimulation device to activate the stimulation elements to stimulate any constricted wall portions in random or in accordance with a predetermined sequence to close the organ's lumen.
370. An intestinal dysfunction treatment apparatus comprising an implantable constriction device configured to gently constrict at least one portion of the tissue wall of a patient's intestines to influence the flow of intestinal contents in the intestinal passageway of the intestines, a stimulation device configured to stimulate the wall portion of the tissue wall, and a control device operable to control the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the flow of intestinal contents.
371. The apparatus according to claim 370, wherein the constriction device is configured to constrict the wall portion to a constricted state in which the blood circulation in the constricted wall portion is substantially unrestricted and the flow in the intestinal passageway is at least restricted, and the control device is operable to control the stimulation device to cause contraction of the wall portion, so that the flow in the intestinal passageway is at least further restricted when the wall portion is kept by the constriction device in the constricted state.
372. The apparatus according to claim 370, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's wall portion, and the control device is operable to control the constriction and stimulation devices independently of each other.
373. The apparatus according to claim 370, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's wall portion, and - the control device is operable to control the stimulation device to stimulate or not to stimulate the wall portion, while the control device controls the constriction device to adjust the constriction of the wall portion, and - the control device is adapted to calibrate the constriction device by controlling the stimulation device to stimulate the wall portion while controlling the constriction device to adjust the constriction of the wall portion until the desired restriction of the flow in the intestinal passageway is obtained.
374. The apparatus according to claim 370, wherein the control device is operable to control the constriction device to adjust the constriction of the wall portion, such that the flow in the intestinal passageway is restricted but not stopped, and is operable - to control the stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the intestinal passageway is further restricted but not stopped, or - to control the stimulation device in a first mode to stimulate the constricted wall portion to stop the flow in the intestinal passageway and to control the stimulation device in a second mode to cease the stimulation of the wall portion to allow flow in the intestinal passageway.
375. The apparatus according to claim 370, wherein the control device is operable to control the constriction device to adjust the constriction of the wall portion, such that the flow in the intestinal passageway is substantially stopped, and to control the stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the intestinal passageway is completely stopped, and wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted wall portion to completely stop the flow in the intestinal passageway, and to control the stimulation device in a second mode to cease the stimulation of the wall portion to allow flow in the intestinal passageway, or to control in the second mode the stimulation device to cease the stimulation of the wall portion and the constriction device to release the wall portion to restore the flow in the intestinal passageway.
376. The apparatus according to claim 370, wherein the control device is operable to control the constriction device in a first mode to constrict the constricted wall portion to stop the flow in the intestinal passageway and to control the constriction device in a second mode to cease the constriction of the wall portion to restore flow in the intestinal passageway.
377. The apparatus according to claim 370, wherein the control device comprises a manually operable switch for switching on and off the constriction device and/or stimulation device, the switch being adapted for subcutaneous implantation in the patient to be manually operated from outside the patient's body.
378. The apparatus according to claim 370, wherein the constriction device is designed to normally keep the patient's wall portion in a constricted state, in which the blood circulation in the constricted wall portion is substantially unrestricted and the flow in the intestinal passageway is at least restricted, wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted wall portion to cause contraction thereof to further restrict but not stop the flow in the intestinal passageway, or to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the intestinal passageway is stopped, and wherein the control device is operable to control the stimulation device in a second mode to cease the stimulation of the wall portion to increase the flow in the intestinal passageway.
379. The apparatus according to claim 370, wherein the control device is operable to control the stimulation device to adjust the intensity of the stimulation of the wall portion in response to a sensed physical parameter of the patient or functional parameter of the apparatus.
380. The apparatus according to claim 370, wherein the control device is operable to control the stimulation device to increase the intensity of the stimulation in response to a sensed parameter related to an increase of pressure in the intestinal passageway, such that the flow in the intestinal passageway remains stopped, further comprising a sensor configured to sense a physical parameter of the patient that relates to the pressure in the intestinal passageway, the control device controlling the stimulation device in response to signals from the sensor, the physical parameter being related to a pressure in the patient's body and the sensor being a pressure related sensor.
381. The apparatus according to claim 370, wherein the control device is operable to control the stimulation device to intermittently and individually stimulate different areas of the wall portion, such that at least two of the areas are stimulated at different points of time, and wherein the control device is operable to control the stimulation device to intermittently stimulate - each area of the different areas of the wall portion during successive time periods, each time period being short enough to maintain over time satisfactory blood circulation in the area until the lapse of the time period, or the areas of the wall portion, such that an area of the wall portion that currently is not stimulated has time to restore substantially normal blood circulation before the stimulation device stimulates the area again.
382. The apparatus according to claim 370, wherein the control device is operable to control the stimulation device to stimulate different areas of the wall portion at a time by sequentially stimulating the different areas of the wall portion, or by shifting over time the stimulation from one area to another, or by shifting over time the stimulation from one area to another such that both areas are temporarily stimulated at the same time during the stimulation shift.
383. The apparatus according to claim 370, wherein the control device is operable to control the stimulation device to intermittently and individually electrically stimulate different areas of the patient's wall portion with electric pulses, and wherein the stimulation device comprises at least one electrical element for engaging the wall portion and for stimulating the wall portion with electric pulses.
384. The apparatus according to claim 383, wherein the pulses form pulse trains, and wherein the control device is operable to control the stimulation device to vary at least one of the following pulse parameters: the off time periods between the individual pulses of each pulse train, the off time periods between the pulse trains, the width of each pulse of the pulse trains, the length of each pulse train, the pulse amplitudes of the pulses of the pulse trains, the frequency of the pulses of the pulse trains, the frequency of the pulse trains, and the number of pulses of each pulse train, wherein at least a first area and a second area of the areas of the wall portion are repeatedly stimulated with a first pulse train of the pulse trains and a second pulse train of the pulse trains, respectively, such that the first and second pulse trains over time are shifted relative to each other, and wherein the first area is stimulated with the first pulse train while the second area is not stimulated with the second pulse train, and vice versa, or the first and second pulse trains are shifted relative to each other such that the first and second pulse trains at least partially overlap each other.
385. The apparatus according to claim 383, wherein the wall portion includes muscle fibers and the stimulation device is configured to stimulate the wall portion including the muscle fibers with the electric pulses, to cause contraction of the muscle fibres to contract the wall portion.
386. The apparatus according to claim 383, wherein the stimulation device comprises a plurality of electrical elements and a structure holding the electrical elements in a the fixed orientation relative to one another, the structure being integrated in or separate from the constriction device, and wherein the electrical elements form an elongate pattern of electrical elements and the structure is applicable on the patient's intestines such that the elongate pattern of electrical elements extends along the wall portion of the intestines in the direction of the flow in the intestinal passageway and the elements abut the respective areas of the wall portion.
387. The apparatus according to claim 383, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to electrically energize the electrical elements, preferably to cyclically energize each element with electric pulses, and wherein the control device is operable to control the stimulation device to energize the electrical elements, such that a number or groups of the electrical elements are energized at the same time or such that the electrical elements are energized one at a time in sequence or groups of the electrical elements are sequentially energized, either randomly or in accordance with a predetermined pattern.
388. The apparatus according to claim 383, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form an elongate pattern of electrical elements, wherein the elements are applicable on the patient's wall such that the elongate pattern of electrical elements extends along the wall portion of the intestines in the direction of the flow in the intestinal passageway and the elements abut the respective areas of the wall portion, and wherein the control device is operable to control the stimulation device - to successively energize the electrical elements longitudinally along the elongate pattern of electrical elements, or - to successively energize the electrical elements along the elongate pattern of electrical elements in a direction opposite to, or in the same direction as, that of the flow in the intestinal passageway, when the stimulation device is applied on the patient's intestines, or - to successively energize the electrical elements from a position substantially at the center of the constricted wall portion towards both ends of the elongate pattern of electrical elements, when the stimulation device is applied on the patient's intestines.
389. The apparatus according to claim 383, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to energize the electrical elements, such that electrical elements currently energized form at least one group of adjacent energized electrical elements, wherein the elements in the group of energized electrical elements form a path of energized electrical elements, and wherein the path of energized electrical elements extends along the patient's intestines, or at least in part or completely around the patient's intestines, when the stimulation device is applied on the intestines.
390. The apparatus according to claim 52, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form a plurality of groups of elements, the groups forming a series of groups extending along the patient's intestines in the direction of flow in the patient's intestinal passageway, when the stimulation device is applied on the intestines, the electrical elements of each group of electrical elements forming a path of elements extending along the patient's intestines, or at least in part or completely around the patient's intestines, and wherein the control device is operable to control the stimulation device - to successively energize the groups of electrical elements in the series of groups in a direction opposite to, or in the same direction as, that of the flow in the intestinal passageway, when the stimulation device is applied on the patient's intestines, or - to successively energize the groups of electrical elements in the series of groups from a position substantially at the center of the constricted wall portion in a direction opposite to and in the same direction as that of the flow in the intestinal passageway, when the stimulation device is applied on the patient's intestines.
391. The apparatus according to claim 370, wherein the stimulation device is configured to thermally stimulate the wall portion, either by cooling the constricted wall portion to cause contraction of the wall portion or by heating the wall portion, when the wall portion is constricted and contracted, to cause expansion of the wall portion, and wherein the constriction device is configured to constrict the wall portion to at least restrict the flow in the intestinal passageway, and the control device is operable to control the stimulation device to cool the constricted wall portion to cause contraction thereof, such that the flow in the intestinal passageway is at least further restricted but not stopped, or further restricted and stopped.
392. The apparatus according to claim 370, wherein the tissue wall portion of the intestines extends between an upstream end and a downstream end of the wall portion with respect to the direction of the flow in the intestinal passageway, and wherein the control device is operable to control at least one of the constriction and stimulation devices to affect the wall portion such that the intestinal contents is actively moved in the intestinal passageway.
393. The apparatus according to claim 370, wherein the constriction device is configured to constrict the entire wall portion between the upstream and downstream ends thereof to restrict the flow in the intestinal passageway, and the control device is operable to control the stimulation device to progressively stimulate the constricted wall portion in the downstream or upstream direction of the intestinal passageway to cause progressive contraction of the wall portion to move the intestinal contents in the intestinal passageway, or to control the stimulation device to stimulate the constricted wall portion to close the intestinal passageway either at the upstream end or the downstream end of the wall portion and to simultaneously control the constriction device to increase the constriction of the entire wall portion to move the intestinal contents in the intestinal passageway.
394. The apparatus according to claim 370, wherein the control device is operable to control the constriction device to vary the constriction of the wall portion and to simultaneously control the stimulation device to progressively stimulate the constricted wall portion in the downstream or upstream direction of the intestinal passageway to cause progressive contraction of the wall portion to move the intestinal contents in the intestinal passageway.
395. The apparatus according to claim 370, wherein the control device is operable to control the stimulation device to stimulate the wall portion and to simultaneously control the constriction device to vary the constriction of different areas of the wall portion such that the wall portion is progressively constricted in the downstream or upstream direction of the intestinal passageway, and wherein the control device is operable to control the stimulation device to progressively stimulate the constricted wall portion to cause progressive contraction thereof in harmony with the progressive constriction of the wall portion performed by the constriction device, or the control device is operable to control an elongated constriction element of the constriction device extending along the wall portion to progressively constrict the wall portion in the downstream or upstream direction of the intestinal passageway, wherein the elongated constriction element comprises contact surfaces dimensioned to contact a length of the wall portion, when the constriction device constricts the wall portion, and the stimulation device comprises a plurality of stimulation elements distributed along the contact surfaces, such that the stimulation elements stimulate the different areas of the wall portion along the length of the wall portion, when the control device controls the stimulation device to stimulate the wall portion.
396. The apparatus according to claim 370, wherein the constriction device is configured to constrict any one of a series of wall portions of the tissue wall to at least restrict the flow in the intestinal passageway, the stimulation device is configured to stimulate the wall portion constricted by the constriction device to close the intestinal passageway, and the control device is operable to control the constriction device to successively constrict the wall portions of the series of wall portions to move the intestinal contents in the intestinal passageway in a peristaltic manner, and wherein the constriction device comprises at least one constriction element that is moveable along the intestines to successively constrict the wall portions of the series of wall portions of the intestines, and the stimulation device comprises at least one stimulation element positioned on the constriction element for stimulating the wall portion constricted by the constriction element to close the intestinal passageway.
397. The apparatus according to claim 396, wherein the control device is operable to control the constriction device to cyclically move the constriction element along the wall portions of the series of wall portions.
398. The apparatus according to claim 396, wherein the constriction device comprises a plurality of constriction elements, each of which is moveable along the intestines to successively constrict the wall portions of the series of wall portions of the intestines, wherein the stimulation device comprises stimulation elements positioned on the constriction elements for stimulating the wall portions constricted by the constriction elements to close the intestinal passageway, wherein the control device is operable to control the constriction device to cyclically move the constriction elements one after the other along the wall portions of the series of wall portions of the intestines, wherein the constriction device comprises a rotor carrying the constriction elements, and the control device is operable to control the rotor to rotate such that each constriction element cyclically constricts the wall portions of the series of wall portions of the intestines, and wherein each constriction element comprises a roller for rolling on the intestines to constrict the latter.
399. The apparatus according to claim 370, wherein the constriction device comprises a first constriction element for constricting the wall portion of the intestines at the upstream end thereof, a second constriction element for constricting the wall portion at the downstream end thereof, and a third constriction element for constricting the wall portion between the upstream and downstream ends thereof, and the control device is operable to control the first, second and third constriction elements to constrict and release the wall portions independently of one another, and wherein the control device is operable to control the first or second constriction element to constrict the wall portion at the upstream or downstream end thereof to close the intestinal passageway and to control the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, whereby the intestinal contents contained in the wall portion between the upstream and downstream ends thereof is moved downstream or upstream in the intestinal passageway, the control device controlling the stimulation device to stimulate the wall portion between the upstream and downstream ends thereof, when the third constriction element constricts the wall portion, or the control device is operable to control the first constriction element to constrict the wall portion at the upstream end thereof to restrict the flow in the intestinal passageway and to control the stimulation device to stimulate the constricted wall portion at the upstream end to close the intestinal passageway, and wherein the control device is operable to control the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, whereby the intestinal contents contained in the wall portion between the upstream and downstream ends thereof is moved downstream in the intestinal passageway, or the control device is operable to control the second constriction element to constrict the wall portion at the downstream end thereof to restrict the flow in the intestinal passageway and to control the stimulation device to stimulate the constricted wall portion at the downstream end to close the intestinal passageway, and the control device is operable to control the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, whereby the intestinal contents contained in the wall portion between the upstream and downstream ends thereof is moved upstream in the intestinal passageway.
400. The apparatus according to claim 370, wherein the constriction device is adjustable, and further comprising an operation device for operating the adjustable constriction device to change the constriction of the patient's wall portion of the intestines wherein the operation device mechanically or hydraulically operates the constriction device.
401. The apparatus according to claim 400, wherein the operation device mechanically operates the constriction device, and the constriction device comprises at least two elongated clamping elements extending along the intestines in the direction of flow in the patient's intestinal passageway on different sides of the intestines, and the operation device operates the clamping elements to clamp the wall portion between the clamping elements to constrict the wall portion.
402. The apparatus according to claim 370, wherein the control device is operable to control the constriction device to close the intestinal passageway, either at an upstream end or a downstream end of the wall portion, and to control the constriction device to constrict the remaining part of the wall portion to move the intestinal contents in the intestinal passageway, and wherein the control device is operable to control the stimulation device to stimulate the wall portion as the constriction device constricts the remaining part of the wall portion.
403. The apparatus according to claim 370, wherein the constriction device is configured to constrict the wall portion to restrict but not stop the flow in the intestinal passageway, and the control device is operable to control the stimulation device to stimulate the wall portion constricted by the constriction device to close the intestinal passageway, either at an upstream end or a downstream end of the wall portion, and to simultaneously control the constriction device to increase the constriction of the wall portion to move the intestinal contents in the intestinal passageway.
404. The apparatus according to claim 370, wherein the constriction device comprises a plurality of separate constriction elements adapted to constrict any wall portions of a series of wall portions, respectively, of the intestines, and the control device is operable to control the constriction device to activate the constriction elements in random or in accordance with a predetermined sequence.
405. The apparatus according to claim 404, wherein the stimulation device comprises stimulation elements positioned on the constriction elements, and wherein the control device is operable to control the stimulation device to activate the stimulation elements to stimulate any wall portions of the series of wall portions constricted by the constriction elements.
406. The apparatus according to claim 405, wherein the control device is operable to control the constriction device to activate the constriction elements to constrict the wall portions of the series of wall portions without completely closing the intestinal passageway, and to control the stimulation device to activate the stimulation elements to stimulate the constricted wall portions one after the other, so that the wall portions of the series of wall portions are successively contracted along the intestines to move the intestinal contents in the intestinal passageway, or to constrict all of the wall portions of the series of wall portions, and to control the stimulation device to activate the stimulation elements to stimulate any constricted wall portions in random or in accordance with a predetermined sequence to close the intestinal passageway.
407. A urinary dysfunction treatment apparatus comprising an implantable constriction device configured to gently constrict at least one portion of the tissue wall of patient's urethra, ureter, renal pelvis or urine bladder to influence the flow of urine, a stimulation device configured to stimulate the wall portion of the tissue wall, and a control device operable to control the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the flow of urine.
408. The apparatus according to claim 407, wherein the constriction device is configured to constrict the wall portion to a constricted state in which the blood circulation in the constricted wall portion is substantially unrestricted and the flow in the urinary passageway is at least restricted, and the control device is operable to control the stimulation device to cause contraction of the wall portion, so that the flow in the urinary passageway is at least further restricted when the wall portion is kept by the constriction device in the constricted state.
409. The apparatus according to claim 408, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's wall portion, and the control device is operable to control the constriction and stimulation devices independently of each other.
410. The apparatus according to claim 408, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's wall portion, and - the control device is operable to control the stimulation device to stimulate or not to stimulate the wall portion, while the control device controls the constriction device to adjust the constriction of the wall portion, and - the control device is operable to calibrate the constriction device by controlling the stimulation device to stimulate the wall portion while controlling the constriction device to adjust the constriction of the wall portion until the desired restriction of the flow in the urinary passageway is obtained.
411. The apparatus according to claim 408, wherein the control device is operable to control the constriction device to adjust the constriction of the wall portion, such that the flow in the urinary passageway is restricted but not stopped, and is operable - to control the stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the urinary passageway is further restricted but not stopped, or - to control the stimulation device in a first mode to stimulate the constricted wall portion to stop the flow in the urinary passageway and to control the stimulation device in a second mode to cease the stimulation of the wall portion to allow flow in the urinary passageway.
412. The apparatus according to claim 408, wherein the control device is operable to control the constriction device to adjust the constriction of the wall portion, such that the flow in the urinary passageway is substantially stopped, and to control the stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the urinary passageway is completely stopped, and wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted wall portion to completely stop the flow in the urinary passageway, and to control the stimulation device in a second mode to cease the stimulation of the wall portion to allow flow in the urinary passageway, or to control in the second mode the stimulation device to cease the stimulation of the wall portion and the constriction device to release the wall portion to restore the flow in the urinary passageway.
413. The apparatus according to claim 408, wherein the control device is operable to control the constriction device in a first mode to constrict the constricted wall portion to stop the flow in the urinary passageway and to control the constriction device in a second mode to cease the constriction of the wall portion to restore flow in the urinary passageway.
414. The apparatus according to claim 408, wherein the control device comprises a manually operable switch for switching on and off the constriction device and/or stimulation device, the switch being adapted for subcutaneous implantation in the patient to be manually operated from outside the patient's body.
415. The apparatus according to claim 408, wherein the constriction device is designed to normally keep the patient's wall portion in a constricted state, in which the blood circulation in the constricted wall portion is substantially unrestricted and the flow in the urinary passageway is at least restricted, wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted wall portion to cause contraction thereof to further restrict but not stop the flow in the urinary passageway, or to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the urinary passageway is stopped, and wherein the control device is operable to control the stimulation device in a second mode to cease the stimulation of the wall portion to increase the flow in the urinary passageway.
416. The apparatus according to claim 408, wherein the control device is operable to control the stimulation device to adjust the intensity of the stimulation of the wall portion in response to a sensed physical parameter of the patient or functional parameter of the apparatus.
417. The apparatus according to claim 408, wherein the control device is operable to control the stimulation device to increase the intensity of the stimulation in response to a sensed parameter related to an increase of pressure in the urinary passageway, such that the flow in the urinary passageway remains stopped, further comprising a sensor configured to sense a physical parameter of the patient that relates to the pressure in the urinary passageway, the control device controlling the stimulation device in response to signals from the sensor, the physical parameter being related to a pressure in the patient's body and the sensor being a pressure related sensor.
418. The apparatus according to claim 408, wherein the control device is operable to control the stimulation device to intermittently and individually stimulate different areas of the wall portion, such that at least two of the areas are stimulated at different points of time, and wherein the control device is operable to control the stimulation device to intermittently stimulate - each area of the different areas of the wall portion during successive time periods, each time period being short enough to maintain over time satisfactory blood circulation in the area until the lapse of the time period, or - the areas of the wall portion, such that an area of the wall portion that currently is not stimulated has time to restore substantially normal blood circulation before the stimulation device stimulates the area again.
419. The apparatus according to claim 408, wherein the control device is operable to control the stimulation device to stimulate different areas of the wall portion at a time by sequentially stimulating the different areas of the wall portion, or by shifting over time the stimulation from one area to another, or by shifting over time the stimulation from one area to another such that both areas are temporarily stimulated at the same time during the stimulation shift.
420. The apparatus according to claim 408, wherein the control device is operable to control the stimulation device to intermittently and individually electrically stimulate different areas of the patient's wall portion with electric pulses, and wherein the stimulation device comprises at least one electrical element for engaging the wall portion and for stimulating the wall portion with electric pulses.
421. The apparatus according to claim 420, wherein the pulses form pulse trains, and wherein the control device is operable to control the stimulation device to vary at least one of the following pulse parameters: the off time periods between the individual pulses of each pulse train, the off time periods between the pulse trains, the width of each pulse of the pulse trains, the length of each pulse train, the pulse amplitudes of the pulses of the pulse trains, the frequency of the pulses of the pulse trains, the frequency of the pulse trains, and the number of pulses of each pulse train, wherein at least a first area and a second area of the areas of the wall portion are repeatedly stimulated with a first pulse train of the pulse trains and a second pulse train of the pulse trains, respectively, such that the first and second pulse trains over time are shifted relative to each other, and wherein the first area is stimulated with the first pulse train while the second area is not stimulated with the second pulse train, and vice versa, or the first and second pulse trains are shifted relative to each other such that the first and second pulse trains at least partially overlap each other.
422. The apparatus according to claim 420, wherein the wall portion includes muscle fibers and the stimulation device is configured to stimulate the wall portion including the muscle fibers with the electric pulses, to cause contraction of the muscle fibres to contract the wall portion.
423. The apparatus according to claim 420, wherein the stimulation device comprises a plurality of electrical elements and a structure holding the electrical elements in a the fixed orientation relative to one another, the structure being integrated in or separate from the constriction device, and wherein the electrical elements form an elongate pattern of electrical elements and the structure is applicable on the patient's urethra, ureter, renal pelvis, or urine bladder such that the elongate pattern of electrical elements extends along the wall portion of the urethra, ureter, renal pelvis, or urine bladder in the direction of the flow in the urinary passageway and the elements abut the respective areas of the wall portion.
424. The apparatus according to claim 420, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to electrically energize the electrical elements, preferably to cyclically energize each element with electric pulses, and wherein the control device is operable to control the stimulation device to energize the electrical elements, such that a number or groups of the electrical elements are energized at the same time or such that the electrical elements are energized one at a time in sequence or groups of the electrical elements are sequentially energized, either randomly or in accordance with a predetermined pattern.
425. The apparatus according to claim 420, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form an elongate pattern of electrical elements, wherein the elements are applicable on the patient's wall such that the elongate pattern of electrical elements extends along the wall portion of the urethra, ureter, renal pelvis, or urine bladder in the direction of the flow in the urinary passageway and the elements abut the respective areas of the wall portion, and wherein the control device is operable to control the stimulation device - to successively energize the electrical elements longitudinally along the elongate pattern of electrical elements, or - to successively energize the electrical elements along the elongate pattern of electrical elements in a direction opposite to, or in the same direction as, that of the flow in the urinary passageway, when the stimulation device is applied on the patient's urethra, ureter, renal pelvis, or urine bladder, or - to successively energize the electrical elements from a position substantially at the center of the constricted wall portion towards both ends of the elongate pattern of electrical elements, when the stimulation device is applied on the patient's urethra, ureter, renal pelvis, or urine bladder.
426. The apparatus according to claim 420, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to energize the electrical elements, such that electrical elements currently energized form at least one group of adjacent energized electrical elements, wherein the elements in the group of energized electrical elements form a path of energized electrical elements, and wherein the path of energized electrical elements extends along the patient's urethra, ureter, renal pelvis, or urine bladder, or at least in part or completely around the patient's urethra, ureter, renal pelvis, or urine bladder, when the stimulation device is applied on the urethra, ureter, renal pelvis, or urine bladder.
427. The apparatus according to claim 420, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form a plurality of groups of elements, the groups forming a series of groups extending along the patient's urethra, ureter, renal pelvis, or urine bladder in the direction of flow in the patient's urinary passageway, when the stimulation device is applied on the urethra, ureter, renal pelvis, or urine bladder, the electrical elements of each group of electrical elements forming a path of elements extending along the patient's urethra, ureter, renal pelvis, or urine bladder, or at least in part or completely around the patient's urethra, ureter, renal pelvis, or urine bladder, and wherein the control device is operable to control the stimulation device - to successively energize the groups of electrical elements in the series of groups in a direction opposite to, or in the same direction as, that of the flow in the urinary passageway, when the stimulation device is applied on the patient's urethra, ureter, renal pelvis, or urine bladder, or - to successively energize the groups of electrical elements in the series of groups from a position substantially at the center of the constricted wall portion in a direction opposite to and in the same direction as that of the flow in the urinary passageway, when the stimulation device is applied on the patient's urethra, ureter, renal pelvis, or urine bladder.
428. The apparatus according to claim 408, wherein the stimulation device is configured to thermally stimulate the wall portion, either by cooling the constricted wall portion to cause contraction of the wall portion or by heating the wall portion, when the wall portion is constricted and contracted, to cause expansion of the wall portion, and wherein the constriction device is configured to constrict the wall portion to at least restrict the flow in the urinary passageway, and the control device is operable to control the stimulation device to cool the constricted wall portion to cause contraction thereof, such that the flow in the urinary passageway is at least further restricted but not stopped, or further restricted and stopped.
429. The apparatus according to claim 408, wherein the tissue wall portion of the urethra, ureter, renal pelvis, or urine bladder extends between an upstream end and a downstream end of the wall portion with respect to the direction of the flow in the urinary passageway, and wherein the control device is operable to control at least one of the constriction and stimulation devices to affect the wall portion such that the urine is actively moved in the urinary passageway.
430. The apparatus according to claim 408, wherein the constriction device is configured to constrict the entire wall portion between the upstream and downstream ends thereof to restrict the flow in the urinary passageway, and the control device is operable to control the stimulation device to progressively stimulate the constricted wall portion in the downstream or upstream direction of the urinary passageway to cause progressive contraction of the wall portion to move the urine in the urinary passageway, or to control the stimulation device to stimulate the constricted wall portion to close the urinary passageway either at the upstream end or the downstream end of the wall portion and to simultaneously control the constriction device to increase the constriction of the entire wall portion to move the urine in the urinary passageway.
431. The apparatus according to claim 408, wherein the control device is operable to control the constriction device to vary the constriction of the wall portion and to simultaneously control the stimulation device to progressively stimulate the constricted wall portion in the downstream or upstream direction of the urinary passageway to cause progressive contraction of the wall portion to move the urine in the urinary passageway.
432. The apparatus according to claim 408, wherein the control device is operable to control the stimulation device to stimulate the wall portion and to simultaneously control the constriction device to vary the constriction of different areas of the wall portion such that the wall portion is progressively constricted in the downstream or upstream direction of the urinary passageway, and wherein the control device is operable to control the stimulation device to progressively stimulate the constricted wall portion to cause progressive contraction thereof in harmony with the progressive constriction of the wall portion performed by the constriction device, or the control device is operable to control an elongated constriction element of the constriction device extending along the wall portion to progressively constrict the wall portion in the downstream or upstream direction of the urinary passageway, wherein the elongated constriction element comprises contact surfaces dimensioned to contact a length of the wall portion, when the constriction device constricts the wall portion, and the stimulation device comprises a plurality of stimulation elements distributed along the contact surfaces, such that the stimulation elements stimulate the different areas of the wall portion along the length of the wall portion, when the control device controls the stimulation device to stimulate the wall portion.
433. The apparatus according to claim 408, wherein the constriction device is configured to constrict any one of a series of wall portions of the the urethra, ureter, renal pelvis, or urine bladder to at least restrict the flow in the urinary passageway, the stimulation device is configured to stimulate the wall portion constricted by the constriction device to close the urinary passageway, and the control device is operable to control the constriction device to successively constrict the wall portions of the series of wall portions to move the urine in the urinary passageway in a peristaltic manner, and wherein the constriction device comprises at least one constriction element that is moveable along the urethra, ureter, renal pelvis, or urine bladder to successively constrict the wall portions of the series of wall portions, and the stimulation device comprises at least one stimulation element positioned on the constriction element for stimulating the wall portion constricted by the constriction element to close the urinary passageway.
434. The apparatus according to claim 433, wherein the control device is operable to control the constriction device to cyclically move the constriction element along the wall portions of the series of wall portions.
435. The apparatus according to claim 433, wherein the constriction device comprises a plurality of constriction elements, each of which is moveable along the urethra, ureter, renal pelvis, or urine bladder to successively constrict the wall portions of the series of wall portions, wherein the stimulation device comprises stimulation elements positioned on the constriction elements for stimulating the wall portions constricted by the constriction elements to close the urinary passageway, wherein the control device is operable to control the constriction device to cyclically move the constriction elements one after the other along the wall portions of the series of wall portions, wherein the constriction device comprises a rotor carrying the constriction elements, and the control device is operable to control the rotor to rotate such that each constriction element cyclically constricts the wall portions of the series of wall portions, and wherein each constriction element comprises a roller for rolling on the urethra, ureter, renal pelvis, or urine bladder to constrict the latter.
436. The apparatus according to claim 408, wherein the constriction device comprises a first constriction element for constricting the wall portion of the urethra, ureter, renal pelvis, or urine bladder at the upstream end thereof, a second constriction element for constricting the wall portion at the downstream end thereof, and a third constriction element for constricting the wall portion between the upstream and downstream ends thereof, and the control device is operable to control the first, second and third constriction elements to constrict and release the wall portions independently of one another, and wherein the control device is operable to control the first or second constriction element to constrict the wall portion at the upstream or downstream end thereof to close the urinary passageway and to control the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, whereby the urine contained in the wall portion between the upstream and downstream ends thereof is moved downstream or upstream in the urinary passageway, the control device controlling the stimulation device to stimulate the wall portion between the upstream and downstream ends thereof, when the third constriction element constricts the wall portion, or the control device is operable to control the first constriction element to constrict the wall portion at the upstream end thereof to restrict the flow in the urinary passageway and to control the stimulation device to stimulate the constricted wall portion at the upstream end to close the urinary passageway, and wherein the control device is operable to control the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, whereby the urine contained in the wall portion between the upstream and downstream ends thereof is moved downstream in the urinary passageway, or the control device is operable to control the second constriction element to constrict the wall portion at the downstream end thereof to restrict the flow in the urinary passageway and to control the stimulation device to stimulate the constricted wall portion at the downstream end to close the urinary passageway, and the control device is operable to control the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, whereby the urine contained in the wall portion between the upstream and downstream ends thereof is moved upstream in the urinary passageway.
437. The apparatus according to claim 408, wherein the constriction device is adjustable, and further comprising an operation device for operating the adjustable constriction device to change the constriction of the patient's wall portion of the urethra, ureter, renal pelvis, or urine bladder wherein the operation device mechanically or hydraulically operates the constriction device.
438. The apparatus according to claim 437, wherein the operation device mechanically operates the constriction device, and the constriction device comprises at least two elongated clamping elements extending along the urethra, ureter, renal pelvis, or urine bladder in the direction of flow in the patient's urinary passageway on different sides of the urethra, ureter, renal pelvis, or urine bladder, and the operation device operates the clamping elements to clamp the wall portion between the clamping elements to constrict the wall portion.
439. The apparatus according to claim 408, wherein the control device is operable to control the constriction device to close the urinary passageway, either at an upstream end or a downstream end of the wall portion, and to control the constriction device to constrict the remaining part of the wall portion to move the urine in the urinary passageway, and wherein the control device is operable to control the stimulation device to stimulate the wall portion as the constriction device constricts the remaining part of the wall portion.
440. The apparatus according to claim 408, wherein the constriction device is configured to constrict the wall portion to restrict but not stop the flow in the urinary passageway, and the control device is operable to control the stimulation device to stimulate the wall portion constricted by the constriction device to close the urinary passageway, either at an upstream end or a downstream end of the wall portion, and to simultaneously control the constriction device to increase the constriction of the wall portion to move the urine in the urinary passageway.
441. The apparatus according to claim 408, wherein the constriction device comprises a plurality of separate constriction elements adapted to constrict any wall portions of a series of wall portions, respectively, of the urethra, ureter, renal pelvis, or urine bladder, and the control device is operable to control the constriction device to activate the constriction elements in random or in accordance with a predetermined sequence.
442. The apparatus according to claim 441, wherein the stimulation device comprises stimulation elements positioned on the constriction elements, and wherein the control device is operable to control the stimulation device to activate the stimulation elements to stimulate any wall portions of the series of wall portions constricted by the constriction elements.
443. The apparatus according to claim 442, wherein the control device is operable to control the constriction device to activate the constriction elements to constrict the wall portions of the series of wall portions without completely closing the urinary passageway, and to control the stimulation device to activate the stimulation elements to stimulate the constricted wall portions one after the other, so that the wall portions of the series of wall portions are successively contracted along the urethra, ureter, renal pelvis, or urine bladder to move the urine in the urinary passageway, or to constrict all of the wall portions of the series of wall portions, and to control the stimulation device to activate the stimulation elements to stimulate any constricted wall portions in random or in accordance with a predetermined sequence to close the urinary passageway.
444. An obesity treatment apparatus comprising an implantable constriction device configured to gently constrict at least one portion of the tissue wall of a patient's stomach to influence the food flow in a food passageway of the stomach, a stimulation device configured to stimulate the wall portion of the tissue wall, and a control device operable to control the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the food flow in the food passageway of the stomach.
445. The apparatus according to claim 444, wherein the constriction device is configured to constrict the wall portion to a constricted state in which the blood circulation in the constricted wall portion is substantially unrestricted and the flow in the food passageway is at least restricted, and the control device is operable to control the stimulation device to cause contraction of the wall portion, so that the flow in the food passageway is at least further restricted when the wall portion is kept by the constriction device in the constricted state.
446. The apparatus according to claim 444, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's wall portion, and the control device is operable to control the constriction and stimulation devices independently of each other.
447. The apparatus according to claim 444, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's wall portion, and - the control device is operable to control the stimulation device to stimulate or not to stimulate the wall portion, while the control device controls the constriction device to adjust the constriction of the wall portion, and - the control device is operable to calibrate the constriction device by controlling the stimulation device to stimulate the wall portion while controlling the constriction device to adjust the constriction of the wall portion until the desired restriction of the flow in the food passageway is obtained.
448. The apparatus according to claim 444, wherein the control device is operable to control the constriction device to adjust the constriction of the wall portion, such that the flow in the food passageway is restricted but not stopped, and is operable - to control the stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the food passageway is further restricted but not stopped, or - to control the stimulation device in a first mode to stimulate the constricted wall portion to stop the flow in the food passageway and to control the stimulation device in a second mode to cease the stimulation of the wall portion to allow flow in the food passageway.
449. The apparatus according to claim 444, wherein the control device is operable to control the constriction device to adjust the constriction of the wall portion, such that the flow in the food passageway is substantially stopped, and to control the stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the food passageway is completely stopped, and wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted wall portion to completely stop the flow in the food passageway, and to control the stimulation device in a second mode to cease the stimulation of the wall portion to allow flow in the food passageway, or to control in the second mode the stimulation device to cease the stimulation of the wall portion and the constriction device to release the wall portion to restore the flow in the food passageway.
450. The apparatus according to claim 444, wherein the control device is operable to control the constriction device in a first mode to constrict the constricted wall portion to stop the flow in the food passageway and to control the constriction device in a second mode to cease the constriction of the wall portion to restore flow in the food passageway.
451. The apparatus according to claim 444, wherein the control device comprises a manually operable switch for switching on and off the constriction device and/or stimulation device, the switch being adapted for subcutaneous implantation in the patient to be manually operated from outside the patient's body.
452. The apparatus according to claim 444, wherein the constriction device is designed to normally keep the patient's wall portion in a constricted state, in which the blood circulation in the constricted wall portion is substantially unrestricted and the flow in the food passageway is at least restricted, wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted wall portion to cause contraction thereof to further restrict but not stop the flow in the food passageway, or to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the food passageway is stopped, and wherein the control device is operable to control the stimulation device in a second mode to cease the stimulation of the wall portion to increase the flow in the food passageway.
453. The apparatus according to claim 444, wherein the control device is operable to control the stimulation device to adjust the intensity of the stimulation of the wall portion in response to a sensed physical parameter of the patient or functional parameter of the apparatus.
454. The apparatus according to claim 444, wherein the control device is operable to control the stimulation device to increase the intensity of the stimulation in response to a sensed parameter related to an increase of pressure in the food passageway, such that the flow in the food passageway remains stopped, further comprising a sensor configured to sense a physical parameter of the patient that relates to the pressure in the food passageway, the control device controlling the stimulation device in response to signals from the sensor, the physical parameter being related to a pressure in the patient's body and the sensor being a pressure related sensor.
455. The apparatus according to claim 444, wherein the control device is operable to control the stimulation device to intermittently and individually stimulate different areas of the wall portion, such that at least two of the areas are stimulated at different points of time, and wherein the control device is operable to control the stimulation device to intermittently stimulate - each area of the different areas of the wall portion during successive time periods, each time period being short enough to maintain over time satisfactory blood circulation in the area until the lapse of the time period, or - the areas of the wall portion, such that an area of the wall portion that currently is not stimulated has time to restore substantially normal blood circulation before the stimulation device stimulates the area again.
456. The apparatus according to claim 444, wherein the control device is operable to control the stimulation device to stimulate different areas of the wall portion at a time by sequentially stimulating the different areas of the wall portion, or by shifting over time the stimulation from one area to another, or by shifting over time the stimulation from one area to another such that both areas are temporarily stimulated at the same time during the stimulation shift.
457. The apparatus according to claim 444, wherein the control device is operable to control the stimulation device to intermittently and individually electrically stimulate different areas of the patient's wall portion with electric pulses, and wherein the stimulation device comprises at least one electrical element for engaging the wall portion and for stimulating the wall portion with electric pulses.
458. The apparatus according to claim 457, wherein the pulses form pulse trains, and wherein the control device is operable to control the stimulation device to vary at least one of the following pulse parameters: the off time periods between the individual pulses of each pulse train, the off time periods between the pulse trains, the width of each pulse of the pulse trains, the length of each pulse train, the pulse amplitudes of the pulses of the pulse trains, the frequency of the pulses of the pulse trains, the frequency of the pulse trains, and the number of pulses of each pulse train, wherein at least a first area and a second area of the areas of the wall portion are repeatedly stimulated with a first pulse train of the pulse trains and a second pulse train of the pulse trains, respectively, such that the first and second pulse trains over time are shifted relative to each other, and wherein the first area is stimulated with the first pulse train while the second area is not stimulated with the second pulse train, and vice versa, or the first and second pulse trains are shifted relative to each other such that the first and second pulse trains at least partially overlap each other.
459. The apparatus according to claim 457, wherein the wall portion includes muscle fibers and the stimulation device is configured to stimulate the wall portion including the muscle fibers with the electric pulses, to cause contraction of the muscle fibres to contract the wall portion.
460. The apparatus according to claim 457, wherein the stimulation device comprises a plurality of electrical elements and a structure holding the electrical elements in a the fixed orientation relative to one another, the structure being integrated in or separate from the constriction device, and wherein the electrical elements form an elongate pattern of electrical elements and the structure is applicable on the patient's stomach such that the elongate pattern of electrical elements extends along the wall portion of the stomach in the direction of the flow in the food passageway and the elements abut the respective areas of the wall portion.
461. The apparatus according to claim 457, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to electrically energize the electrical elements, preferably to cyclically energize each element with electric pulses, and wherein the control device is operable to control the stimulation device to energize the electrical elements, such that a number or groups of the electrical elements are energized at the same time or such that the electrical elements are energized one at a time in sequence or groups of the electrical elements are sequentially energized, either randomly or in accordance with a predetermined pattern.
462. The apparatus according to claim 457, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form an elongate pattern of electrical elements, wherein the elements are applicable on the patient's wall such that the elongate pattern of electrical elements extends along the wall portion of the stomach in the direction of the flow in the food passageway and the elements abut the respective areas of the wall portion, and wherein the control device is operable to control the stimulation device - to successively energize the electrical elements longitudinally along the elongate pattern of electrical elements, or - to successively energize the electrical elements along the elongate pattern of electrical elements in a direction opposite to, or in the same direction as, that of the flow in the food passageway, when the stimulation device is applied on the patient's stomach, or - to successively energize the electrical elements from a position substantially at the center of the constricted wall portion towards both ends of the elongate pattern of electrical elements, when the stimulation device is applied on the patient's stomach.
463. The apparatus according to claim 457, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to energize the electrical elements, such that electrical elements currently energized form at least one group of adjacent energized electrical elements, wherein the elements in the group of energized electrical elements form a path of energized electrical elements, and wherein the path of energized electrical elements extends along the patient's stomach, or at least in part or completely around the patient's stomach, when the stimulation device is applied on the stomach.
464. The apparatus according to claim 457, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form a plurality of groups of elements, the groups forming a series of groups extending along the patient's stomach in the direction of flow in the patient's food passageway, when the stimulation device is applied on the stomach, the electrical elements of each group of electrical elements forming a path of elements extending along the patient's stomach, or at least in part or completely around the patient's stomach, and wherein the control device is operable to control the stimulation device - to successively energize the groups of electrical elements in the series of groups in a direction opposite to, or in the same direction as, that of the flow in the food passageway, when the stimulation device is applied on the patient's stomach, or - to successively energize the groups of electrical elements in the series of groups from a position substantially at the center of the constricted wall portion in a direction opposite to and in the same direction as that of the flow in the food passageway, when the stimulation device is applied on the patient's stomach.
465. The apparatus according to claim 457, wherein the stimulation device is configured to thermally stimulate the wall portion, either by cooling the constricted wall portion to cause contraction of the wall portion or by heating the wall portion, when the wall portion is constricted and contracted, to cause expansion of the wall portion, and wherein the constriction device is configured to constrict the wall portion to at least restrict the flow in the food passageway, and the control device is operable to control the stimulation device to cool the constricted wall portion to cause contraction thereof, such that the flow in the food passageway is at least further restricted but not stopped, or further restricted and stopped.
466. The apparatus according to claim 457, wherein the tissue wall portion of the stomach extends between an upstream end and a downstream end of the wall portion with respect to the direction of the flow in the food passageway, and wherein the control device is operable to control at least one of the constriction and stimulation devices to affect the wall portion such that the food is actively moved in the food passageway.
467. The apparatus according to claim 457, wherein the constriction device is configured to constrict the entire wall portion between the upstream and downstream ends thereof to restrict the flow in the food passageway, and the control device is operable to control the stimulation device to progressively stimulate the constricted wall portion in the downstream or upstream direction of the food passageway to cause progressive contraction of the wall portion to move the food in the food passageway, or to control the stimulation device to stimulate the constricted wall portion to close the food passageway either at the upstream end or the downstream end of the wall portion and to simultaneously control the constriction device to increase the constriction of the entire wall portion to move the food in the food passageway.
468. The apparatus according to claim 457, wherein the control device is operable to control the constriction device to vary the constriction of the wall portion and to simultaneously control the stimulation device to progressively stimulate the constricted wall portion in the downstream or upstream direction of the food passageway to cause progressive contraction of the wall portion to move the food in the food passageway.
469. The apparatus according to claim 457, wherein the control device is operable to control the stimulation device to stimulate the wall portion and to simultaneously control the constriction device to vary the constriction of different areas of the wall portion such that the wall portion is progressively constricted in the downstream or upstream direction of the food passageway, and wherein the control device is operable to control the stimulation device to progressively stimulate the constricted wall portion to cause progressive contraction thereof in harmony with the progressive constriction of the wall portion performed by the constriction device, or the control device is operable to control an elongated constriction element of the constriction device extending along the wall portion to progressively constrict the wall portion in the downstream or upstream direction of the food passageway, wherein the elongated constriction element comprises contact surfaces dimensioned to contact a length of the wall portion, when the constriction device constricts the wall portion, and the stimulation device comprises a plurality of stimulation elements distributed along the contact surfaces, such that the stimulation elements stimulate the different areas of the wall portion along the length of the wall portion, when the control device controls the stimulation device to stimulate the wall portion.
470. The apparatus according to claim 457, wherein the constriction device is configured to constrict any one of a series of wall portions of the the stomach to at least restrict the flow in the food passageway, the stimulation device is configured to stimulate the wall portion constricted by the constriction device to close the food passageway, and the control device is operable to control the constriction device to successively constrict the wall portions of the series of wall portions to move the food in the food passageway in a peristaltic manner, and wherein the constriction device comprises at least one constriction element that is moveable along the stomach to successively constrict the wall portions of the series of wall portions, and the stimulation device comprises at least one stimulation element positioned on the constriction element for stimulating the wall portion constricted by the constriction element to close the food passageway.
471. The apparatus according to claim 470, wherein the control device is operable to control the constriction device to cyclically move the constriction element along the wall portions of the series of wall portions.
472. The apparatus according to claim 470, wherein the constriction device comprises a plurality of constriction elements, each of which is moveable along the stomach to successively constrict the wall portions of the series of wall portions, wherein the stimulation device comprises stimulation elements positioned on the constriction elements for stimulating the wall portions constricted by the constriction elements to close the food passageway, wherein the control device is operable to control the constriction device to cyclically move the constriction elements one after the other along the wall portions of the series of wall portions, wherein the constriction device comprises a rotor carrying the constriction elements, and the control device is operable to control the rotor to rotate such that each constriction element cyclically constricts the wall portions of the series of wall portions, and wherein each constriction element comprises a roller for rolling on the stomach to constrict the latter.
473. The apparatus according to claim 444, wherein the constriction device comprises a first constriction element for constricting the wall portion of the stomach at the upstream end thereof, a second constriction element for constricting the wall portion at the downstream end thereof, and a third constriction element for constricting the wall portion between the upstream and downstream ends thereof, and the control device is operable to control the first, second and third constriction elements to constrict and release the wall portions independently of one another, and wherein the control device is operable to control the first or second constriction element to constrict the wall portion at the upstream or downstream end thereof to close the food passageway and to control the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, whereby the food contained in the wall portion between the upstream and downstream ends thereof is moved downstream or upstream in the food passageway, the control device controlling the stimulation device to stimulate the wall portion between the upstream and downstream ends thereof, when the third constriction element constricts the wall portion, or the control device is operable to control the first constriction element to constrict the wall portion at the upstream end thereof to restrict the flow in the food passageway and to control the stimulation device to stimulate the constricted wall portion at the upstream end to close the food passageway, and wherein the control device is operable to control the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, whereby the food contained in the wall portion between the upstream and downstream ends thereof is moved downstream in the food passageway, or the control device is operable to control the second constriction element to constrict the wall portion at the downstream end thereof to restrict the flow in the food passageway and to control the stimulation device to stimulate the constricted wall portion at the downstream end to close the food passageway, and the control device is operable to control the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, whereby the food contained in the wall portion between the upstream and downstream ends thereof is moved upstream in the food passageway.
474. The apparatus according to claim 444, wherein the constriction device is adjustable, and further comprising an operation device for operating the adjustable constriction device to change the constriction of the patient's wall portion of the stomach wherein the operation device mechanically or hydraulically operates the constriction device.
475. The apparatus according to claim 474, wherein the operation device mechanically operates the constriction device, and the constriction device comprises at least two elongated clamping elements extending along the stomach in the direction of flow in the patient's food passageway on different sides of the stomach, and the operation device operates the clamping elements to clamp the wall portion between the clamping elements to constrict the wall portion.
476. The apparatus according to claim 444, wherein the control device is operable to control the constriction device to close the food passageway, either at an upstream end or a downstream end of the wall portion, and to control the constriction device to constrict the remaining part of the wall portion to move the food in the food passageway, and wherein the control device is operable to control the stimulation device to stimulate the wall portion as the constriction device constricts the remaining part of the wall portion.
477. The apparatus according to claim 444, wherein the constriction device is configured to constrict the wall portion to restrict but not stop the flow in the food passageway, and the control device is operable to control the stimulation device to stimulate the wall portion constricted by the constriction device to close the food passageway, either at an upstream end or a downstream end of the wall portion, and to simultaneously control the constriction device to increase the constriction of the wall portion to move the food in the food passageway.
478. The apparatus according to claim 113, wherein the constriction device comprises a plurality of separate constriction elements adapted to constrict any wall portions of a series of wall portions, respectively, of the stomach, and the control device is operable to control the constriction device to activate the constriction elements in random or in accordance with a predetermined sequence.
479. The apparatus according to claim 478, wherein the stimulation device comprises stimulation elements positioned on the constriction elements, and wherein the control device is operable to control the stimulation device to activate the stimulation elements to stimulate any wall portions of the series of wall portions constricted by the constriction elements.
480. The apparatus according to claim 479, wherein the control device is operable to control the constriction device to activate the constriction elements to constrict the wall portions of the series of wall portions without completely closing the food passageway, and to control the stimulation device to activate the stimulation elements to stimulate the constricted wall portions one after the other, so that the wall portions of the series of wall portions are successively contracted along the stomach to move the food in the food passageway, or to constrict all of the wall portions of the series of wall portions, and to control the stimulation device to activate the stimulation elements to stimulate any constricted wall portions in random or in accordance with a predetermined sequence to close the food passageway.
481. An obesity treatment apparatus for treating an obese patient surgically modified by any one of a group of operations called Vertical Banded Gastroplasty, wherein the stomach is compartmentalized into a smaller proximal compartment adjacent the esophagus and a larger distal compartment, the smaller proximal compartment communicating with the larger distal compartment through an outlet opening, the apparatus comprising an implantable constriction device configured to gently constrict at least one wall portion of the tissue wall of the patient's stomach to influence the food flow in a food passageway extending in the smaller proximal compartment through the outlet opening, an implantable stimulation device configured to stimulate the wall portion of the tissue wall, and a control device operable to control the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the food flow in the food passageway.
482. The apparatus according to claim 481, wherein the constriction device is configured to constrict the wall portion to a constricted state in which the blood circulation in the constricted wall portion is substantially unrestricted and the flow in the food passageway is at least restricted, and the control device is operable to control the stimulation device to cause contraction of the wall portion, so that the flow in the food passageway is at least further restricted when the wall portion is kept by the constriction device in the constricted state.
483. The apparatus according to claim 481, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's wall portion, and the control device is operable to control the constriction and stimulation devices independently of each other.
484. The apparatus according to claim 481, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's wall portion, and - the control device is operable to control the stimulation device to stimulate or not to stimulate the wall portion, while the control device controls the constriction device to adjust the constriction of the wall portion, and - the control device is operable to calibrate the constriction device by controlling the stimulation device to stimulate the wall portion while controlling the constriction device to adjust the constriction of the wall portion until the desired restriction of the flow in the food passageway is obtained.
485. The apparatus according to claim 481, wherein the control device is operable to control the constriction to form a size of the outlet opening that restricts but does not stop the food flow in the food passageway, and is operable - to control the stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that the outlet opening is reduced to further restrict but not stop the food flow in the food passageway, or - to control the stimulation device in a first mode to stimulate the constricted wall portion to stop the flow in the food passageway and to control the stimulation device in a second mode to cease the stimulation of the wall portion to allow flow in the food passageway.
486. The apparatus according to claim 481, wherein the control device is operable to control the constriction device to constrict the wall portion to form a size of the outlet opening that substantially stops the food flow in the food passageway, and to control the stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the food passageway is completely stopped, and wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted wall portion to cause contraction thereof, such that the outlet opening is closed to completely stop the food flow in the food passageway, and to control the stimulation device in a second mode to cease the stimulation of the wall portion to open the outlet opening to allow food flow in the food passageway, or to control in the second mode the stimulation device to cease the stimulation of the wall portion and the constriction device to release the wall portion to restore the flow in the food passageway.
487. The apparatus according to claim 481, wherein the control device is operable to control the constriction device in a first mode to constrict the wall portion to close the outlet opening to stop the food flow in the food passageway and to control the constriction device in a second mode to cease the constriction of the wall portion to open the outlet opening to restore food flow in the food passageway.
488. The apparatus according to claim 481, wherein the control device comprises a manually operable switch for switching on and off the constriction device and/or stimulation device, the switch being adapted for subcutaneous implantation in the patient to be manually operated from outside the patient's body.
489. The apparatus according to claim 481, wherein the constriction device is designed to normally keep the patient's wall portion in a constricted state, in which the blood circulation in the constricted wall portion is substantially unrestricted and the flow in the food passageway is at least restricted, wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted wall portion to cause contraction thereof to further restrict but not stop the flow in the food passageway, or to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the food passageway is stopped, and wherein the control device is operable to control the stimulation device in a second mode to cease the stimulation of the wall portion to to open the outlet to allow food flow in the food passageway.
490. The apparatus according to claim 481, wherein the control device is operable to control the stimulation device to adjust the intensity of the stimulation of the wall portion in response to a sensed physical parameter of the patient or functional parameter of the apparatus.
491. The apparatus according to claim 481, wherein the control device is operable to control the constriction device to constrict the wall portion to form a size of the outlet opening that substantially stops the food flow in the food passageway, and to control the stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the food passageway is completely stopped, and wherein the control device is operable to control the stimulation device to increase the intensity of the stimulation in response to a sensed parameter related to an increase of pressure in the food passageway, such that the flow in the food passageway remains stopped, further comprising a sensor configured to sense a physical parameter of the patient that relates to the pressure in the food passageway, the control device controlling the stimulation device in response to signals from the sensor, the physical parameter being related to a pressure in the patient's body and the sensor being a pressure related sensor.
492. The apparatus according to claim 481, wherein the control device is operable to control the stimulation device to intermittently and individually stimulate different areas of the wall portion, such that at least two of the areas are stimulated at different points of time, and wherein the control device is operable to control the stimulation device to intermittently stimulate - each area of the different areas of the wall portion during successive time periods, each time period being short enough to maintain over time satisfactory blood circulation in the area until the lapse of the time period, or - the areas of the wall portion, such that an area of the wall portion that currently is not stimulated has time to restore substantially normal blood circulation before the stimulation device stimulates the area again.
493. The apparatus according to claim 481, wherein the control device is operable to control the stimulation device to stimulate different areas of the wall portion at a time by sequentially stimulating the different areas of the wall portion, or by shifting over time the stimulation from one area to another, or by shifting over time the stimulation from one area to another such that both areas are temporarily stimulated at the same time during the stimulation shift.
494. The apparatus according to claim 481, wherein the control device is operable to control the stimulation device to intermittently and individually electrically stimulate different areas of the patient's wall portion with electric pulses, and wherein the stimulation device comprises at least one electrical element for engaging the wall portion and for stimulating the wall portion with electric pulses.
495. The apparatus according to claim 494, wherein the pulses form pulse trains, and wherein the control device is operable to control the stimulation device to vary at least one of the following pulse parameters: the off time periods between the individual pulses of each pulse train, the off time periods between the pulse trains, the width of each pulse of the pulse trains, the length of each pulse train, the pulse amplitudes of the pulses of the pulse trains, the frequency of the pulses of the pulse trains, the frequency of the pulse trains, and the number of pulses of each pulse train, wherein at least a first area and a second area of the areas of the wall portion are repeatedly stimulated with a first pulse train of the pulse trains and a second pulse train of the pulse trains, respectively, such that the first and second pulse trains over time are shifted relative to each other, and wherein the first area is stimulated with the first pulse train while the second area is not stimulated with the second pulse train, and vice versa, or the first and second pulse trains are shifted relative to each other such that the first and second pulse trains at least partially overlap each other.
496. The apparatus according to claim 494, wherein the wall portion includes muscle fibers and the stimulation device is configured to stimulate the wall portion including the muscle fibers with the electric pulses, to cause contraction of the muscle fibres to contract the wall portion.
497. The apparatus according to claim 494, wherein the stimulation device comprises a plurality of electrical elements and a structure holding the electrical elements in a the fixed orientation relative to one another, the structure being integrated in or separate from the constriction device, and wherein the electrical elements form an elongate pattern of electrical elements and the structure is applicable on the patient's stomach such that the elongate pattern of electrical elements extends along the wall portion of the stomach in the direction of the flow in the food passageway and the elements abut the respective areas of the wall portion.
498. The apparatus according to claim 494, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to electrically energize the electrical elements, preferably to cyclically energize each element with electric pulses, and wherein the control device is operable to control the stimulation device to energize the electrical elements, such that a number or groups of the electrical elements are energized at the same time or such that the electrical elements are energized one at a time in sequence or groups of the electrical elements are sequentially energized, either randomly or in accordance with a predetermined pattern.
499. The apparatus according to claim 494, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form an elongate pattern of electrical elements, wherein the elements are applicable on the patient's wall such that the elongate pattern of electrical elements extends along the wall portion of the stomach in the direction of the flow in the food passageway and the elements abut the respective areas of the wall portion, and wherein the control device is operable to control the stimulation device - to successively energize the electrical elements longitudinally along the elongate pattern of electrical elements, or - to successively energize the electrical elements along the elongate pattern of electrical elements in a direction opposite to, or in the same direction as, that of the flow in the food passageway, when the stimulation device is applied on the patient's stomach, or - to successively energize the electrical elements from a position substantially at the center of the constricted wall portion towards both ends of the elongate pattern of electrical elements, when the stimulation device is applied on the patient's stomach.
500. The apparatus according to claim 494, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to energize the electrical elements, such that electrical elements currently energized form at least one group of adjacent energized electrical elements, wherein the elements in the group of energized electrical elements form a path of energized electrical elements, and wherein the path of energized electrical elements extends along the patient's stomach, or at least in part or completely around the patient's stomach, when the stimulation device is applied on the stomach.
501. The apparatus according to claim 494, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form a plurality of groups of elements, the groups forming a series of groups extending along the patient's stomach in the direction of flow in the patient's food passageway, when the stimulation device is applied on the stomach, the electrical elements of each group of electrical elements forming a path of elements extending along the patient's stomach, or at least in part or completely around the patient's stomach, and wherein the control device is operable to control the stimulation device - to successively energize the groups of electrical elements in the series of groups in a direction opposite to, or in the same direction as, that of the flow in the food passageway, when the stimulation device is applied on the patient's stomach, or - to successively energize the groups of electrical elements in the series of groups from a position substantially at the center of the constricted wall portion in a direction opposite to and in the same direction as that of the flow in the food passageway, when the stimulation device is applied on the patient's stomach.
502. The apparatus according to claim 481, wherein the stimulation device is configured to thermally stimulate the wall portion, either by cooling the constricted wall portion to cause contraction of the wall portion or by heating the wall portion, when the wall portion is constricted and contracted, to cause expansion of the wall portion, and wherein the constriction device is configured to constrict the wall portion to form a size of the outlet opening that at least restricts the food flow in the food passageway, and the control device is operable to control the stimulation device to cool the constricted wall portion to cause contraction thereof, such that the outlet opening is reduced to at least further restrict but not stop, or to further restrict and stop the food flow in the food passageway.
503. The apparatus according to claim 481, wherein the tissue wall portion of the stomach extends between an upstream end and a downstream end of the wall portion with respect to the direction of the flow in the food passageway, and wherein the control device is operable to control at least one of the constriction and stimulation devices to affect the wall portion such that the food is actively moved in the food passageway.
504. The apparatus according to claim 481, wherein the constriction device is configured to constrict the entire wall portion between the upstream and downstream ends thereof to restrict the flow in the food passageway, and the control device is operable to control the stimulation device to progressively stimulate the constricted wall portion in the downstream or upstream direction of the food passageway to cause progressive contraction of the wall portion to move the food in the food passageway, or to control the stimulation device to stimulate the constricted wall portion to close the food passageway either at the upstream end or the downstream end of the wall portion and to simultaneously control the constriction device to increase the constriction of the entire wall portion to move the food in the food passageway.
505. The apparatus according to claim 481, wherein the control device is operable to control the constriction device to vary the constriction of the wall portion and to simultaneously control the stimulation device to progressively stimulate the constricted wall portion in the downstream or upstream direction of the food passageway to cause progressive contraction of the wall portion to move the food in the food passageway.
506. The apparatus according to claim 481, wherein the control device is operable to control the stimulation device to stimulate the wall portion and to simultaneously control the constriction device to vary the constriction of different areas of the wall portion such that the wall portion is progressively constricted in the downstream or upstream direction of the food passageway, and wherein the control device is operable to control the stimulation device to progressively stimulate the constricted wall portion to cause progressive contraction thereof in harmony with the progressive constriction of the wall portion performed by the constriction device, or the control device is operable to control an elongated constriction element of the constriction device extending along the wall portion to progressively constrict the wall portion in the downstream or upstream direction of the food passageway, wherein the elongated constriction element comprises contact surfaces dimensioned to contact a length of the wall portion, when the constriction device constricts the wall portion, and the stimulation device comprises a plurality of stimulation elements distributed along the contact surfaces, such that the stimulation elements stimulate the different areas of the wall portion along the length of the wall portion, when the control device controls the stimulation device to stimulate the wall portion.
507. The apparatus according to claim 481, wherein the constriction device is configured to constrict any one of a series of wall portions of the the stomach to at least restrict the flow in the food passageway, the stimulation device is configured to stimulate the wall portion constricted by the constriction device to close the food passageway, and the control device is operable to control the constriction device to successively constrict the wall portions of the series of wall portions to move the food in the food passageway in a peristaltic manner, and wherein the constriction device comprises at least one constriction element that is moveable along the stomach to successively constrict the wall portions of the series of wall portions, and the stimulation device comprises at least one stimulation element positioned on the constriction element for stimulating the wall portion constricted by the constriction element to close the food passageway.
508. The apparatus according to claim 507, wherein the control device is operable to control the constriction device to cyclically move the constriction element along the wall portions of the series of wall portions.
509. The apparatus according to claim 507, wherein the constriction device comprises a plurality of constriction elements, each of which is moveable along the stomach to successively constrict the wall portions of the series of wall portions, wherein the stimulation device comprises stimulation elements positioned on the constriction elements for stimulating the wall portions constricted by the constriction elements to close the food passageway, wherein the control device is operable to control the constriction device to cyclically move the constriction elements one after the other along the wall portions of the series of wall portions, wherein the constriction device comprises a rotor carrying the constriction elements, and the control device is operable to control the rotor to rotate such that each constriction element cyclically constricts the wall portions of the series of wall portions, and wherein each constriction element comprises a roller for rolling on the stomach to constrict the latter.
510. The apparatus according to claim 481, wherein the constriction device comprises a first constriction element for constricting the wall portion of the stomach at the upstream end thereof, a second constriction element for constricting the wall portion at the downstream end thereof, and a third constriction element for constricting the wall portion between the upstream and downstream ends thereof, and the control device is operable to control the first, second and third constriction elements to constrict and release the wall portions independently of one another, and wherein the control device is operable to control the first or second constriction element to constrict the wall portion at the upstream or downstream end thereof to close the food passageway and to control the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, whereby the food contained in the wall portion between the upstream and downstream ends thereof is moved downstream or upstream in the food passageway, the control device controlling the stimulation device to stimulate the wall portion between the upstream and downstream ends thereof, when the third constriction element constricts the wall portion, or the control device is operable to control the first constriction element to constrict the wall portion at the upstream end thereof to restrict the flow in the food passageway and to control the stimulation device to stimulate the constricted wall portion at the upstream end to close the food passageway, and wherein the control device is operable to control the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, whereby the food contained in the wall portion between the upstream and downstream ends thereof is moved downstream in the food passageway, or the control device is operable to control the second constriction element to constrict the wall portion at the downstream end thereof to restrict the flow in the food passageway and to control the stimulation device to stimulate the constricted wall portion at the downstream end to close the food passageway, and the control device is operable to control the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, whereby the food contained in the wall portion between the upstream and downstream ends thereof is moved upstream in the food passageway.
511. The apparatus according to claim 481, wherein the constriction device is adjustable, and further comprising an operation device for operating the adjustable constriction device to change the constriction of the patient's wall portion of the stomach wherein the operation device mechanically or hydraulically operates the constriction device.
512. The apparatus according to claim 511, wherein the operation device mechanically operates the constriction device, and the constriction device comprises at least two elongated clamping elements extending along the stomach in the direction of flow in the patient's food passageway on different sides of the stomach, and the operation device operates the clamping elements to clamp the wall portion between the clamping elements to constrict the wall portion.
513. The apparatus according to claim 481, wherein the control device is operable to control the constriction device to close the food passageway, either at an upstream end or a downstream end of the wall portion, and to control the constriction device to constrict the remaining part of the wall portion to move the food in the food passageway, and wherein the control device is operable to control the stimulation device to stimulate the wall portion as the constriction device constricts the remaining part of the wall portion.
514. The apparatus according to claim 481, wherein the constriction device is configured to constrict the wall portion to restrict but not stop the flow in the food passageway, and the control device is operable to control the stimulation device to stimulate the wall portion constricted by the constriction device to close the food passageway, either at an upstream end or a downstream end of the wall portion, and to simultaneously control the constriction device to increase the constriction of the wall portion to move the food in the food passageway.
515. The apparatus according to claim 418, wherein the constriction device comprises a plurality of separate constriction elements adapted to constrict any wall portions of a series of wall portions, respectively, of the stomach, and the control device is operable to control the constriction device to activate the constriction elements in random or in accordance with a predetermined sequence.
516. The apparatus according to claim 515, wherein the stimulation device comprises stimulation elements positioned on the constriction elements, and wherein the control device is operable to control the stimulation device to activate the stimulation elements to stimulate any wall portions of the series of wall portions constricted by the constriction elements.
517. The apparatus according to claim 516, wherein the control device is operable to control the constriction device to activate the constriction elements to constrict the wall portions of the series of wall portions without completely closing the food passageway, and to control the stimulation device to activate the stimulation elements to stimulate the constricted wall portions one after the other, so that the wall portions of the series of wall portions are successively contracted along the stomach to move the food in the food passageway, or to constrict all of the wall portions of the series of wall portions, and to control the stimulation device to activate the stimulation elements to stimulate any constricted wall portions in random or in accordance with a predetermined sequence to close the food passageway.
518. A sexual dysfunction treatment apparatus for treating an impotent male patient comprising:
a stimulation device configured to stimulate at least one penile portion of the patient's normal penile tissue or the prolongation thereof, and a control device operable to control the stimulation device to stimulate the penile portion to cause contraction thereof to at least restrict the blood flow leaving the penis to achieve erection.
a stimulation device configured to stimulate at least one penile portion of the patient's normal penile tissue or the prolongation thereof, and a control device operable to control the stimulation device to stimulate the penile portion to cause contraction thereof to at least restrict the blood flow leaving the penis to achieve erection.
519. The apparatus according to claim 518, further comprising an implantable constriction device configured to gently constrict the penile portion to restrict the blood flow leaving the penis, wherein the control device is operable to control the stimulation device to stimulate the penile portion constricted by the constriction device to at least further restrict the blood flow leaving the penis to achieve erection.
520. The apparatus according to claim 519, wherein the constriction device is configured to constrict the penile portion to a constricted state in which the blood circulation in the constricted penile portion is substantially unrestricted and the exit penile blood flow is at least restricted, and the control device is operable to control the stimulation device to cause contraction of the penile portion, so that the exit penile blood flow is at least further restricted when the penile portion is kept by the constriction device in the constricted state.
521. The apparatus according to claim 519, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's penile portion, and the control device is operable to control the constriction and stimulation devices independently of each other.
522. The apparatus according to claim 519, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's penile portion, and - the control device is operable to control the stimulation device to stimulate or not to stimulate the penile portion, while the control device controls the constriction device to adjust the constriction of the penile portion, and - the control device is operable to calibrate the constriction device by controlling the stimulation device to stimulate the penile portion while controlling the constriction device to adjust the constriction of the penile portion until the desired restriction of the exit penile blood flow is obtained.
523. The apparatus according to claim 519, wherein the control device is operable to control the constriction device to adjust the constriction of the penile portion, such that the exit penile blood flow is restricted but not stopped, and is operable - to control the stimulation device to stimulate the constricted penile portion to cause contraction thereof, such that the exit penile blood flow is further restricted but not stopped, or - to control the stimulation device in a first mode to stimulate the constricted penile portion to stop the exit penile blood flow and to control the stimulation device in a second mode to cease the stimulation of the penile portion to allow exit penile blood flow.
524. The apparatus according to claim 519, wherein the control device is operable to control the constriction device to adjust the constriction of the penile portion, such that the exit penile blood flow is substantially stopped, and to control the stimulation device to stimulate the constricted penile portion to cause contraction thereof, such that the exit penile blood flow is completely stopped, and wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted penile portion to completely stop the exit penile blood flow, and to control the stimulation device in a second mode to cease the stimulation of the penile portion to allow exit penile blood flow, or to control in the second mode the stimulation device to cease the stimulation of the penile portion and the constriction device to release the penile portion to restore the exit penile blood flow.
525. The apparatus according to claim 519, wherein the control device is operable to control the constriction device in a first mode to constrict the constricted penile portion to stop the exit penile blood flow and to control the constriction device in a second mode to cease the constriction of the penile portion to restore exit penile blood flow.
526. The apparatus according to claim 519, wherein the control device comprises a manually operable switch for switching on and off the constriction device and/or stimulation device, the switch being adapted for subcutaneous implantation in the patient to be manually operated from outside the patient's body.
527. The apparatus according to claim 519, wherein the constriction device is designed to normally keep the patient's penile portion in a constricted state, in which the blood circulation in the constricted penile portion is substantially unrestricted and the exit penile blood flow is at least restricted, wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted penile portion to cause contraction thereof to further restrict but not stop the exit penile blood flow, or to stimulate the constricted penile portion to cause contraction thereof, such that the exit penile blood flow is stopped, and wherein the control device is operable to control the stimulation device in a second mode to cease the stimulation of the penile portion to increase the exit penile blood flow.
528. The apparatus according to claim 518, wherein the control device is operable to control the stimulation device to adjust the intensity of the stimulation of the penile portion in response to a sensed physical parameter of the patient or functional parameter of the apparatus.
529. The apparatus according to claim 519, wherein the control device is operable to control the constriction device to adjust the constriction of the penile portion, such that the exit penile blood flow is substantially stopped, and to control the stimulation device to stimulate the constricted penile portion to cause contraction thereof, such that the exit penile blood flow is completely stopped, and wherein the control device is operable to control the stimulation device to increase the intensity of the stimulation in response to a sensed parameter related to an increase of pressure in the penile portion, such that the exit penile blood flow remains stopped, further comprising a sensor configured to sense a physical parameter of the patient that relates to the pressure in the penile portion, the control device controlling the stimulation device in response to signals from the sensor, the physical parameter being related to a pressure in the patient's body and the sensor being a pressure related sensor.
530. The apparatus according to claim 518, wherein the control device is operable to control the stimulation device to intermittently and individually stimulate different areas of the penile portion, such that at least two of the areas are stimulated at different points of time, and wherein the control device is operable to control the stimulation device to intermittently stimulate - each area of the different areas of the penile portion during successive time periods, each time period being short enough to maintain over time satisfactory blood circulation in the area until the lapse of the time period, or - the areas of the penile portion, such that an area of the penile portion that currently is not stimulated has time to restore substantially normal blood circulation before the stimulation device stimulates the area again.
531. The apparatus according to claim 518, wherein the control device is operable to control the stimulation device to stimulate different areas of the penile portion at a time by sequentially stimulating the different areas of the penile portion, or by shifting over time the stimulation from one area to another, or by shifting over time the stimulation from one area to another such that both areas are temporarily stimulated at the same time during the stimulation shift.
532. The apparatus according to claim 518, wherein the control device is operable to control the stimulation device to intermittently and individually electrically stimulate different areas of the patient's penile portion with electric pulses, and wherein the stimulation device comprises at least one electrical element for engaging the penile portion and for stimulating the penile portion with electric pulses.
533. The apparatus according to claim 532, wherein the pulses form pulse trains, and wherein the control device is operable to control the stimulation device to vary at least one of the following pulse parameters: the off time periods between the individual pulses of each pulse train, the off time periods between the pulse trains, the width of each pulse of the pulse trains, the length of each pulse train, the pulse amplitudes of the pulses of the pulse trains, the frequency of the pulses of the pulse trains, the frequency of the pulse trains, and the number of pulses of each pulse train, wherein at least a first area and a second area of the areas of the penile portion are repeatedly stimulated with a first pulse train of the pulse trains and a second pulse train of the pulse trains, respectively, such that the first and second pulse trains over time are shifted relative to each other, and wherein the first area is stimulated with the first pulse train while the second area is not stimulated with the second pulse train, and vice versa, or the first and second pulse trains are shifted relative to each other such that the first and second pulse trains at least partially overlap each other.
534. The apparatus according to claim 532, wherein the penile portion includes muscle fibers and the stimulation device is configured to stimulate the penile portion including the muscle fibers with the electric pulses, to cause contraction of the muscle fibres to contract the penile portion.
535. The apparatus according to claim 532, wherein the stimulation device comprises a plurality of electrical elements and a structure holding the electrical elements in a the fixed orientation relative to one another, the structure being integrated in or separate from the constriction device, and wherein the electrical elements form an elongate pattern of electrical elements and the structure is applicable on the patient's penile portion such that the elongate pattern of electrical elements extends along the penile portion in the direction of the exit penile blood flow and the elements abut the respective areas of the penile portion.
536. The apparatus according to claim 532, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to electrically energize the electrical elements, preferably to cyclically energize each element with electric pulses, and wherein the control device is operable to control the stimulation device to energize the electrical elements, such that a number or groups of the electrical elements are energized at the same time or such that the electrical elements are energized one at a time in sequence or groups of the electrical elements are sequentially energized, either randomly or in accordance with a predetermined pattern.
537. The apparatus according to claim 532, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form an elongate pattern of electrical elements, wherein the elements are applicable on the penile portion such that the elongate pattern of electrical elements extends along the penile portion in the direction of the exit penile blood flow and the elements abut the respective areas of the penile portion, and wherein the control device is operable to control the stimulation device - to successively energize the electrical elements longitudinally along the elongate pattern of electrical elements, or - to successively energize the electrical elements along the elongate pattern of electrical elements in a direction opposite to, or in the same direction as, that of the exit penile blood flow, when the stimulation device is applied on the patient's penile portion, or - to successively energize the electrical elements from a position substantially at the center of the constricted penile portion towards both ends of the elongate pattern of electrical elements, when the stimulation device is applied on the patient's penile portion.
538. The apparatus according to claim 532, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to energize the electrical elements, such that electrical elements currently energized form at least one group of adjacent energized electrical elements, wherein the elements in the group of energized electrical elements form a path of energized electrical elements, and wherein the path of energized electrical elements extends along the patient's penile portion, or at least in part or completely around the patient's penile portion, when the stimulation device is applied on the penile portion.
539. The apparatus according to claim 532, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form a plurality of groups of elements, the groups forming a series of groups extending along the patient's penile portion in the direction of the exit penile blood flow, when the stimulation device is applied on the penile portion, the electrical elements of each group of electrical elements forming a path of elements extending along the patient's penile portion, or at least in part or completely around the patient's penile portion, and wherein the control device is operable to control the stimulation device - to successively energize the groups of electrical elements in the series of groups in a direction opposite to, or in the same direction as, that of the exit penile blood flow, when the stimulation device is applied on the patient's penile portion, or - to successively energize the groups of electrical elements in the series of groups from a position substantially at the center of the penile portion in a direction opposite to and in the same direction as that of the exit penile blood flow, when the stimulation device is applied on the patient's penile portion.
540. The apparatus according to claim 519, wherein the stimulation device is configured to thermally stimulate the penile portion, either by cooling the constricted penile portion to cause contraction of the penile portion or by heating the penile portion, when the penile portion is constricted and contracted, to cause expansion of the penile portion, and wherein the constriction device is configured to constrict the penile portion to at least restrict the exit penile blood flow, and the control device is operable to control the stimulation device to cool the constricted penile portion to cause contraction thereof, such that the exit penile blood flow is at least further restricted but not stopped, or further restricted and stopped.
541. A sexual dysfunction treatment apparatus for treating a female patient comprising:
an implantable stimulation device configured to stimulate at least one portion of the patient's female erectile tissue, and a control device operable to control the stimulation device to stimulate the erectile tissue portion to cause contraction thereof to at least restrict the venous blood flow leaving the erectile tissue to obtain engorgement with blood of the female erectile tissue.
an implantable stimulation device configured to stimulate at least one portion of the patient's female erectile tissue, and a control device operable to control the stimulation device to stimulate the erectile tissue portion to cause contraction thereof to at least restrict the venous blood flow leaving the erectile tissue to obtain engorgement with blood of the female erectile tissue.
542. The apparatus according to claim 541, further comprising an implantable constriction device configured to gently constrict the erectile tissue portion to restrict the venous blood flow leaving the erectile tissue, wherein the control device is operable to control the stimulation device to stimulate the erectile tissue portion constricted by the constriction device to at least further restrict the venous blood flow leaving the erectile tissue to obtain engorgement with blood of the female erectile tissue.
543. The apparatus according to claim 542, wherein the constriction device is configured to constrict the erectile tissue portion to a constricted state in which the blood circulation in the constricted erectile tissue portion is substantially unrestricted and the exit erectile blood flow is at least restricted, and the control device is operable to control the stimulation device to cause contraction of the erectile tissue portion, so that the exit erectile blood flow is at least further restricted when the erectile tissue portion is kept by the constriction device in the constricted state.
544. The apparatus according to claim 542, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's erectile tissue portion, and the control device is operable to control the constriction and stimulation devices independently of each other.
545. The apparatus according to claim 542, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's erectile tissue portion, and - the control device is operable to control the stimulation device to stimulate or not to stimulate the erectile tissue portion, while the control device controls the constriction device to adjust the constriction of the erectile tissue portion, and - the control device is operable to calibrate the constriction device by controlling the stimulation device to stimulate the erectile tissue portion while controlling the constriction device to adjust the constriction of the erectile tissue portion until the desired restriction of the exit erectile blood flow is obtained.
546. The apparatus according to claim 542, wherein the control device is operable to control the constriction device to adjust the constriction of the erectile tissue portion, such that the exit erectile blood flow is restricted but not stopped, and is operable - to control the stimulation device to stimulate the constricted erectile tissue portion to cause contraction thereof, such that the exit erectile blood flow is further restricted but not stopped, or - to control the stimulation device in a first mode to stimulate the constricted erectile tissue portion to stop the exit erectile blood flow and to control the stimulation device in a second mode to cease the stimulation of the erectile tissue portion to allow exit erectile blood flow.
547. The apparatus according to claim 542, wherein the control device is operable to control the constriction device to adjust the constriction of the erectile tissue portion, such that the exit erectile blood flow is substantially stopped, and wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted erectile tissue portion to completely stop the exit erectile blood flow, and to control the stimulation device in a second mode to cease the stimulation of the erectile tissue portion to allow exit erectile blood flow, or to control in the second mode the stimulation device to cease the stimulation of the erectile tissue portion and the constriction device to release the erectile tissue portion to restore the exit erectile blood flow.
548. The apparatus according to claim 542, wherein the control device is operable to control the constriction device in a first mode to constrict the constricted erectile tissue portion to stop the exit erectile blood flow and to control the constriction device in a second mode to cease the constriction of the erectile tissue portion to restore exit erectile blood flow.
549. The apparatus according to claim 542, wherein the control device comprises a manually operable switch for switching on and off the constriction device and/or stimulation device, the switch being adapted for subcutaneous implantation in the patient to be manually operated from outside the patient's body.
550. The apparatus according to claim 542, wherein the constriction device is designed to normally keep the patient's erectile tissue portion in a constricted state, in which the blood circulation in the constricted erectile tissue portion is substantially unrestricted and the exit erectile blood flow is at least restricted, wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted erectile tissue portion to cause contraction thereof to further restrict but not stop the exit erectile blood flow, or to stimulate the constricted erectile tissue portion to cause contraction thereof, such that the exit erectile blood flow is stopped, and wherein the control device is operable to control the stimulation device in a second mode to cease the stimulation of the erectile tissue portion to allow the exit erectile blood flow.
551. The apparatus according to claim 541, wherein the control device is operable to control the stimulation device to adjust the intensity of the stimulation of the erectile tissue portion in response to a sensed physical parameter of the patient or functional parameter of the apparatus.
552. The apparatus according to claim 542, wherein the control device is operable to control the constriction device to adjust the constriction of the erectile tissue portion, such that the exit erectile blood flow is substantially stopped, and to control the stimulation device to stimulate the constricted erectile tissue portion to cause contraction thereof, such that the exit erectile blood flow is completely stopped, and wherein the control device is operable to control the stimulation device to increase the intensity of the stimulation in response to a sensed parameter related to an increase of pressure in the erectile tissue portion, such that the exit erectile blood flow remains stopped, further comprising a sensor configured to sense a physical parameter of the patient that relates to the pressure in the erectile tissue portion, the control device controlling the stimulation device in response to signals from the sensor, the physical parameter being related to a pressure in the patient's body and the sensor being a pressure related sensor.
553. The apparatus according to claim 541, wherein the control device is operable to control the stimulation device to intermittently and individually stimulate different areas of the erectile tissue portion, such that at least two of the areas are stimulated at different points of time, and wherein the control device is operable to control the stimulation device to intermittently stimulate - each area of the different areas of the erectile tissue portion during successive time periods, each time period being short enough to maintain over time satisfactory blood circulation in the area until the lapse of the time period, or - the areas of the erectile tissue portion, such that an area of the erectile tissue portion that currently is not stimulated has time to restore substantially normal blood circulation before the stimulation device stimulates the area again.
554. The apparatus according to claim 541, wherein the control device is operable to control the stimulation device to stimulate different areas of the erectile tissue portion at a time by sequentially stimulating the different areas of the erectile tissue portion, or by shifting over time the stimulation from one area to another, or by shifting over time the stimulation from one area to another such that both areas are temporarily stimulated at the same time during the stimulation shift.
555. The apparatus according to claim 541, wherein the control device is operable to control the stimulation device to intermittently and individually electrically stimulate different areas of the patient's erectile tissue portion with electric pulses, and wherein the stimulation device comprises at least one electrical element for engaging the erectile tissue portion and for stimulating the erectile tissue portion with electric pulses.
556. The apparatus according to claim 555, wherein the pulses form pulse trains, and wherein the control device is operable to control the stimulation device to vary at least one of the following pulse parameters: the off time periods between the individual pulses of each pulse train, the off time periods between the pulse trains, the width of each pulse of the pulse trains, the length of each pulse train, the pulse amplitudes of the pulses of the pulse trains, the frequency of the pulses of the pulse trains, the frequency of the pulse trains, and the number of pulses of each pulse train, wherein at least a first area and a second area of the areas of the erectile tissue portion are repeatedly stimulated with a first pulse train of the pulse trains and a second pulse train of the pulse trains, respectively, such that the first and second pulse trains over time are shifted relative to each other, and wherein the first area is stimulated with the first pulse train while the second area is not stimulated with the second pulse train, and vice versa, or the first and second pulse trains are shifted relative to each other such that the first and second pulse trains at least partially overlap each other.
557. The apparatus according to claim 555, wherein the erectile tissue portion includes muscle fibers and the stimulation device is configured to stimulate the erectile tissue portion including the muscle fibers with the electric pulses, to cause contraction of the muscle fibres to contract the erectile tissue portion.
558. The apparatus according to claim 555, wherein the stimulation device comprises a plurality of electrical elements and a structure holding the electrical elements in a the fixed orientation relative to one another, the structure being integrated in or separate from the constriction device, and wherein the electrical elements form an elongate pattern of electrical elements and the structure is applicable on the patient's erectile tissue portion such that the elongate pattern of electrical elements extends along the erectile tissue portion in the direction of the exit erectile blood flow and the elements abut the respective areas of the erectile tissue portion.
559. The apparatus according to claim 555, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to electrically energize the electrical elements, preferably to cyclically energize each element with electric pulses, and wherein the control device is operable to control the stimulation device to energize the electrical elements, such that a number or groups of the electrical elements are energized at the same time or such that the electrical elements are energized one at a time in sequence or groups of the electrical elements are sequentially energized, either randomly or in accordance with a predetermined pattern.
560. The apparatus according to claim 555, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form an elongate pattern of electrical elements, wherein the elements are applicable on the erectile tissue portion such that the elongate pattern of electrical elements extends along the erectile tissue portion in the direction of the exit erectile blood flow and the elements abut the respective areas of the erectile tissue portion, and wherein the control device is operable to control the stimulation device - to successively energize the electrical elements longitudinally along the elongate pattern of electrical elements, or - to successively energize the electrical elements along the elongate pattern of electrical elements in a direction opposite to, or in the same direction as, that of the exit erectile blood flow, when the stimulation device is applied on the patient's erectile tissue portion, or to successively energize the electrical elements from a position substantially at the center of the constricted erectile tissue portion towards both ends of the elongate pattern of electrical elements, when the stimulation device is applied on the patient's erectile tissue portion.
561. The apparatus according to claim 555, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to energize the electrical elements, such that electrical elements currently energized form at least one group of adjacent energized electrical elements, wherein the elements in the group of energized electrical elements form a path of energized electrical elements, and wherein the path of energized electrical elements extends along the patient's erectile tissue portion, or at least in part or completely around the patient's erectile tissue portion, when the stimulation device is applied on the erectile tissue portion.
562. The apparatus according to claim 555, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form a plurality of groups of elements, the groups forming a series of groups extending along the patient's erectile tissue portion in the direction of the exit erectile blood flow, when the stimulation device is applied on the erectile tissue portion, the electrical elements of each group of electrical elements forming a path of elements extending along the patient's erectile tissue portion, or at least in part or completely around the patient's erectile tissue portion, and wherein the control device is operable to control the stimulation device - to successively energize the groups of electrical elements in the series of groups in a direction opposite to, or in the same direction as, that of the exit erectile blood flow, when the stimulation device is applied on the patient's erectile tissue portion, or - to successively energize the groups of electrical elements in the series of groups from a position substantially at the center of the erectile tissue portion in a direction opposite to and in the same direction as that of the exit erectile blood flow, when the stimulation device is applied on the patient's erectile tissue portion.
563. The apparatus according to claim 542, wherein the stimulation device is configured to thermally stimulate the erectile tissue portion, either by cooling the constricted erectile tissue portion to cause contraction of the erectile tissue portion or by heating the erectile tissue portion, when the erectile tissue portion is constricted and contracted, to cause expansion of the erectile tissue portion, and wherein the constriction device is configured to constrict the erectile tissue portion to at least restrict the exit erectile blood flow, and the control device is operable to control the stimulation device to cool the constricted erectile tissue portion to cause contraction thereof, such that the exit erectile blood flow is at least further restricted but not stopped, or further restricted and stopped.
564. A pregnancy control apparatus comprising:
a movement influence device configured to influence the movement of an egg appearing in the lumen of a uterine tube of a female patient, and a control device operable to control the movement influence device to influence the movement of the egg in the lumen of the uterine tube.
a movement influence device configured to influence the movement of an egg appearing in the lumen of a uterine tube of a female patient, and a control device operable to control the movement influence device to influence the movement of the egg in the lumen of the uterine tube.
565. The apparatus according to claim 564, wherein the movement influence device comprises an implantable constriction device configured to constrict at least one portion of the uterine tube wall, and the control device is operable to control the constriction device to constrict the uterine tube wall portion to influence the movement of the egg in the uterine tube.
566. The apparatus according to claim 565, wherein the control device is operable to control the constriction device to constrict the uterine tube wall portion to restrict the lumen of the uterine tube, such that the egg appearing in the lumen of the uterine tube is prevented from entering the uterine cavity, and to control the constriction device to release the uterine tube such that the egg is allowed to enter the uterine cavity.
567. The apparatus according to claim 565, wherein the movement influence device comprises an implantable stimulation device configured to stimulate the uterine tube wall portion, and the control device is operable to control the stimulation device to stimulate the uterine tube wall portion, as the constriction device constricts the uterine tube wall portion, to cause contraction of the uterine tube wall portion to further influence the movement of the egg appearing in the uterine tube.
568. The apparatus according to claim 567, wherein the constriction device is configured to gently constrict the uterine tube wall portion to restrict the egg movement in the lumen of the uterine tube, and the control device is operable to control the stimulation device to stimulate the uterine tube wall portion, as the constriction device constricts the uterine tube wall portion, to cause contraction of the uterine tube wall portion to further restrict the egg movement in the lumen of the uterine tube.
569. The apparatus according to claim 567, wherein the constriction device is configured to constrict the uterine tube wall portion to a constricted state in which the blood circulation in the constricted uterine tube wall portion is substantially unrestricted and the movement of the egg in the lumen of the uterine tube is at least restricted, and the control device is operable to control the stimulation device to cause contraction of the uterine tube wall portion, so that the egg movement in the lumen of the uterine tube is at least further restricted, when the uterine tube wall portion is kept by the constriction device in the constricted state.
570. The apparatus according to claim 567, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's uterine tube wall portion, and the control device is operable to control the constriction and stimulation devices independently of each other.
571. The apparatus according to claim 567, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's uterine tube wall portion, and the control device is operable to control the stimulation device to stimulate or not to stimulate the uterine tube wall portion, while the control device controls the constriction device to adjust the constriction of the uterine tube wall portion, and wherein the control device is adapted to calibrate the constriction device by controlling the stimulation device to stimulate the uterine tube wall portion while controlling the constriction device to adjust the constriction of the uterine tube wall portion until the desired restriction of the egg movement in the lumen of the uterine tube is obtained.
572. The apparatus according to claim 567, wherein the control device is operable to control the constriction device to adjust the constriction of the uterine tube wall portion, such that the egg movement in the lumen of the uterine tube is restricted but not stopped, and is operable - to control the stimulation device to stimulate the constricted uterine tube wall portion to cause contraction thereof, such that the egg movement in the lumen of the uterine tube is further restricted but not stopped, or - to control the stimulation device in a first mode to stimulate the constricted uterine tube wall portion to stop the egg movement in the lumen of the uterine tube and to control the stimulation device in a second mode to cease the stimulation of the uterine tube wall portion to allow egg movement in the lumen of the uterine tube.
573. The apparatus according to claim 567, wherein the control device is operable to control the constriction device to adjust the constriction of the uterine tube wall portion, such that the egg movement in the lumen of the uterine tube is substantially stopped, and wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted uterine tube wall portion to completely stop the egg movement in the lumen of the uterine tube, and to control the stimulation device in a second mode to cease the stimulation of the uterine tube wall portion to allow egg movement in the lumen of the uterine tube, or to control in the second mode the stimulation device to cease the stimulation of the uterine tube wall portion and the constriction device to release the uterine tube wall portion to restore the egg movement in the lumen of the uterine tube.
574. The apparatus according to claim 567, wherein the control device comprises a manually operable switch for switching on and off the constriction device and/or stimulation device, the switch being adapted for subcutaneous implantation in the patient to be manually operated from outside the patient's body.
575. The apparatus according to claim 567, wherein the constriction device is designed to normally keep the patient's uterine tube wall portion in a constricted state, in which the blood circulation in the constricted uterine tube wall portion is substantially unrestricted and the egg movement in the lumen of the uterine tube is at least restricted, wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted uterine tube wall portion to cause contraction thereof to further restrict but not stop the egg movement in the lumen of the uterine tube, or to stimulate the constricted uterine tube wall portion to cause contraction thereof, such that the egg movement in the lumen of the uterine tube is stopped, and wherein the control device is operable to control the stimulation device in a second mode to cease the stimulation of the uterine tube wall portion to allow the egg movement in the lumen of the uterine tube.
576. The apparatus according to claim 567, wherein the control device is operable to control the stimulation device to adjust the intensity of the stimulation of the uterine tube wall portion in response to a sensed physical parameter of the patient or functional parameter of the apparatus.
577. The apparatus according to claim 568, wherein the control device is operable to control the stimulation device to stimulate the uterine tube wall portion to cause contraction of the uterine tube wall portion such that the egg movement is stopped, and the control device is further operable to control the stimulation device to increase the intensity of the stimulation in response to a sensed parameter related to an increase of pressure in the lumen of the uterine tube, such that the egg movement remains stopped, further comprising a sensor configured to sense a physical parameter of the patient that relates to the pressure in the lumen of the uterine tube, the control device being operable to control the stimulation device in response to signals from the sensor, the physical parameter being related to a pressure in the patient's body and the sensor being a pressure related sensor.
578. The apparatus according to claim 567, wherein the control device is operable to control the stimulation device to intermittently and individually stimulate different areas of the uterine tube wall portion, such that at least two of the areas are stimulated at different points of time, and wherein the control device is operable to control the stimulation device to intermittently stimulate - each area of the different areas of the uterine tube wall portion during successive time periods, each time period being short enough to maintain over time satisfactory blood circulation in the area until the lapse of the time period, or - the areas of the uterine tube wall portion, such that an area of the uterine tube wall portion that currently is not stimulated has time to restore substantially normal blood circulation before the stimulation device stimulates the area again.
579. The apparatus according to claim 567, wherein the control device is operable to control the stimulation device to stimulate different areas of the uterine tube wall portion at a time by sequentially stimulating the different areas of the uterine tube wall portion, or by shifting over time the stimulation from one area to another, or by shifting over time the stimulation from one area to another such that both areas are temporarily stimulated at the same time during the stimulation shift.
580. The apparatus according to claim 567, wherein the control device is operable to control the stimulation device to intermittently and individually electrically stimulate different areas of the patient's uterine tube wall portion with electric pulses, and wherein the stimulation device comprises at least one electrical element for engaging the uterine tube wall portion and for stimulating the uterine tube wall portion with electric pulses.
581. The apparatus according to claim 580, wherein the pulses form pulse trains, and wherein the control device is operable to control the stimulation device to vary at least one of the following pulse parameters: the off time periods between the individual pulses of each pulse train, the off time periods between the pulse trains, the width of each pulse of the pulse trains, the length of each pulse train, the pulse amplitudes of the pulses of the pulse trains, the frequency of the pulses of the pulse trains, the frequency of the pulse trains, and the number of pulses of each pulse train, wherein at least a first area and a second area of the areas of the uterine tube wall portion are repeatedly stimulated with a first pulse train of the pulse trains and a second pulse train of the pulse trains, respectively, such that the first and second pulse trains over time are shifted relative to each other, and wherein the first area is stimulated with the first pulse train while the second area is not stimulated with the second pulse train, and vice versa, or the first and second pulse trains are shifted relative to each other such that the first and second pulse trains at least partially overlap each other.
582. The apparatus according to claim 580, wherein the uterine tube wall portion includes muscle fibers and the stimulation device is configured to stimulate the uterine tube wall portion including the muscle fibers with the electric pulses, to cause contraction of the muscle fibres to contract the uterine tube wall portion.
583. The apparatus according to claim 580, wherein the stimulation device comprises a plurality of electrical elements and a structure holding the electrical elements in a the fixed orientation relative to one another, the structure being integrated in or separate from the constriction device, and wherein the electrical elements form an elongate pattern of electrical elements and the structure is applicable on the uterine tube such that the elongate pattern of electrical elements extends along the uterine tube and the elements abut the respective areas of the uterine tube wall portion.
584. The apparatus according to claim 580, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to electrically energize the electrical elements, preferably to cyclically energize each element with electric pulses, and wherein the control device is operable to control the stimulation device to energize the electrical elements, such that a number or groups of the electrical elements are energized at the same time or such that the electrical elements are energized one at a time in sequence or groups of the electrical elements are sequentially energized, either randomly or in accordance with a predetermined pattern.
585. The apparatus according to claim 580, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form an elongate pattern of electrical elements, wherein the elements are applicable on the uterine tube wall such that the elongate pattern of electrical elements extends along the uterine tube and the elements abut the respective areas of the uterine tube wall portion, and wherein the control device is operable to control the stimulation device to successively energize the electrical elements longitudinally along the elongate pattern of electrical elements, or to successively energize the electrical elements along the elongate pattern of electrical elements in a direction opposite to, or in the same direction as, that of the egg movement in the lumen of the uterine tube, when the stimulation device is applied on the patient's uterine tube, or - to successively energize the electrical elements from a position substantially at the center of the constricted uterine tube wall portion towards both ends of the elongate pattern of electrical elements, when the stimulation device is applied on the uterine tube.
586. The apparatus according to claim 580, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to energize the electrical elements, such that electrical elements currently energized form at least one group of adjacent energized electrical elements, wherein the elements in the group of energized electrical elements form a path of energized electrical elements, and wherein the path of energized electrical elements extends along the uterine tube, or at least in part or completely around the uterine tube, when the stimulation device is applied on the uterine tube.
587. The apparatus according to claim 580, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form a plurality of groups of elements, the groups forming a series of groups extending along the uterine tube, when the stimulation device is applied on the uterine tube, the electrical elements of each group of electrical elements forming a path of elements extending along the uterine tube, or at least in part or completely around the uterine tube, and wherein the control device is operable to control the stimulation device - to successively energize the groups of electrical elements in the series of groups in a direction opposite to, or in the same direction as, that of the egg movement in the lumen of the uterine tube, when the stimulation device is applied on the uterine tube, or - to successively energize the groups of electrical elements in the series of groups from a position substantially at the center of the constricted uterine tube wall portion in a direction opposite to and in the same direction as that of the egg movement in the lumen of the uterine tube, when the stimulation device is applied on the uterine tube.
588. The apparatus according to claim 567, wherein the stimulation device is configured to thermally stimulate the uterine tube wall portion, either by cooling the constricted uterine tube wall portion to cause contraction of the uterine tube wall portion or by heating the uterine tube wall portion, when the uterine tube wall portion is constricted and contracted, to cause expansion of the uterine tube wall portion, and wherein the constriction device is configured to constrict the uterine tube wall portion to at least restrict the egg movement in the lumen of the uterine tube, and the control device is operable to control the stimulation device to cool the constricted uterine tube wall portion to cause contraction thereof, such that the egg movement in the lumen of the uterine tube is at least further restricted but not stopped, or further restricted and stopped.
589. The apparatus according to claim 567, wherein the uterine tube wall portion extends between an upstream end and a downstream end of the uterine tube wall portion with respect to the direction of the egg movement in the lumen of the uterine tube, and wherein the control device is operable to control at least one of the constriction and stimulation devices to affect the uterine tube wall portion such that the egg is actively moved in the lumen of the uterine tube.
590. The apparatus according to claim 589, wherein the constriction device is configured to constrict the entire uterine tube wall portion between the upstream and downstream ends thereof to restrict the egg movement in the lumen of the uterine tube, and the control device is operable to control the stimulation device to progressively stimulate the constricted uterine tube wall portion in the downstream or upstream direction of the lumen of the uterine tube to cause progressive contraction of the uterine tube wall portion to move the egg in the lumen of the uterine tube, or - to control the stimulation device to stimulate the constricted uterine tube wall portion to close the lumen of the uterine tube either at the upstream end or the downstream end of the uterine tube wall portion and to simultaneously control the constriction device to increase the constriction of the entire uterine tube wall portion to move the egg in the lumen of the uterine tube.
591. The apparatus according to claim 567, wherein the control device is operable to control the constriction device to vary the constriction of the uterine tube wall portion and to simultaneously control the stimulation device to progressively stimulate the constricted uterine tube wall portion in the downstream or upstream direction of the lumen of the uterine tube to cause progressive contraction of the uterine tube wall portion to move the egg in the lumen of the uterine tube.
592. The apparatus according to claim 567, wherein the control device is operable to control the stimulation device to stimulate the uterine tube wall portion and to simultaneously control the constriction device to vary the constriction of different areas of the uterine tube wall portion such that the uterine tube wall portion is progressively constricted in the downstream or upstream direction of the lumen of the uterine tube, and wherein the control device is operable to control the stimulation device to progressively stimulate the constricted uterine tube wall portion to cause progressive contraction thereof in harmony with the progressive constriction of the uterine tube wall portion performed by the constriction device, or - the control device is operable to control an elongated constriction element of the constriction device extending along the uterine tube wall portion to progressively constrict the uterine tube wall portion in the downstream or upstream direction of the lumen of the uterine tube, wherein the elongated constriction element comprises contact surfaces dimensioned to contact a length of the uterine tube wall portion, when the constriction device constricts the uterine tube wall portion, and the stimulation device comprises a plurality of stimulation elements distributed along the contact surfaces, such that the stimulation elements stimulate the different areas of the uterine tube wall portion along the length of the uterine tube wall portion, when the control device controls the stimulation device to stimulate the uterine tube wall portion.
593. The apparatus according to claim 567, wherein the constriction device is configured to constrict any one of a series of uterine tube wall portions of the uterine tube to at least restrict the egg movement in the lumen of the uterine tube, the stimulation device is configured to stimulate the uterine tube wall portion constricted by the constriction device to close the lumen of the uterine tube, and the control device is operable to control the constriction device to successively constrict the uterine tube wall portions of the series of uterine tube wall portions to move the egg in the lumen of the uterine tube in a peristaltic manner, and wherein the constriction device comprises at least one constriction element that is moveable along the uterine tube to successively constrict the uterine tube wall portions of the series of uterine tube wall portions, and the stimulation device comprises at least one stimulation element positioned on the constriction element for stimulating the uterine tube wall portion constricted by the constriction element.
594. The apparatus according to claim 593, wherein the control device is operable to control the constriction device to cyclically move the constriction element along the uterine tube wall portions of the series of uterine tube wall portions.
595. The apparatus according to claim 593, wherein the constriction device comprises a plurality of constriction elements, each of which is moveable along the uterine tube to successively constrict the uterine tube wall portions of the series of uterine tube wall portions, wherein the stimulation device comprises stimulation elements positioned on the constriction elements for stimulating the uterine tube wall portions constricted by the constriction elements, wherein the control device is operable to control the constriction device to cyclically move the constriction elements one after the other along the uterine tube wall portions of the series of uterine tube wall portions, wherein the constriction device comprises a rotor carrying the constriction elements, and the control device is operable to control the rotor to rotate such that each constriction element cyclically constricts the uterine tube wall portions of the series of uterine tube wall portions, and wherein each constriction element comprises a roller for rolling on the uterine tube to constrict the latter.
596. The apparatus according to claim 567, wherein the constriction device comprises a first constriction element for constricting the uterine tube wall portion at an upstream end thereof, a second constriction element for constricting the uterine tube wall portion at an downstream end thereof, and a third constriction element for constricting the uterine tube wall portion between the upstream and downstream ends thereof, and the control device is operable to control the first, second and third constriction elements to constrict and release the uterine tube wall portions independently of one another, and wherein the control device is operable to control the first or second constriction element to constrict the uterine tube wall portion at the upstream or downstream end thereof to close the lumen of the uterine tube and to control the third constriction element to constrict the uterine tube wall portion between the upstream and downstream ends thereof, whereby an egg contained in the uterine tube wall portion between the upstream and downstream ends thereof is moved downstream or upstream in the lumen of the uterine tube, the control device controlling the stimulation device to stimulate the uterine tube wall portion between the upstream and downstream ends thereof, when the third constriction element constricts the uterine tube wall portion, or the control device is operable to control the first constriction element to constrict the uterine tube wall portion at the upstream end thereof to restrict the egg movement in the lumen of the uterine tube and to control the stimulation device to stimulate the constricted uterine tube wall portion at the upstream end to close the lumen of the uterine tube, and wherein the control device is operable to control the third constriction element to constrict the uterine tube wall portion between the upstream and downstream ends thereof, whereby an egg contained in the uterine tube wall portion between the upstream and downstream ends thereof is moved downstream in the lumen of the uterine tube, or - the control device is operable to control the second constriction element to constrict the uterine tube wall portion at the downstream end thereof to restrict the egg movement in the lumen of the uterine tube and to control the stimulation device to stimulate the constricted uterine tube wall portion at the downstream end to close the lumen of the uterine tube, and the control device is operable to control the third constriction element to constrict the uterine tube wall portion between the upstream and downstream ends thereof, whereby an egg contained in the uterine tube wall portion between the upstream and downstream ends thereof is moved upstream in the lumen of the uterine tube.
597. The apparatus according to claim 565, wherein the constriction device is adjustable, and further comprising an operation device operating the adjustable constriction device to change the constriction of the patient's uterine tube wall portion, wherein the operation device mechanically or hydraulically operates the constriction device.
598. The apparatus according to claim 597, wherein the operation device mechanically operates the constriction device, and the constriction device comprises at least two elongated clamping elements extending along the uterine tube on different sides of the uterine tube, and the operation device operates the clamping elements to clamp the uterine tube wall portion between the clamping elements to constrict the uterine tube wall portion.
599. The apparatus according to claim 567, wherein the control device is operable to control the constriction device to close the lumen of the uterine tube, either at an upstream end or a downstream end of the uterine tube wall portion, and to control the constriction device to constrict the remaining part of the uterine tube wall portion to move the egg in the lumen of the uterine tube, and wherein the control device is operable to control the stimulation device to stimulate the uterine tube wall portion as the constriction device constricts the remaining part of the uterine tube wall portion.
600. The apparatus according to claim 567, wherein the constriction device is configured to constrict the uterine tube wall portion to restrict but not stop the egg movement in the lumen of the uterine tube, and the control device is operable to control the stimulation device to stimulate the uterine tube wall portion constricted by the constriction device to close the lumen of the uterine tube, either at an upstream end or a downstream end of the uterine tube wall portion, and to simultaneously control the constriction device to increase the constriction of the uterine tube wall portion to cause the egg in the lumen of the uterine tube to move through the lumen.
601. The apparatus according to claim 567, wherein the constriction device comprises a plurality of separate constriction elements adapted to constrict any uterine tube wall portions of a series of uterine tube wall portions, respectively, of the uterine tube, and the control device is operable to control the constriction device to activate the constriction elements in random or in accordance with a predetermined sequence.
602. The apparatus according to claim 601, wherein the stimulation device comprises stimulation elements positioned on the constriction elements, and wherein the control device is operable to control the stimulation device to activate the stimulation elements to stimulate any uterine tube wall portions of the series of uterine tube wall portions constricted by the constriction elements.
603. The apparatus according to claim 602, wherein the control device is operable to control the constriction device to activate the constriction elements - to constrict the uterine tube wall portions of the series of uterine tube wall portions without completely closing the lumen of the uterine tube, and to control the stimulation device to activate the stimulation elements to stimulate the constricted uterine tube wall portions one after the other, so that the uterine tube wall portions of the series of uterine tube wall portions are successively contracted along the uterine tube to move the egg in the lumen of the uterine tube, or to constrict all of the uterine tube wall portions of the series of uterine tube wall portions, and to control the stimulation device to activate the stimulation elements to stimulate any constricted uterine tube wall portions in random or in accordance with a predetermined sequence to close the lumen of the uterine tube.
604. A pregnancy control apparatus comprising:
a flow influence device configured to influence a flow of sperms appearing in the lumen of a uterine tube of a female patient, and a control device operable to control the flow influence device to influence the flow of sperms in the uterine tube.
a flow influence device configured to influence a flow of sperms appearing in the lumen of a uterine tube of a female patient, and a control device operable to control the flow influence device to influence the flow of sperms in the uterine tube.
605. An apparatus according to claim 604, wherein the flow influence device comprises an implantable constriction device configured to constrict at least one portion of the uterine tube wall, and the control device is operable to control the constriction device to constrict the uterine tube wall portion to influence the flow of sperms in the lumen of the uterine tube.
606. The apparatus according to claim 605, wherein the constriction device is configured to constrict the uterine tube to restrict the flow of sperms therein, and the control device is operable to control the constriction device to constrict the uterine tube such that the flow of sperms in the uterine tube is stopped, and to control the constriction device to release the uterine tube such that the sperms appearing in the uterine tube are allowed to flow in the uterine tube.
607. An apparatus according to claim 605, wherein the flow influence device comprises an implantable stimulation device configured to stimulate the uterine tube wall portion, and the control device is operable to control the stimulation device to stimulate the uterine tube wall portion, as the constriction device constricts the uterine tube wall portion, to cause contraction of the uterine tube wall portion to further influence the flow of sperms in the uterine tube.
608. An apparatus according to claim 607, wherein the constriction device is configured to gently constrict the uterine tube wall portion to restrict the flow of sperms in the uterine tube, and the control device is operable to control the stimulation device to stimulate the uterine tube wall portion, as the constriction device constricts the uterine tube wall portion, to cause contraction of the uterine tube wall portion to further restrict the flow of sperms in the uterine tube.
609. The apparatus according to claim 607, wherein the constriction device is configured to constrict the uterine tube wall portion to a constricted state in which the blood circulation in the constricted uterine tube wall portion is substantially unrestricted and the sperm flow in the lumen of the uterine tube is at least restricted, and the control device is operable to control the stimulation device to cause contraction of the uterine tube wall portion, so that the sperm flow in the lumen of the uterine tube is at least further restricted when the uterine tube wall portion is kept by the constriction device in the constricted state.
610. The apparatus according to claim 607, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's uterine tube wall portion, and the control device is operable to control the constriction and stimulation devices independently of each other.
611. The apparatus according to claim 607, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's uterine tube wall portion, and the control device is operable to control the stimulation device to stimulate or not to stimulate the uterine tube wall portion, while the control device controls the constriction device to adjust the constriction of the uterine tube wall portion, and wherein the control device is adapted to calibrate the constriction device by controlling the stimulation device to stimulate the uterine tube wall portion while controlling the constriction device to adjust the constriction of the uterine tube wall portion until the desired restriction of the sperm flow in the lumen of the uterine tube is obtained.
612. The apparatus according to claim 607, wherein the control= device is operable to control the constriction device to adjust the constriction of the uterine tube wall portion, such that the sperm flow in the lumen of the uterine tube is restricted but not stopped, and is operable to control the stimulation device to stimulate the constricted uterine tube wall portion to cause contraction thereof, such that the sperm flow in the lumen of the uterine tube is further restricted but not stopped, or to control the stimulation device in a first mode to stimulate the constricted uterine tube wall portion to stop the sperm flow in the lumen of the uterine tube and to control the stimulation device in a second mode to cease the stimulation of the uterine tube wall portion to allow sperm flow in the lumen of the uterine tube.
613. The apparatus according to claim 607, wherein the control device is operable to control the constriction device to adjust the constriction of the uterine tube wall portion, such that the sperm flow in the lumen of the uterine tube is substantially stopped, and wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted uterine tube wall portion to completely stop the sperm flow in the lumen of the uterine tube, and to control the stimulation device in a second mode to cease the stimulation of the uterine tube wall portion to allow sperm flow in the lumen of the uterine tube, or to control in the second mode the stimulation device to cease the stimulation of the uterine tube wall portion and the constriction device to release the uterine tube wall portion to restore the sperm flow in the lumen of the uterine tube.
614. The apparatus according to claim 607, wherein the control device comprises a manually operable switch for switching on and off the constriction device and/or stimulation device, the switch being adapted for subcutaneous implantation in the patient to be manually operated from outside the patient's body.
615. The apparatus according to claim 607, wherein the constriction device is designed to normally keep the patient's uterine tube wall portion in a constricted state, in which the blood circulation in the constricted uterine tube wall portion is substantially unrestricted and the sperm flow in the lumen of the uterine tube is at least restricted, wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted uterine tube wall portion to cause contraction thereof to further restrict but not stop the sperm flow in the lumen of the uterine tube, or to stimulate the constricted uterine tube wall portion to cause contraction thereof, such that the sperm flow in the lumen of the uterine tube is stopped, and wherein the control device is operable to control the stimulation device in a second mode to cease the stimulation of the uterine tube wall portion to allow the sperm flow in the lumen of the uterine tube.
616. The apparatus according to claim 607, wherein the control device is operable to control the stimulation device to adjust the intensity of the stimulation of the uterine tube wall portion in response to a sensed physical parameter of the patient or functional parameter of the apparatus.
617. The apparatus according to claim 608, wherein the control device is operable to control the stimulation device to stimulate the uterine tube wall portion to cause contraction of the uterine tube wall portion such that the sperm flow is stopped, and the control device is further operable to control the stimulation device to increase the intensity of the stimulation in response to a sensed parameter related to an increase of pressure in the lumen of the uterine tube, such that the sperm flow remains stopped, further comprising a sensor configured to sense a physical parameter of the patient that relates to the pressure in the lumen of the uterine tube, the control device being operable to control the stimulation device in response to signals from the sensor, the physical parameter being related to a pressure in the patient's body and the sensor being a pressure related sensor.
618. The apparatus according to claim 607, wherein the control device is operable to control the stimulation device to intermittently and individually stimulate different areas of the uterine tube wall portion, such that at least two of the areas are stimulated at different points of time, and wherein the control device is operable to control the stimulation device to intermittently stimulate - each area of the different areas of the uterine tube wall portion during successive time periods, each time period being short enough to maintain over time satisfactory blood circulation in the area until the lapse of the time period, or - the areas of the uterine tube wall portion, such that an area of the uterine tube wall portion that currently is not stimulated has time to restore substantially normal blood circulation before the stimulation device stimulates the area again.
619. The apparatus according to claim 607, wherein the control device is operable to control the stimulation device to stimulate different areas of the uterine tube wall portion at a time by sequentially stimulating the different areas of the uterine tube wall portion, or by shifting over time the stimulation from one area to another, or by shifting over time the stimulation from one area to another such that both areas are temporarily stimulated at the same time during the stimulation shift.
620. The apparatus according to claim 607, wherein the control device is operable to control the stimulation device to intermittently and individually electrically stimulate different areas of the patient's uterine tube wall portion with electric pulses, and wherein the stimulation device comprises at least one electrical element for engaging the uterine tube wall portion and for stimulating the uterine tube wall portion with electric pulses.
621. The apparatus according to claim 620, wherein the pulses form pulse trains, and wherein the control device is operable to control the stimulation device to vary at least one of the following pulse parameters: the off time periods between the individual pulses of each pulse train, the off time periods between the pulse trains, the width of each pulse of the pulse trains, the length of each pulse train, the pulse amplitudes of the pulses of the pulse trains, the frequency of the pulses of the pulse trains, the frequency of the pulse trains, and the number of pulses of each pulse train, wherein at least a first area and a second area of the areas of the uterine tube wall portion are repeatedly stimulated with a first pulse train of the pulse trains and a second pulse train of the pulse trains, respectively, such that the first and second pulse trains over time are shifted relative to each other, and wherein the first area is stimulated with the first pulse train while the second area is not stimulated with the second pulse train, and vice versa, or the first and second pulse trains are shifted relative to each other such that the first and second pulse trains at least partially overlap each other.
622. The apparatus according to claim 620, wherein the uterine tube wall portion includes muscle fibers and the stimulation device is configured to stimulate the uterine tube wall portion including the muscle fibers with the electric pulses, to cause contraction of the muscle fibres to contract the uterine tube wall portion.
623. The apparatus according to claim 620, wherein the stimulation device comprises a plurality of electrical elements and a structure holding the electrical elements in a the fixed orientation relative to one another, the structure being integrated in or separate from the constriction device, and wherein the electrical elements form an elongate pattern of electrical elements and the structure is applicable on the uterine tube such that the elongate pattern of electrical elements extends along the uterine tube and the elements abut the respective areas of the uterine tube wall portion.
624. The apparatus according to claim 620, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to electrically energize the electrical elements, preferably to cyclically energize each element with electric pulses, and wherein the control device is operable to control the stimulation device to energize the electrical elements, such that a number or groups of the electrical elements are energized at the same time or such that the electrical elements are energized one at a time in sequence or groups of the electrical elements are sequentially energized, either randomly or in accordance with a predetermined pattern.
625. The apparatus according to claim 620, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form an elongate pattern of electrical elements, wherein the elements are applicable on the uterine tube wall such that the elongate pattern of electrical elements extends along the uterine tube and the elements abut the respective areas of the uterine tube wall portion, and wherein the control device is operable to control the stimulation device - to successively energize the electrical elements longitudinally along the elongate pattern of electrical elements, or to successively energize the electrical elements along the elongate pattern of electrical elements in a direction opposite to, or in the same direction as, that of the sperm flow in the lumen of the uterine tube, when the stimulation device is applied on the patient's uterine tube, or to successively energize the electrical elements from a position substantially at the center of the constricted uterine tube wall portion towards both ends of the elongate pattern of electrical elements, when the stimulation device is applied on the uterine tube.
626. The apparatus according to claim 620, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to energize the electrical elements, such that electrical elements currently energized form at least one group of adjacent energized electrical elements, wherein the elements in the group of energized electrical elements form a path of energized electrical elements, and wherein the path of energized electrical elements extends along the uterine tube, or at least in part or completely around the uterine tube, when the stimulation device is applied on the uterine tube.
627. The apparatus according to claim 620, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form a plurality of groups of elements, the groups forming a series of groups extending along the uterine tube, when the stimulation device is applied on the uterine tube, the electrical elements of each group of electrical elements forming a path of elements extending along the uterine tube, or at least in part or completely around the uterine tube, and wherein the control device is operable to control the stimulation device - to successively energize the groups of electrical elements in the series of groups in a direction opposite to, or in the same direction as, that of the sperm flow in the lumen of the uterine tube, when the stimulation device is applied on the uterine tube, or to successively energize the groups of electrical elements in the series of groups from a position substantially at the center of the constricted uterine tube wall portion in a direction opposite to and in the same direction as that of the sperm flow in the lumen of the uterine tube, when the stimulation device is applied on the uterine tube.
628. The apparatus according to claim 607, wherein the stimulation device is configured to thermally stimulate the uterine tube wall portion, either by cooling the constricted uterine tube wall portion to cause contraction of the uterine tube wall portion or by heating the uterine tube wall portion, when the uterine tube wall portion is constricted and contracted, to cause expansion of the uterine tube wall portion, and wherein the constriction device is configured to constrict the uterine tube wall portion to at least restrict the sperm flow in the lumen of the uterine tube, and the control device is operable to control the stimulation device to cool the constricted uterine tube wall portion to cause contraction thereof, such that the sperm flow in the lumen of the uterine tube is at least further restricted but not stopped, or further restricted and stopped.
629. The apparatus according to claim 607, wherein the uterine tube wall portion extends between an upstream end and a downstream end of the uterine tube wall portion with respect to the direction of the sperm flow in the lumen of the uterine tube, and wherein the control device is operable to control at least one of the constriction and stimulation devices to affect the uterine tube wall portion such that the sperms are actively moved in the lumen of the uterine tube.
630. The apparatus according to claim 629, wherein the constriction device is configured to constrict the entire uterine tube wall portion between the upstream and downstream ends thereof to restrict the sperm flow in the lumen of the uterine tube, and the control device is operable to control the stimulation device to progressively stimulate the constricted uterine tube wall portion in the downstream or upstream direction of the lumen of the uterine tube to cause progressive contraction of the uterine tube wall portion to move the sperms in the lumen of the uterine tube, or - to control the stimulation device to stimulate the constricted uterine tube wall portion to close the lumen of the uterine tube either at the upstream end or the downstream end of the uterine tube wall portion and to simultaneously control the constriction device to increase the constriction of the entire uterine tube wall portion to move the sperms in the lumen of the uterine tube.
631. The apparatus according to claim 607, wherein the control device is operable to control the constriction device to vary the constriction of the uterine tube wall portion and to simultaneously control the stimulation device to progressively stimulate the constricted uterine tube wall portion in the downstream or upstream direction of the lumen of the uterine tube to cause progressive contraction of the uterine tube wall portion to move the sperms in the lumen of the uterine tube.
632. The apparatus according to claim 607, wherein the control device is operable to control the stimulation device to stimulate the uterine tube wall portion and to simultaneously control the constriction device to vary the constriction of different areas of the uterine tube wall portion such that the uterine tube wall portion is progressively constricted in the downstream or upstream direction of the lumen of the uterine tube, and wherein the control device is operable to control the stimulation device to progressively stimulate the constricted uterine tube wall portion to cause progressive contraction thereof in harmony with the progressive constriction of the uterine tube wall portion performed by the constriction device, or the control device is operable to control an elongated constriction element of the constriction device extending along the uterine tube wall portion to progressively constrict the uterine tube wall portion in the downstream or upstream direction of the lumen of the uterine tube, wherein the elongated constriction element comprises contact surfaces dimensioned to contact a length of the uterine tube wall portion, when the constriction device constricts the uterine tube wall portion, and the stimulation device comprises a plurality of stimulation elements distributed along the contact surfaces, such that the stimulation elements stimulate the different areas of the uterine tube wall portion along the length of the uterine tube wall portion, when the control device controls the stimulation device to stimulate the uterine tube wall portion.
633. The apparatus according to claim 607, wherein the constriction device is configured to constrict any one of a series of uterine tube wall portions of the uterine tube to at least restrict the sperm flow in the lumen of the uterine tube, the stimulation device is configured to stimulate the uterine tube wall portion constricted by the constriction device to close the lumen of the uterine tube, and the control device is operable to control the constriction device to successively constrict the uterine tube wall portions of the series of uterine tube wall portions to move the sperms in the lumen of the uterine tube in a peristaltic manner, and wherein the constriction device comprises at least one constriction element that is moveable along the uterine tube to successively constrict the uterine tube wall portions of the series of uterine tube wall portions, and the stimulation device comprises at least one stimulation element positioned on the constriction element for stimulating the uterine tube wall portion constricted by the constriction element.
634. The apparatus according to claim 633, wherein the control device is operable to control the constriction device to cyclically move the constriction element along the uterine tube wall portions of the series of uterine tube wall portions.
635. The apparatus according to claim 633, wherein the constriction device comprises a plurality of constriction elements, each of which is moveable along the uterine tube to successively constrict the uterine tube wall portions of the series of uterine tube wall portions, wherein the stimulation device comprises stimulation elements positioned on the constriction elements for stimulating the uterine tube wall portions constricted by the constriction elements, wherein the control device is operable to control the constriction device to cyclically move the constriction elements one after the other along the uterine tube wall portions of the series of uterine tube wall portions, wherein the constriction device comprises a rotor carrying the constriction elements, and the control device is operable to control the rotor to rotate such that each constriction element cyclically constricts the uterine tube wall portions of the series of uterine tube wall portions, and wherein each constriction element comprises a roller for rolling on the uterine tube to constrict the latter.
636. The apparatus according to claim 607, wherein the constriction device comprises a first constriction element for constricting the uterine tube wall portion at an upstream end thereof, a second constriction element for constricting the uterine tube wall portion at an downstream end thereof, and a third constriction element for constricting the uterine tube wall portion between the upstream and downstream ends thereof, and the control device is operable to control the first, second and third constriction elements to constrict and release the uterine tube wall portions independently of one another, and wherein - the control device is operable to control the first or second constriction element to constrict the uterine tube wall portion at the upstream or downstream end thereof to close the lumen of the uterine tube and to control the third constriction element to constrict the uterine tube wall portion between the upstream and downstream ends thereof, whereby sperms contained in the uterine tube wall portion between the upstream and downstream ends thereof are moved downstream or upstream in the lumen of the uterine tube, the control device controlling the stimulation device to stimulate the uterine tube wall portion between the upstream and downstream ends thereof, when the third constriction element constricts the uterine tube wall portion, or - the control device is operable to control the first constriction element to constrict the uterine tube wall portion at the upstream end thereof to restrict the sperm flow in the lumen of the uterine tube and to control the stimulation device to stimulate the constricted uterine tube wall portion at the upstream end to close the lumen of the uterine tube, and wherein the control device is operable to control the third constriction element to constrict the uterine tube wall portion between the upstream and downstream ends thereof, whereby sperms contained in the uterine tube wall portion between the upstream and downstream ends thereof are moved downstream in the lumen of the uterine tube, or - the control device is operable to control the second constriction element to constrict the uterine tube wall portion at the downstream end thereof to restrict the sperm flow in the lumen of the uterine tube and to control the stimulation device to stimulate the constricted uterine tube wall portion at the downstream end to close the lumen of the uterine tube, and the control device is operable to control the third constriction element to constrict the uterine tube wall portion between the upstream and downstream ends thereof, whereby sperms contained in the uterine tube wall portion between the upstream and downstream ends thereof are moved upstream in the lumen of the uterine tube.
637. The apparatus according to claim 607 wherein the constriction device is adjustable, and further comprising an operation device operating the adjustable constriction device to change the constriction of the patient's uterine tube wall portion, wherein the operation device mechanically or hydraulically operates the constriction device.
638. The apparatus according to claim 637, wherein the operation device mechanically operates the constriction device, and the constriction device comprises at least two elongated clamping elements extending along the uterine tube on different sides of the uterine tube, and the operation device operates the clamping elements to clamp the uterine tube wall portion between the clamping elements to constrict the uterine tube wall portion.
639. The apparatus according to claim 607, wherein the control device is operable to control the constriction device to close the lumen of the uterine tube, either at an upstream end or a downstream end of the uterine tube wall portion, and to control the constriction device to constrict the remaining part of the uterine tube wall portion to move the sperms in the lumen of the uterine tube, and wherein the control device is operable to control the stimulation device to stimulate the uterine tube wall portion as the constriction device constricts the remaining part of the uterine tube wall portion.
640. The apparatus according to claim 607, wherein the constriction device is configured to constrict the uterine tube wall portion to restrict but not stop the sperm flow in the lumen of the uterine tube, and the control device is operable to control the stimulation device to stimulate the uterine tube wall portion constricted by the constriction device to close the lumen of the uterine tube, either at an upstream end or a downstream end of the uterine tube wall portion, and to simultaneously control the constriction device to increase the constriction of the uterine tube wall portion to cause the sperms in the lumen of the uterine tube to move through the lumen.
641. The apparatus according to claim 607, wherein the constriction device comprises a plurality of separate constriction elements adapted to constrict any uterine tube wall portions of a series of uterine tube wall portions, respectively, of the uterine tube, and the control device is operable to control the constriction device to activate the constriction elements in random or in accordance with a predetermined sequence.
642. The apparatus according to claim 641, wherein the stimulation device comprises stimulation elements positioned on the constriction elements, and wherein the control device is operable to control the stimulation device to activate the stimulation elements to stimulate any uterine tube wall portions of the series of uterine tube wall portions constricted by the constriction elements.
643. The apparatus according to claim 641, wherein the control device is operable to control the constriction device to activate the constriction elements to constrict the uterine tube wall portions of the series of uterine tube wall portions without completely closing the lumen of the uterine tube, and to control the stimulation device to activate the stimulation elements to stimulate the constricted uterine tube wall portions one after the other, so that the uterine tube wall portions of the series of uterine tube wall portions are successively contracted along the uterine tube to move the sperms in the lumen of the uterine tube, or - to constrict all of the uterine tube wall portions of the series of uterine tube wall portions, and to control the stimulation device to activate the stimulation elements to stimulate any constricted uterine tube wall portions in random or in accordance with a predetermined sequence to close the lumen of the uterine tube.
644. A blood flow control apparatus for controlling a flow of blood and/or other bodily matter in a patient's blood vessel, the apparatus comprising an implantable constriction device configured to gently constrict at least one portion of the tissue wall of the blood vessel to influence the flow in the blood vessel, a stimulation device configured to stimulate the wall portion of the tissue wall, and a control device operable to control the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further influence the flow in the blood vessel.
645. The apparatus according to claim 644, wherein the constriction device is configured to constrict the wall portion to a constricted state in which the blood circulation in the constricted wall portion is substantially unrestricted and the flow in the blood vessel is at least restricted, and the control device is operable to control the stimulation device to cause contraction of the wall portion, so that the flow in the blood vessel is at least further restricted when the wall portion is kept by the constriction device in the constricted state.
646. The apparatus according to claim 644, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's wall portion, and the control device is operable to control the constriction and stimulation devices independently of each other.
647. The apparatus according to claim 644, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's wall portion, and the control device is operable to control the stimulation device to stimulate or not to stimulate the wall portion, while the control device controls the constriction device to adjust the constriction of the wall portion, and the control device is operable to calibrate the constriction device by controlling the stimulation device to stimulate the wall portion while controlling the constriction device to adjust the constriction of the wall portion until the desired restriction of the flow in the blood vessel is obtained.
648. The apparatus according to claim 644, wherein the control device is operable to control the constriction device to adjust the constriction of the wall portion, such that the flow in the blood vessel is restricted but not stopped, and is operable to control the stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the blood vessel is further restricted but not stopped, or to control the stimulation device in a first mode to stimulate the constricted wall portion to stop the flow in the blood vessel and to control the stimulation device in a second mode to cease the stimulation of the wall portion to allow flow in the blood vessel.
649. The apparatus according to claim 644, wherein the control device is operable to control the constriction device to adjust the constriction of the wall portion, such that the flow in the blood vessel is substantially stopped, and wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted wall portion to completely stop the flow in the blood vessel, and to control the stimulation device in a second mode to cease the stimulation of the wall portion to allow flow in the blood vessel, or to control in the second mode the stimulation device to cease the stimulation of the wall portion and the constriction device to release the wall portion to restore the flow in the blood vessel.
650. The apparatus according to claim 644, wherein the control device is operable to control the constriction device in a first mode to constrict the constricted wall portion to stop the flow in the blood vessel and to control the constriction device in a second mode to cease the constriction of the wall portion to restore flow in the blood vessel.
651. The apparatus according to claim 644, wherein the control device comprises a manually operable switch for switching on and off the constriction device and/or stimulation device, the switch being adapted for subcutaneous implantation in the patient to be manually operated from outside the patient's body.
652. The apparatus according to claim 644, wherein the constriction device is designed to normally keep the patient's wall portion in a constricted state, in which the blood circulation in the constricted wall portion is substantially unrestricted and the flow in the blood vessel is at least restricted, wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted wall portion to cause contraction thereof to further restrict but not stop the flow in the blood vessel, or to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the blood vessel is stopped, and wherein the control device is operable to control the stimulation device in a second mode to cease the stimulation of the wall portion to increase the flow in the blood vessel.
653. The apparatus according to claim 644, wherein the control device is operable to control the stimulation device to adjust the intensity of the stimulation of the wall portion in response to a sensed physical parameter of the patient or functional parameter of the apparatus.
654. The apparatus according to claim 644, wherein the control device is operable to control the constriction device to adjust the constriction of the wall portion, such that the flow in the blood vessel is substantially stopped, and to control the stimulation device to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the blood vessel is completely stopped, and wherein the control device is operable to control the stimulation device to increase the intensity of the stimulation in response to a sensed parameter related to an increase of pressure in the blood vessel, such that the flow in the blood vessel remains stopped, further comprising a sensor configured to sense a physical parameter of the patient that relates to the pressure in the blood vessel, the control device controlling the stimulation device in response to signals from the sensor, the physical parameter being related to a pressure in the patient's body and the sensor being a pressure related sensor.
655. The apparatus according to claim 644, wherein the control device is operable to control the stimulation device to intermittently and individually stimulate different areas of the wall portion, such that at least two of the areas are stimulated at different points of time, and wherein the control device is operable to control the stimulation device to intermittently stimulate - each area of the different areas of the wall portion during successive time periods, each time period being short enough to maintain over time satisfactory blood circulation in the area until the lapse of the time period, or - the areas of the wall portion, such that an area of the wall portion that currently is not stimulated has time to restore substantially normal blood circulation before the stimulation device stimulates the area again.
656. The apparatus according to claim 644, wherein the control device is operable to control the stimulation device to stimulate different areas of the wall portion at a time by sequentially stimulating the different areas of the wall portion, or by shifting over time the stimulation from one area to another, or by shifting over time the stimulation from one area to another such that both areas are temporarily stimulated at the same time during the stimulation shift.
657. The apparatus according to claim 644, wherein the control device is operable to control the stimulation device to intermittently and individually electrically stimulate different areas of the patient's wall portion with electric pulses, and wherein the stimulation device comprises at least one electrical element for engaging the wall portion and for stimulating the wall portion with electric pulses.
658. The apparatus according to claim 657, wherein the pulses form pulse trains, and wherein the control device is operable to control the stimulation device to vary at least one of the following pulse parameters: the off time periods between the individual pulses of each pulse train, the off time periods between the pulse trains, the width of each pulse of the pulse trains, the length of each pulse train, the pulse amplitudes of the pulses of the pulse trains, the frequency of the pulses of the pulse trains, the frequency of the pulse trains, and the number of pulses of each pulse train, wherein at least a first area and a second area of the areas of the wall portion are repeatedly stimulated with a first pulse train of the pulse trains and a second pulse train of the pulse trains, respectively, such that the first and second pulse trains over time are shifted relative to each other, and wherein the first area is stimulated with the first pulse train while the second area is not stimulated with the second pulse train, and vice versa, or the first and second pulse trains are shifted relative to each other such that the first and second pulse trains at least partially overlap each other.
659. The apparatus according to claim 657, wherein the wall portion includes muscle fibers and the stimulation device is configured to stimulate the wall portion including the muscle fibers with the electric pulses, to cause contraction of the muscle fibres to contract the wall portion.
660. The apparatus according to claim 657, wherein the stimulation device comprises a plurality of electrical elements and a structure holding the electrical elements in a the fixed orientation relative to one another, the structure being integrated in or separate from the constriction device, and wherein the electrical elements form an elongate pattern of electrical elements and the structure is applicable on the patient's blood vessel such that the elongate pattern of electrical elements extends along the blood vessel and the elements abut the respective areas of the wall portion.
661. The apparatus according to claim 657, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to electrically energize the electrical elements, preferably to cyclically energize each element with electric pulses, and wherein the control device is operable to control the stimulation device to energize the electrical elements, such that a number or groups of the electrical elements are energized at the same time or such that the electrical elements are energized one at a time in sequence or groups of the electrical elements are sequentially energized, either randomly or in accordance with a predetermined pattern.
662. The apparatus according to claim 657, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form an elongate pattern of electrical elements, wherein the elements are applicable on the patient's wall such that the elongate pattern of electrical elements extends along the blood vessel and the elements abut the respective areas of the wall portion, and wherein the control device is operable to control the stimulation device to successively energize the electrical elements longitudinally along the elongate pattern of electrical elements, or to successively energize the electrical elements along the elongate pattern of electrical elements in a direction opposite to, or in the same direction as, that of the flow in the blood vessel, when the stimulation device is applied on the blood vessel, Or - to successively energize the electrical elements from a position substantially at the center of the constricted wall portion towards both ends of the elongate pattern of electrical elements, when the stimulation device is applied on the blood vessel.
663. The apparatus according to claim 657, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to energize the electrical elements, such that electrical elements currently energized form at least one group of adjacent energized electrical elements, wherein the elements in the group of energized electrical elements form a path of energized electrical elements, and wherein the path of energized electrical elements extends along the blood vessel, or at least in part or completely around the blood vessel, when the stimulation device is applied on the blood vessel.
664. The apparatus according to claim 657, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form a plurality of groups of elements, the groups forming a series of groups extending along the blood vessel, when the stimulation device is applied on the blood vessel, the electrical elements of each group of electrical elements forming a path of elements extending along the blood vessel, or at least in part or completely around the blood vessel, and wherein the control device is operable to control the stimulation device to successively energize the groups of electrical elements in the series of groups in a direction opposite to, or in the same direction as, that of the flow in the blood vessel, when the stimulation device is applied on the blood vessel, or to successively energize the groups of electrical elements in the series of groups from a position substantially at the center of the constricted wall portion in a direction opposite to and in the same direction as that of the flow in the blood vessel, when the stimulation device is applied on the blood vessel.
665. The apparatus according to claim 644, wherein the stimulation device is configured to thermally stimulate the wall portion, either by cooling the constricted wall portion to cause contraction of the wall portion or by heating the wall portion, when the wall portion is constricted and contracted, to cause expansion of the wall portion, and wherein the constriction device is configured to constrict the wall portion to at least restrict the flow in the blood vessel, and the control device is operable to control the stimulation device to cool the constricted wall portion to cause contraction thereof, such that the flow in the blood vessel is at least further restricted but not stopped, or further restricted and stopped.
666. The apparatus according to claim 644, wherein the tissue wall portion of the blood vessel extends between an upstream end and a downstream end of the wall portion with respect to the direction of the flow in the blood vessel, and wherein the control device is operable to control at least one of the constriction and stimulation devices to affect the wall portion such that the blood is actively moved in the blood vessel.
667. The apparatus according to claim 644, wherein the constriction device is configured to constrict the entire wall portion between the upstream and downstream ends thereof to restrict the flow in the blood vessel, and the control device is operable to control the stimulation device to progressively stimulate the constricted wall portion in the downstream or upstream direction of the blood vessel to cause progressive contraction of the wall portion to move the blood in the blood vessel, or to control the stimulation device to stimulate the constricted wall portion to close the blood vessel either at the upstream end or the downstream end of the wall portion and to simultaneously control the constriction device to increase the constriction of the entire wall portion to move the blood in the blood vessel.
668. The apparatus according to claim 644, wherein the control device is operable to control the constriction device to vary the constriction of the wall portion and to simultaneously control the stimulation device to progressively stimulate the constricted wall portion in the downstream or upstream direction of the blood vessel to cause progressive contraction of the wall portion to move the blood in the blood vessel.
669. The apparatus according to claim 644, wherein the control device is operable to control the stimulation device to stimulate the wall portion and to simultaneously control the constriction device to vary the constriction of different areas of the wall portion such that the wall portion is progressively constricted in the downstream or upstream direction of the blood vessel, and wherein the control device is operable to control the stimulation device to progressively stimulate the constricted wall portion to cause progressive contraction thereof in harmony with the progressive constriction of the wall portion performed by the constriction device, or the control device is operable to control an elongated constriction element of the constriction device extending along the wall portion to progressively constrict the wall portion in the downstream or upstream direction of the blood vessel, wherein the elongated constriction element comprises contact surfaces dimensioned to contact a length of the wall portion, when the constriction device constricts the wall portion, and the stimulation device comprises a plurality of stimulation elements distributed along the contact surfaces, such that the stimulation elements stimulate the different areas of the wall portion along the length of the wall portion, when the control device controls the stimulation device to stimulate the wall portion.
670. The apparatus according to claim 644, wherein the constriction device is configured to constrict any one of a series of wall portions of the blood vessel to at least restrict the flow in the blood vessel, the stimulation device is configured to stimulate the wall portion constricted by the constriction device to close the blood vessel, and the control device is operable to control the constriction device to successively constrict the wall portions of the series of wall portions to move the blood in the blood vessel in a peristaltic manner, and wherein the constriction device comprises at least one constriction element that is moveable along the blood vessel to successively constrict the wall portions of the series of wall portions, and the stimulation device comprises at least one stimulation element positioned on the constriction element for stimulating the wall portion constricted by the constriction element to close the blood vessel.
671. The apparatus according to claim 670, wherein the control device is operable to control the constriction device to cyclically move the constriction element along the wall portions of the series of wall portions.
672. The apparatus according to claim 670, wherein the constriction device comprises a plurality of constriction elements, each of which is moveable along the blood vessel to successively constrict the wall portions of the series of wall portions, wherein the stimulation device comprises stimulation elements positioned on the constriction elements for stimulating the wall portions constricted by the constriction elements to close the blood vessel, wherein the control device is operable to control the constriction device to cyclically move the constriction elements one after the other along the wall portions of the series of wall portions, wherein the constriction device comprises a rotor carrying the constriction elements, and the control device is operable to control the rotor to rotate such that each constriction element cyclically constricts the wall portions of the series of wall portions, and wherein each constriction element comprises a roller for rolling on the blood vessel to constrict the latter.
673. The apparatus according to claim 644, wherein the constriction device comprises a first constriction element for constricting the wall portion of the blood vessel at the upstream end thereof, a second constriction element for constricting the wall portion at the downstream end thereof, and a third constriction element for constricting the wall portion between the upstream and downstream ends thereof, and the control device is operable to control the first, second and third constriction elements to constrict and release the wall portions independently of one another, and wherein the control device is operable to control the first or second constriction element to constrict the wall portion at the upstream or downstream end thereof to close the blood vessel and to control the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, whereby the blood contained in the wall portion between the upstream and downstream ends thereof is moved downstream or upstream in the blood vessel, the control device controlling the stimulation device to stimulate the wall portion between the upstream and downstream ends thereof, when the third constriction element constricts the wall portion, or the control device is operable to control the first constriction element to constrict the wall portion at the upstream end thereof to restrict the flow in the blood vessel and to control the stimulation device to stimulate the constricted wall portion at the upstream end to close the blood vessel, and wherein the control device is operable to control the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, whereby the blood contained in the wall portion between the upstream and downstream ends thereof is moved downstream in the blood vessel, or the control device is operable to control the second constriction element to constrict the wall portion at the downstream end thereof to restrict the flow in the blood vessel and to control the stimulation device to stimulate the constricted wall portion at the downstream end to close the blood vessel, and the control device is operable to control the third constriction element to constrict the wall portion between the upstream and downstream ends thereof, whereby the blood contained in the wall portion between the upstream and downstream ends thereof is moved upstream in the blood vessel.
674. The apparatus according to claim 644, wherein the constriction device is adjustable, and further comprising an operation device for operating the adjustable constriction device to change the constriction of the patient's wall portion of the blood vessel wherein the operation device mechanically or hydraulically operates the constriction device.
675. The apparatus according to claim 674, wherein the operation device mechanically operates the constriction device, and the constriction device comprises at least two elongated clamping elements extending along the blood vessel in the direction of flow in the patient's blood vessel on different sides of the blood vessel, and the operation device operates the clamping elements to clamp the wall portion between the clamping elements to constrict the wall portion.
676. The apparatus according to claim 644, wherein the control device is operable to control the constriction device to close the blood vessel, either at an upstream end or a downstream end of the wall portion, and to control the constriction device to constrict the remaining part of the wall portion to move the blood in the blood vessel, and wherein the control device is operable to control the stimulation device to stimulate the wall portion as the constriction device constricts the remaining part of the wall portion.
677. The apparatus according to claim 644, wherein the constriction device is configured to constrict the wall portion to restrict but not stop the flow in the blood vessel, and the control device is operable to control the stimulation device to stimulate the wall portion constricted by the constriction device to close the blood vessel, either at an upstream end or a downstream end of the wall portion, and to simultaneously control the constriction device to increase the constriction of the wall portion to move the blood in the blood vessel.
678. The apparatus according to claim 644, wherein the constriction device comprises a plurality of separate constriction elements adapted to constrict any wall portions of a series of wall portions, respectively, of the blood vessel, and the control device is operable to control the constriction device to activate the constriction elements in random or in accordance with a predetermined sequence.
679. The apparatus according to claim 678, wherein the stimulation device comprises stimulation elements positioned on the constriction elements, and wherein the control device is operable to control the stimulation device to activate the stimulation elements to stimulate any wall portions of the series of wall portions constricted by the constriction elements.
680. The apparatus according to claim 679, wherein the control device is operable to control the constriction device to activate the constriction elements to constrict the wall portions of the series of wall portions without completely closing the blood vessel, and to control the stimulation device to activate the stimulation elements to stimulate the constricted wall portions one after the other, so that the wall portions of the series of wall portions are successively contracted along the blood vessel to move the blood in the blood vessel, or to constrict all of the wall portions of the series of wall portions, and to control the stimulation device to activate the stimulation elements to stimulate any constricted wall portions in random or in accordance with a predetermined sequence to close the blood vessel.
681. A vascular aneurysm treatment apparatus for treating a vascular aneurysm of a blood vessel in a human or mammal patient, the apparatus comprising an implantable constriction device configured to gently constrict at least one portion of the tissue wall of the blood vessel extending along the aneurysm to reduce the bulge of the blood vessel caused by the aneurysm, a stimulation device for stimulating the wall portion of the blood vessel tissue wall, and a control device for controlling the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion to further reduce the bulge of the blood vessel and strengthen the blood vessel tissue wall.
682. The apparatus according to claim 681, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's wall portion, and the control device is operable to control the constriction and stimulation devices independently of each other.
683. The apparatus according to claim 681, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's wall portion, and - the control device is operable to control the stimulation device to stimulate or not to stimulate the wall portion, while the control device controls the constriction device to adjust the constriction of the wall portion, and - the control device is operable to calibrate the constriction device by controlling the stimulation device to stimulate the wall portion while controlling the constriction device to adjust the constriction of the wall portion until the desired reduction of the bulge of the aneurysm is obtained.
684. The apparatus according to claim 681, wherein the control device is operable to control the constriction device to adjust the constriction of the wall portion, such that the flow in the blood vessel is restricted but not stopped, and is operable to control the stimulation device in a first mode to stimulate the constricted wall portion to cause contraction of the wall portion such that the flow in the blood vessel is stopped and to control the stimulation device in a second mode to cease the stimulation of the wall portion to allow flow in the blood vessel.
685. The apparatus according to claim 681, wherein the control device is operable to control the constriction device in a first mode to constrict the constricted wall portion to stop the flow in the blood vessel and to control the constriction device in a second mode to cease the constriction of the wall portion to restore flow in the blood vessel.
686. The apparatus according to claim 681, wherein the control device comprises a manually operable switch for switching on and off the constriction device and/or stimulation device, the switch being adapted for subcutaneous implantation in the patient to be manually operated from outside the patient's body.
687. The apparatus according to claim 681, wherein the constriction device is designed to normally keep the patient's wall portion in a constricted state, in which the bulge of the aneurysm is reduced as desired, wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted wall portion to cause contraction thereof, such that the flow in the blood vessel is stopped, and wherein the control device is operable to control the stimulation device in a second mode to cease the stimulation of the wall portion to restore the flow in the blood vessel.
688. The apparatus according to claim 681, wherein the control device is operable to control the stimulation device to adjust the intensity of the stimulation of the wall portion in response to a sensed physical parameter of the patient or functional parameter of the apparatus.
689. The apparatus according to claim 681, further comprising a sensor configured to sense a physical parameter of the patient that relates to the pressure in the blood vessel, the control device controlling the constriction device and/or stimulation device to adjust the constriction and/or contraction of the wall portion in response to signals from the sensor.
690. The apparatus according to claim 681, wherein the control device is operable to control the stimulation device to intermittently and individually stimulate different areas of the wall portion, such that at least two of the areas are stimulated at different points of time, and wherein the control device is operable to control the stimulation device to intermittently stimulate - each area of the different areas of the wall portion during successive time periods, each time period being short enough to maintain over time satisfactory blood circulation in the area until the lapse of the time period, or - the areas of the wall portion, such that an area of the wall portion that currently is not stimulated has time to restore substantially normal blood circulation before the stimulation device stimulates the area again.
691. The apparatus according to claim 681, wherein the control device is operable to control the stimulation device to stimulate different areas of the wall portion at a time by sequentially stimulating the different areas of the wall portion, or by shifting over time the stimulation from one area to another, or by shifting over time the stimulation from one area to another such that both areas are temporarily stimulated at the same time during the stimulation shift.
692. The apparatus according to claim 681, wherein the control device is operable to control the stimulation device to intermittently and individually electrically stimulate different areas of the patient's wall portion with electric pulses, and wherein the stimulation device comprises at least one electrical element for engaging the wall portion and for stimulating the wall portion with electric pulses.
693. The apparatus according to claim 692, wherein the pulses form pulse trains, and wherein the control device is operable to control the stimulation device to vary at least one of the following pulse parameters: the off time periods between the individual pulses of each pulse train, the off time periods between the pulse trains, the width of each pulse of the pulse trains, the length of each pulse train, the pulse amplitudes of the pulses of the pulse trains, the frequency of the pulses of the pulse trains, the frequency of the pulse trains, and the number of pulses of each pulse train, wherein at least a first area and a second area of the areas of the wall portion are repeatedly stimulated with a first pulse train of the pulse trains and a second pulse train of the pulse trains, respectively, such that the first and second pulse trains over time are shifted relative to each other, and wherein the first area is stimulated with the first pulse train while the second area is not stimulated with the second pulse train, and vice versa, or the first and second pulse trains are shifted relative to each other such that the first and second pulse trains at least partially overlap each other.
694. The apparatus according to claim 692, wherein the stimulation device comprises a plurality of electrical elements and a structure holding the electrical elements in a the fixed orientation relative to one another, the structure being integrated in or separate from the constriction device, and wherein the electrical elements form an elongate pattern of electrical elements and the structure is applicable on the patient's blood vessel such that the elongate pattern of electrical elements extends along the blood vessel and the elements abut the respective areas of the wall portion.
695. The apparatus according to claim 692, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to electrically energize the electrical elements, preferably to cyclically energize each element with electric pulses, and wherein the control device is operable to control the stimulation device to energize the electrical elements, such that a number or groups of the electrical elements are energized at the same time or such that the electrical elements are energized one at a time in sequence or groups of the electrical elements are sequentially energized, either randomly or in accordance with a predetermined pattern.
696. The apparatus according to claim 692, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form an elongate pattern of electrical elements, wherein the elements are applicable on the patient's wall such that the elongate pattern of electrical elements extends along the blood vessel and the elements abut the respective areas of the wall portion, and wherein the control device is operable to control the stimulation device - to successively energize the electrical elements longitudinally along the elongate pattern of electrical elements, or - to successively energize the electrical elements along the elongate pattern of electrical elements in a direction opposite to, or in the same direction as, that of the flow in the blood vessel, when the stimulation device is applied on the blood vessel, or - to successively energize the electrical elements from a position substantially at the center of the constricted wall portion towards both ends of the elongate pattern of electrical elements, when the stimulation device is applied on the blood vessel.
697. The apparatus according to claim 692, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to energize the electrical elements, such that electrical elements currently energized form at least one group of adjacent energized electrical elements, wherein the elements in the group of energized electrical elements form a path of energized electrical elements, and wherein the path of energized electrical elements extends along the blood vessel, or at least in part or completely around the blood vessel, when the stimulation device is applied on the blood vessel.
698. The apparatus according to claim 692, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form a plurality of groups of elements, the groups forming a series of groups extending along the blood vessel, when the stimulation device is applied on the blood vessel, the electrical elements of each group of electrical elements forming a path of elements extending along the blood vessel, or at least in part or completely around the blood vessel, and wherein the control device is operable to control the stimulation device - to successively energize the groups of electrical elements in the series of groups in a direction opposite to, or in the same direction as, that of the flow in the blood vessel, when the stimulation device is applied on the blood vessel, or - to successively energize the groups of electrical elements in the series of groups from a position substantially at the center of the constricted wall portion in a direction opposite to and in the same direction as that of the flow in the blood vessel, when the stimulation device is applied on the blood vessel.
699. The apparatus according to claim 681, wherein the stimulation device is configured to thermally stimulate the wall portion, either by cooling the constricted wall portion to cause contraction of the wall portion or by heating the wall portion, when the wall portion is constricted and contracted, to cause expansion of the wall portion, and wherein the constriction device is configured to constrict the wall portion to at least reduce the bulge of the aneurysm, and the control device is operable to control the stimulation device to cool the constricted wall portion to cause contraction thereof, such that the bulge of the aneurysm is further reduced.
700. The apparatus according to claim 681, wherein the control device is operable to control the stimulation device to stimulate the wall portion and to simultaneously control the constriction device to vary the constriction of different areas of the wall portion such that the wall portion is progressively constricted in the downstream or upstream direction of the blood vessel, and wherein - the control device is operable to control the stimulation device to progressively stimulate the constricted wall portion to cause progressive contraction thereof in harmony with the progressive constriction of the wall portion performed by the constriction device, or - the control device is operable to control an elongated constriction element of the constriction device extending along the wall portion to progressively constrict the wall portion in the downstream or upstream direction of the blood vessel, wherein the elongated constriction element comprises contact surfaces dimensioned to contact a length of the wall portion, when the constriction device constricts the wall portion, and the stimulation device comprises a plurality of stimulation elements distributed along the contact surfaces, such that the stimulation elements stimulate the different areas of the wall portion along the length of the wall portion, when the control device controls the stimulation device to stimulate the wall portion.
701. The apparatus according to claim 681, wherein the constriction device is adjustable, and further comprising an operation device for operating the adjustable constriction device to change the constriction of the patient's wall portion of the blood vessel wherein the operation device mechanically or hydraulically operates the constriction device.
702. The apparatus according to claim 701, wherein the operation device mechanically operates the constriction device, and the constriction device comprises at least two elongated clamping elements extending along the blood vessel on different sides of the blood vessel, and the operation device operates the clamping elements to clamp the wall portion between the clamping elements to constrict the wall portion.
703. The apparatus according to claim 681, wherein the constriction device comprises a plurality of separate constriction elements adapted to constrict any wall portions of a series of wall portions, respectively, of the blood vessel, and the control device is operable to control the constriction device to activate the constriction elements in random or in accordance with a predetermined sequence.
704. The apparatus according to claim 703, wherein the stimulation device comprises stimulation elements positioned on the constriction elements, and wherein the control device is operable to control the stimulation device to activate the stimulation elements to stimulate any wall portions of the series of wall portions constricted by the constriction elements.
705. A male contraception apparatus for obtaining a time-limited sterility of a male mammalian individual comprising:
a flow influence device configured to influence a flow of sperms appearing in the lumen of a vas deference of a male patient, and a control device operable to control the flow influence device to influence the flow of sperms in the vas deference.
a flow influence device configured to influence a flow of sperms appearing in the lumen of a vas deference of a male patient, and a control device operable to control the flow influence device to influence the flow of sperms in the vas deference.
706. An apparatus according to claim 705, wherein the flow influence device comprises an implantable constriction device configured to constrict at least one portion of the vas deference wall, and the control device is operable to control the constriction device to constrict the vas deference wall portion to influence the flow of sperms in the lumen of the vas deference.
707. The apparatus according to claim 706, wherein the constriction device is configured to constrict the vas deference to restrict the flow of sperms therein, and the control device is operable to control the constriction device to constrict the vas deference such that the flow of sperms in the vas deference is stopped, and to control the constriction device to release the vas deference such that the sperms appearing in the vas deference are allowed to flow in the vas deference.
708. An apparatus according to claim 705, wherein the constriction device is configured to gently constrict the vas deference wall portion to influence the flow of sperms in the lumen of the vas deference, the flow influence device comprises an implantable stimulation device configured to stimulate the vas deference wall portion, and the control device is operable to control the stimulation device to stimulate the vas deference wall portion, as the constriction device constricts the vas deference wall portion, to cause contraction of the vas deference wall portion to further influence the flow of sperms in the vas deference.
709. An apparatus according to claim 708, wherein the constriction device is configured to gently constrict the vas deference wall portion to restrict the flow of sperms in the vas deference, and the control device is operable to control the stimulation device to stimulate the vas deference wall portion, as the constriction device constricts the vas deference wall portion, to cause contraction of the vas deference wall portion to further restrict the flow of sperms in the vas deference.
710. The apparatus according to claim 709, wherein the constriction device is configured to constrict the vas deference wall portion to a constricted state in which the blood circulation in the constricted vas deference wall portion is substantially unrestricted and the sperm flow in the lumen of the vas deference is at least restricted, and the control device is operable to control the stimulation device to cause contraction of the vas deference wall portion, so that the sperm flow in the lumen of the vas deference is at least further restricted when the vas deference wall portion is kept by the constriction device in the constricted state.
711. The apparatus according to claim 708, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's vas deference wall portion, and the control device is operable to control the constriction and stimulation devices independently of each other.
712. The apparatus according to claim 709, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's vas deference wall portion, and the control device is operable to control the stimulation device to stimulate or not to stimulate the vas deference wall portion, while the control device controls the constriction device to adjust the constriction of the vas deference wall portion, and wherein the control device is adapted to calibrate the constriction device by controlling the stimulation device to stimulate the vas deference wall portion while controlling the constriction device to adjust the constriction of the vas deference wall portion until the desired restriction of the sperm flow in the lumen of the vas deference is obtained.
713. The apparatus according to claim 709, wherein the control device is operable to control the constriction device to adjust the constriction of the vas deference wall portion, such that the sperm flow in the lumen of the vas deference is restricted but not stopped, and is operable - to control the stimulation device to stimulate the constricted vas deference wall portion to cause contraction thereof, such that the sperm flow in the lumen of the vas deference is further restricted but not stopped, or - to control the stimulation device in a first mode to stimulate the constricted vas deference wall portion to stop the sperm flow in the lumen of the vas deference and to control the stimulation device in a second mode to cease the stimulation of the vas deference wall portion to allow sperm flow in the lumen of the vas deference.
714. The apparatus according to claim 709, wherein the control device is operable to control the constriction device to adjust the constriction of the vas deference wall portion, such that the sperm flow in the lumen of the vas deference is substantially stopped, and wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted vas deference wall portion to completely stop the sperm flow in the lumen of the vas deference, and to control the stimulation device in a second mode to cease the stimulation of the vas deference wall portion to allow sperm flow in the lumen of the vas deference, or to control in the second mode the stimulation device to cease the stimulation of the vas deference wall portion and the constriction device to release the vas deference wall portion to restore the sperm flow in the lumen of the vas deference.
715. The apparatus according to claim 708, wherein the control device comprises a manually operable switch for switching on and off the constriction device and/or stimulation device, the switch being adapted for subcutaneous implantation in the patient to be manually operated from outside the patient's body.
716. The apparatus according to claim 709, wherein the constriction device is designed to normally keep the patient's vas deference wall portion in a constricted state, in which the blood circulation in the constricted vas deference wall portion is substantially unrestricted and the sperm flow in the lumen of the vas deference is at least restricted, wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted vas deference wall portion to cause contraction thereof to further restrict but not stop the sperm flow in the lumen of the vas deference, or to stimulate the constricted vas deference wall portion to cause contraction thereof, such that the sperm flow in the lumen of the vas deference is stopped, and wherein the control device is operable to control the stimulation device in a second mode to cease the stimulation of the vas deference wall portion to allow the sperm flow in the lumen of the vas deference.
717. The apparatus according to claim 708, wherein the control device is operable to control the stimulation device to adjust the intensity of the stimulation of the vas deference wall portion in response to a sensed physical parameter of the patient or functional parameter of the apparatus.
718. The apparatus according to claim 709, wherein the control device is operable to control the stimulation device to stimulate the vas deference wall portion to cause contraction of the vas deference wall portion such that the sperm flow is stopped, and the control device is further operable to control the stimulation device to increase the intensity of the stimulation in response to a sensed parameter related to an increase of pressure in the lumen of the vas deference, such that the sperm flow remains stopped, further comprising a sensor configured to sense a physical parameter of the patient that relates to the pressure in the lumen of the vas deference, the control device being operable to control the stimulation device in response to signals from the sensor, the physical parameter being related to a pressure in the patient's body and the sensor being a pressure related sensor.
719. The apparatus according to claim 708, wherein the control device is operable to control the stimulation device to intermittently and individually stimulate different areas of the vas deference wall portion, such that at least two of the areas are stimulated at different points of time, and wherein the control device is operable to control the stimulation device to intermittently stimulate - each area of the different areas of the vas deference wall portion during successive time periods, each time period being short enough to maintain over time satisfactory blood circulation in the area until the lapse of the time period, or - the areas of the vas deference wall portion, such that an area of the vas deference wall portion that currently is not stimulated has time to restore substantially normal blood circulation before the stimulation device stimulates the area again.
720. The apparatus according to claim 708, wherein the control device is operable to control the stimulation device to stimulate different areas of the vas deference wall portion at a time by sequentially stimulating the different areas of the vas deference wall portion, or by shifting over time the stimulation from one area to another, or by shifting over time the stimulation from one area to another such that both areas are temporarily stimulated at the same time during the stimulation shift.
721. The apparatus according to claim 708, wherein the control device is operable to control the stimulation device to intermittently and individually electrically stimulate different areas of the patient's vas deference wall portion with electric pulses, and wherein the stimulation device comprises at least one electrical element for engaging the vas deference wall portion and for stimulating the vas deference wall portion with electric pulses.
722. The apparatus according to claim 721, wherein the pulses form pulse trains, and wherein the control device is operable to control the stimulation device to vary at least one of the following pulse parameters: the off time periods between the individual pulses of each pulse train, the off time periods between the pulse trains, the width of each pulse of the pulse trains, the length of each pulse train, the pulse amplitudes of the pulses of the pulse trains, the frequency of the pulses of the pulse trains, the frequency of the pulse trains, and the number of pulses of each pulse train, wherein at least a first area and a second area of the areas of the vas deference wall portion are repeatedly stimulated with a first pulse train of the pulse trains and a second pulse train of the pulse trains, respectively, such that the first and second pulse trains over time are shifted relative to each other, and wherein the first area is stimulated with the first pulse train while the second area is not stimulated with the second pulse train, and vice versa, or the first and second pulse trains are shifted relative to each other such that the first and second pulse trains at least partially overlap each other.
723. The apparatus according to claim 721, wherein the vas deference wall portion includes muscle fibers and the stimulation device is configured to stimulate the vas deference wall portion including the muscle fibers with the electric pulses, to cause contraction of the muscle fibres to contract the vas deference wall portion.
724. The apparatus according to claim 721, wherein the stimulation device comprises a plurality of electrical elements and a structure holding the electrical elements in a the fixed orientation relative to one another, the structure being integrated in or separate from the constriction device, and wherein the electrical elements form an elongate pattern of electrical elements and the structure is applicable on the vas deference such that the elongate pattern of electrical elements extends along the vas deference and the elements abut the respective areas of the vas deference wall portion.
725. The apparatus according to claim 721, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to electrically energize the electrical elements, preferably to cyclically energize each element with electric pulses, and wherein the control device is operable to control the stimulation device to energize the electrical elements, such that a number or groups of the electrical elements are energized at the same time or such that the electrical elements are energized one at a time in sequence or groups of the electrical elements are sequentially energized, either randomly or in accordance with a predetermined pattern.
726. The apparatus according to claim 721, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form an elongate pattern of electrical elements, wherein the elements are applicable on the vas deference wall such that the elongate pattern of electrical elements extends along the vas deference and the elements abut the respective areas of the vas deference wall portion, and wherein the control device is operable to control the stimulation device to successively energize the electrical elements longitudinally along the elongate pattern of electrical elements, or - to successively energize the electrical elements along the elongate pattern of electrical elements in a direction opposite to, or in the same direction as, that of the sperm flow in the lumen of the vas deference, when the stimulation device is applied on the patient's vas deference, or - to successively energize the electrical elements from a position substantially at the center of the constricted vas deference wall portion towards both ends of the elongate pattern of electrical elements, when the stimulation device is applied on the vas deference.
727. The apparatus according to claim 721, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to energize the electrical elements, such that electrical elements currently energized form at least one group of adjacent energized electrical elements, wherein the elements in the group of energized electrical elements form a path of energized electrical elements, and wherein the path of energized electrical elements extends along the vas deference, or at least in part or completely around the vas deference, when the stimulation device is applied on the vas deference.
728. The apparatus according to claim 721, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form a plurality of groups of elements, the groups forming a series of groups extending along the vas deference, when the stimulation device is applied on the vas deference, the electrical elements of each group of electrical elements forming a path of elements extending along the vas deference, or at least in part or completely around the vas deference, and wherein the control device is operable to control the stimulation device - to successively energize the groups of electrical elements in the series of groups in a direction opposite to, or in the same direction as, that of the sperm flow in the lumen of the vas deference, when the stimulation device is applied on the vas deference, or - to successively energize the groups of electrical elements in the series of groups from a position substantially at the center of the constricted vas deference wall portion in a direction opposite to and in the same direction as that of the sperm flow in the lumen of the vas deference, when the stimulation device is applied on the vas deference.
729. The apparatus according to claim 709, wherein the stimulation device is configured to thermally stimulate the vas deference wall portion, either by cooling the constricted vas deference wall portion to cause contraction of the vas deference wall portion or by heating the vas deference wall portion, when the vas deference wall portion is constricted and contracted, to cause expansion of the vas deference wall portion, and wherein the constriction device is configured to constrict the vas deference wall portion to at least restrict the sperm flow in the lumen of the vas deference, and the control device is operable to control the stimulation device to cool the constricted vas deference wall portion to cause contraction thereof, such that the sperm flow in the lumen of the vas deference is at least further restricted but not stopped, or further restricted and stopped.
730. The apparatus according to claim 708, wherein the vas deference wall portion extends between an upstream end and a downstream end of the vas deference wall portion with respect to the direction of the sperm flow in the lumen of the vas deference, and wherein the control device is operable to control at least one of the constriction and stimulation devices to affect the vas deference wall portion such that the sperms are actively moved in the lumen of the vas deference.
731. The apparatus according to claim 730, wherein the constriction device is configured to constrict the entire vas deference wall portion between the upstream and downstream ends thereof to restrict the sperm flow in the lumen of the vas deference, and the control device is operable - to control the stimulation device to progressively stimulate the constricted vas deference wall portion in the downstream or upstream direction of the lumen of the vas deference to cause progressive contraction of the vas deference wall portion to move the sperms in the lumen of the vas deference, or - to control the stimulation device to stimulate the constricted vas deference wall portion to close the lumen of the vas deference either at the upstream end or the downstream end of the vas deference wall portion and to simultaneously control the constriction device to increase the constriction of the entire vas deference wall portion to move the sperms in the lumen of the vas deference.
732. The apparatus according to claim 708, wherein the control device is operable to control the constriction device to vary the constriction of the vas deference wall portion and to simultaneously control the stimulation device to progressively stimulate the constricted vas deference wall portion in the downstream or upstream direction of the lumen of the vas deference to cause progressive contraction of the vas deference wall portion to move the sperms in the lumen of the vas deference.
733. The apparatus according to claim 708, wherein the control device is operable to control the stimulation device to stimulate the vas deference wall portion and to simultaneously control the constriction device to vary the constriction of different areas of the vas deference wall portion such that the vas deference wall portion is progressively constricted in the downstream or upstream direction of the lumen of the vas deference, and wherein - the control device is operable to control the stimulation device to progressively stimulate the constricted vas deference wall portion to cause progressive contraction thereof in harmony with the progressive constriction of the vas deference wall portion performed by the constriction device, or - the control device is operable to control an elongated constriction element of the constriction device extending along the vas deference wall portion to progressively constrict the vas deference wall portion in the downstream or upstream direction of the lumen of the vas deference, wherein the elongated constriction element comprises contact surfaces dimensioned to contact a length of the vas deference wall portion, when the constriction device constricts the vas deference wall portion, and the stimulation device comprises a plurality of stimulation elements distributed along the contact surfaces, such that the stimulation elements stimulate the different areas of the vas deference wall portion along the length of the vas deference wall portion, when the control device controls the stimulation device to stimulate the vas deference wall portion.
734. The apparatus according to claim 708, wherein the constriction device is configured to constrict any one of a series of vas deference wall portions of the vas deference to at least restrict the sperm flow in the lumen of the vas deference, the stimulation device is configured to stimulate the vas deference wall portion constricted by the constriction device to close the lumen of the vas deference, and the control device is operable to control the constriction device to successively constrict the vas deference wall portions of the series of vas deference wall portions to move the sperms in the lumen of the vas deference in a peristaltic manner, and wherein the constriction device comprises at least one constriction element that is moveable along the vas deference to successively constrict the vas deference wall portions of the series of vas deference wall portions, and the stimulation device comprises at least one stimulation element positioned on the constriction element for stimulating the vas deference wall portion constricted by the constriction element.
735. The apparatus according to claim 734, wherein the control device is operable to control the constriction device to cyclically move the constriction element along the vas deference wall portions of the series of vas deference wall portions.
736. The apparatus according to claim 734, wherein the constriction device comprises a plurality of constriction elements, each of which is moveable along the vas deference to successively constrict the vas deference wall portions of the series of vas deference wall portions, wherein the stimulation device comprises stimulation elements positioned on the constriction elements for stimulating the vas deference wall portions constricted by the constriction elements, wherein the control device is operable to control the constriction device to cyclically move the constriction elements one after the other along the vas deference wall portions of the series of vas deference wall portions, wherein the constriction device comprises a rotor carrying the constriction elements, and the control device is operable to control the rotor to rotate such that each constriction element cyclically constricts the vas deference wall portions of the series of vas deference wall portions, and wherein each constriction element comprises a roller for rolling on the vas deference to constrict the latter.
737. The apparatus according to claim 708, wherein the constriction device comprises a first constriction element for constricting the vas deference wall portion at an upstream end thereof, a second constriction element for constricting the vas deference wall portion at an downstream end thereof, and a third constriction element for constricting the vas deference wall portion between the upstream and downstream ends thereof, and the control device is operable to control the first, second and third constriction elements to constrict and release the vas deference wall portions independently of one another, and wherein - the control device is operable to control the first or second constriction element to constrict the vas deference wall portion at the upstream or downstream end thereof to close the lumen of the vas deference and to control the third constriction element to constrict the vas deference wall portion between the upstream and downstream ends thereof, whereby sperms contained in the vas deference wall portion between the upstream and downstream ends thereof are moved downstream or upstream in the lumen of the vas deference, the control device controlling the stimulation device to stimulate the vas deference wall portion between the upstream and downstream ends thereof, when the third constriction element constricts the vas deference wall portion, or - the control device is operable to control the first constriction element to constrict the vas deference wall portion at the upstream end thereof to restrict the sperm flow in the lumen of the vas deference and to control the stimulation device to stimulate the constricted vas deference wall portion at the upstream end to close the lumen of the vas deference, and wherein the control device is operable to control the third constriction element to constrict the vas deference wall portion between the upstream and downstream ends thereof, whereby sperms contained in the vas deference wall portion between the upstream and downstream ends thereof are moved downstream in the lumen of the vas deference, or - the control device is operable to control the second constriction element to constrict the vas deference wall portion at the downstream end thereof to restrict the sperm flow in the lumen of the vas deference and to control the stimulation device to stimulate the constricted vas deference wall portion at the downstream end to close the lumen of the vas deference, and the control device is operable to control the third constriction element to constrict the vas deference wall portion between the upstream and downstream ends thereof, whereby sperms contained in the vas deference wall portion between the upstream and downstream ends thereof are moved upstream in the lumen of the vas deference.
738. The apparatus according to claim 706, wherein the constriction device is adjustable, and further comprising an operation device operating the adjustable constriction device to change the constriction of the patient's vas deference wall portion, wherein the operation device mechanically or hydraulically operates the constriction device.
739. The apparatus according to claim 738, wherein the operation device mechanically operates the constriction device, and the constriction device comprises at least two elongated clamping elements extending along the vas deference on different sides of the vas deference, and the operation device operates the clamping elements to clamp the vas deference wall portion between the clamping elements to constrict the vas deference wall portion.
740. The apparatus according to claim 708, wherein the control device is operable to control the constriction device to close the lumen of the vas deference, either at an upstream end or a downstream end of the vas deference wall portion, and to control the constriction device to constrict the remaining part of the vas deference wall portion to move the sperms in the lumen of the vas deference, and wherein the control device is operable to control the stimulation device to stimulate the vas deference wall portion as the constriction device constricts the remaining part of the vas deference wall portion.
741. The apparatus according to claim 708, wherein the constriction device is configured to constrict the vas deference wall portion to restrict but not stop the sperm flow in the lumen of the vas deference, and the control device is operable to control the stimulation device to stimulate the vas deference wall portion constricted by the constriction device to close the lumen of the vas deference, either at an upstream end or a downstream end of the vas deference wall portion, and to simultaneously control the constriction device to increase the constriction of the vas deference wall portion to cause the sperms in the lumen of the vas deference to move through the lumen.
742. The apparatus according to claim 708, wherein the constriction device comprises a plurality of separate constriction elements adapted to constrict any vas deference wall portions of a series of vas deference wall portions, respectively, of the vas deference, and the control device is operable to control the constriction device to activate the constriction elements in random or in accordance with a predetermined sequence.
743. The apparatus according to claim 742, wherein the stimulation device comprises stimulation elements positioned on the constriction elements, and wherein the control device is operable to control the stimulation device to activate the stimulation elements to stimulate any vas deference wall portions of the series of vas deference wall portions constricted by the constriction elements.
744. The apparatus according to claim 742, wherein the control device is operable to control the constriction device to activate the constriction elements to constrict the vas deference wall portions of the series of vas deference wall portions without completely closing the lumen of the vas deference, and to control the stimulation device to activate the stimulation elements to stimulate the constricted vas deference wall portions one after the other, so that the vas deference wall portions of the series of vas deference wall portions are successively contracted along the vas deference to move the sperms in the lumen of the vas deference, or - to constrict all of the vas deference wall portions of the series of vas deference wall portions, and to control the stimulation device to activate the stimulation elements to stimulate any constricted vas deference wall portions in random or in accordance with a predetermined sequence to close the lumen of the vas deference.
745. A gallstone trouble treatment apparatus for treating a patient suffering from gallstone trouble, comprising at least one implantable stimulation device configured to stimulate at least one portion of the tissue wall of a biliary duct of the patient, and a control device operable to control the stimulation device to stimulate the tissue wall portion to cause contraction of the tissue wall portion to influence the movement of bile and/or gallstones in the biliary duct.
746. The apparatus according to claim 745, wherein the control device is operable to control the stimulation device to stimulate the tissue wall portion to cause contractions of the tissue wall portion such that the contractions of the tissue wall portion actively move bile and/or gallstones in the biliary duct.
747. The apparatus according to claim 745, further comprising at least two stimulation devices configured to stimulate at least two different portions of the tissue wall of the biliary duct, including the heptic ducts, the common bile duct, the cystic ducts and their sphincters.
748. The apparatus according to claim 745, further comprising an implantable constriction device configured to gently constrict the tissue wall portion to influence the movement of bile and/or gallstones in the biliary duct, wherein the control device is operable to control the stimulation device to stimulate the tissue wall portion, as the constriction device constricts the tissue wall portion, to cause contraction of the tissue wall portion to further influence the movement of bile and/or gallstones in the biliary duct.
749. The apparatus according to claim 748, wherein the constriction device is configured to gently constrict the tissue wall portion to restrict the movement of of bile and/or gallstones in the biliary duct, and the control device is operable to control the stimulation device to stimulate the tissue wall portion, as the constriction device constricts the tissue wall portion, to cause contraction of the tissue wall portion to further restrict the movement of bile and/or gallstones in the biliary duct.
750. The apparatus according to claim 749, wherein the constriction device is configured to constrict the tissue wall portion to a constricted state in which the blood circulation in the constricted tissue wall portion is substantially unrestricted and the movement of bile and/or gallstones in the biliary duct is at least restricted, and the control device is operable to control the stimulation device to cause contraction of the tissue wall portion, so that the movement of bile and/or gallstones in the biliary duct is at least further restricted when the tissue wall portion is kept by the constriction device in the constricted state.
751. The apparatus according to claim 748, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's tissue wall portion, and the control device is operable to control the constriction and stimulation devices independently of each other.
752. The apparatus according to claim 749, wherein the control device is operable to control the constriction device to adjust the constriction of the patient's tissue wall portion, and the control device is operable to control the stimulation device to stimulate or not to stimulate the tissue wall portion, while the control device controls the constriction device to adjust the constriction of the tissue wall portion, and wherein the control device is adapted to calibrate the constriction device by controlling the stimulation device to stimulate the tissue wall portion while controlling the constriction device to adjust the constriction of the tissue wall portion until the desired restriction of the movement of bile and/or gallstones in the biliary duct is obtained.
753. The apparatus according to claim 749, wherein the control device is operable to control the constriction device to adjust the constriction of the tissue wall portion, such that the movement of bile and/or gallstones in the biliary duct is restricted but not stopped, and is operable - to control the stimulation device to stimulate the constricted tissue wall portion to cause contraction thereof, such that the movement of bile and/or gallstones in the biliary duct is further restricted but not stopped, or - to control the stimulation device in a first mode to stimulate the constricted tissue wall portion to stop the movement of bile and/or gallstones in the biliary duct and to control the stimulation device in a second mode to cease the stimulation of the tissue wall portion to allow movement of bile and/or gallstones in the biliary duct.
754. The apparatus according to claim 749, wherein the control device is operable to control the constriction device to adjust the constriction of the tissue wall portion, such that the movement of bile and/or gallstones in the biliary duct is substantially stopped, and wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted tissue wall portion to completely stop the movement of bile and/or gallstones in the biliary duct, and to control the stimulation device in a second mode to cease the stimulation of the tissue wall portion to allow movement of bile and/or gallstones in the biliary duct, or to control in the second mode the stimulation device to cease the stimulation of the tissue wall portion and the constriction device to release the tissue wall portion to restore the movement of bile and/or gallstones in the biliary duct.
755. The apparatus according to claim 748, wherein the control device comprises a manually operable switch for switching on and off the constriction device and/or stimulation device, the switch being adapted for subcutaneous implantation in the patient to be manually operated from outside the patient's body.
756. The apparatus according to claim 749, wherein the constriction device is designed to normally keep the patient's tissue wall portion in a constricted state, in which the blood circulation in the constricted tissue wall portion is substantially unrestricted and the movement of bile and/or gallstones in the biliary duct is at least restricted, wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted tissue wall portion to cause contraction thereof to further restrict but not stop the movement of bile and/or gallstones in the biliary duct, or to stimulate the constricted tissue wall portion to cause contraction thereof, such that the movement of bile and/or gallstones in the biliary duct is stopped, and wherein the control device is operable to control the stimulation device in a second mode to cease the stimulation of the tissue wall portion to allow the movement of bile and/or gallstones in the biliary duct.
757. The apparatus according to claim 745, wherein the control device is operable to control the stimulation device to adjust the intensity of the stimulation of the tissue wall portion in response to a sensed physical parameter of the patient or functional parameter of the apparatus.
758. The apparatus according to claim 749, wherein the control device is operable to control the stimulation device to stimulate the tissue wall portion to cause contraction of the tissue wall portion such that the movement of bile and/or gallstones is stopped, and the control device is further operable to control the stimulation device to increase the intensity of the stimulation in response to a sensed parameter related to an increase of pressure in the lumen of the biliary duct, such that the movement of bile and/or gallstones remains stopped, further comprising a sensor configured to sense a physical parameter of the patient that relates to the pressure in the lumen of the biliary duct, the control device being operable to control the stimulation device in response to signals from the sensor, the physical parameter being related to a pressure in the patient's body and the sensor being a pressure related sensor.
759. The apparatus according to claim 745, wherein the control device is operable to control the stimulation device to intermittently and individually stimulate different areas of the tissue wall portion, such that at least two of the areas are stimulated at different points of time, and wherein the control device is operable to control the stimulation device to intermittently stimulate - each area of the different areas of the tissue wall portion during successive time periods, each time period being short enough to maintain over time satisfactory blood circulation in the area until the lapse of the time period, or - the areas of the tissue wall portion, such that an area of the tissue wall portion that currently is not stimulated has time to restore substantially normal blood circulation before the stimulation device stimulates the area again.
760. The apparatus according to claim 745, wherein the control device is operable to control the stimulation device to stimulate different areas of the tissue wall portion at a time by sequentially stimulating the different areas of the tissue wall portion, or by shifting over time the stimulation from one area to another, or by shifting over time the stimulation from one area to another such that both areas are temporarily stimulated at the same time during the stimulation shift.
761. The apparatus according to claim 745, wherein the control device is operable to control the stimulation device to intermittently and individually electrically stimulate different areas of the patient's tissue wall portion with electric pulses, and wherein the stimulation device comprises at least one electrical element for engaging the tissue wall portion and for stimulating the tissue wall portion with electric pulses.
762. The apparatus according to claim 761, wherein the pulses form pulse trains, and wherein the control device is operable to control the stimulation device to vary at least one of the following pulse parameters: the off time periods between the individual pulses of each pulse train, the off time periods between the pulse trains, the width of each pulse of the pulse trains, the length of each pulse train, the pulse amplitudes of the pulses of the pulse trains, the frequency of the pulses of the pulse trains, the frequency of the pulse trains, and the number of pulses of each pulse train, wherein at least a first area and a second area of the areas of the tissue wall portion are repeatedly stimulated with a first pulse train of the pulse trains and a second pulse train of the pulse trains, respectively, such that the first and second pulse trains over time are shifted relative to each other, and wherein the first area is stimulated with the first pulse train while the second area is not stimulated with the second pulse train, and vice versa, or the first and second pulse trains are shifted relative to each other such that the first and second pulse trains at least partially overlap each other.
763. The apparatus according to claim 761, wherein the tissue wall portion includes muscle fibers and the stimulation device is configured to stimulate the tissue wall portion including the muscle fibers with the electric pulses, to cause contraction of the muscle fibres to contract the tissue wall portion.
764. The apparatus according to claim 761, wherein the stimulation device comprises a plurality of electrical elements and a structure holding the electrical elements in a the fixed orientation relative to one another, the structure being integrated in or separate from the constriction device, and wherein the electrical elements form an elongate pattern of electrical elements and the structure is applicable on the biliary duct such that the elongate pattern of electrical elements extends along the biliary duct and the elements abut the respective areas of the tissue wall portion.
765. The apparatus according to claim 761, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to electrically energize the electrical elements, preferably to cyclically energize each element with electric pulses, and wherein the control device is operable to control the stimulation device to energize the electrical elements, such that a number or groups of the electrical elements are energized at the same time or such that the electrical elements are energized one at a time in sequence or groups of the electrical elements are sequentially energized, either randomly or in accordance with a predetermined pattern.
766. The apparatus according to claim 761, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form an elongate pattern of electrical elements, wherein the elements are applicable on the biliary duct wall such that the elongate pattern of electrical elements extends along the biliary duct and the elements abut the respective areas of the tissue wall portion, and wherein the control device is operable to control the stimulation device - to successively energize the electrical elements longitudinally along the elongate pattern of electrical elements, or - to successively energize the electrical elements along the elongate pattern of electrical elements in a direction opposite to, or in the same direction as, that of the movement of bile and/or gallstones in the biliary duct, when the stimulation device is applied on the patient's biliary duct, or - to successively energize the electrical elements from a position substantially at the center of the constricted tissue wall portion towards both ends of the elongate pattern of electrical elements, when the stimulation device is applied on the biliary duct.
767. The apparatus according to claim 761, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to energize the electrical elements, such that electrical elements currently energized form at least one group of adjacent energized electrical elements, wherein the elements in the group of energized electrical elements form a path of energized electrical elements, and wherein the path of energized electrical elements extends along the biliary duct, or at least in part or completely around the biliary duct, when the stimulation device is applied on the biliary duct.
768. The apparatus according to claim 761, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form a plurality of groups of elements, the groups forming a series of groups extending along the biliary duct, when the stimulation device is applied on the biliary duct, the electrical elements of each group of electrical elements forming a path of elements extending along the biliary duct, or at least in part or completely around the biliary duct, and wherein the control device is operable to control the stimulation device to successively energize the groups of electrical elements in the series of groups in a direction opposite to, or in the same direction as, that of the movement of bile and/or gallstones in the biliary duct, when the stimulation device is applied on the biliary duct, or - to successively energize the groups of electrical elements in the series of groups from a position substantially at the center of the constricted tissue wall portion in a direction opposite to and in the same direction as that of the movement of bile and/or gallstones in the biliary duct, when the stimulation device is applied on the biliary duct.
769. The apparatus according to claim 749, wherein the stimulation device is configured to thermally stimulate the tissue wall portion, either by cooling the constricted tissue wall portion to cause contraction of the tissue wall portion or by heating the tissue wall portion, when the tissue wall portion is constricted and contracted, to cause expansion of the tissue wall portion, and wherein the constriction device is configured to constrict the tissue wall portion to at least restrict the movement of bile and/or gallstones in the biliary duct, and the control device is operable to control the stimulation device to cool the constricted tissue wall portion to cause contraction thereof, such that the movement of bile and/or gallstones in the biliary duct is at least further restricted but not stopped, or further restricted and stopped.
770. The apparatus according to claim 748, wherein the tissue wall portion extends between an upstream end and a downstream end of the tissue wall portion with respect to the direction of the movement of bile and/or gallstones in the biliary duct, and wherein the control device is operable to control at least one of the constriction and stimulation devices to affect the tissue wall portion such that the bile and/or gallstones are actively moved in the lumen of the biliary duct.
771. The apparatus according to claim 770, wherein the constriction device is configured to constrict the entire tissue wall portion between the upstream and downstream ends thereof to restrict the movement of bile and/or gallstones in the biliary duct, and the control device is operable - to control the stimulation device to progressively stimulate the constricted tissue wall portion in the downstream or upstream direction of the lumen of the biliary duct to cause progressive contraction of the tissue wall portion to move the bile and/or gallstones in the lumen of the biliary duct, or - to control the stimulation device to stimulate the constricted tissue wall portion to close the lumen of the biliary duct either at the upstream end or the downstream end of the tissue wall portion and to simultaneously control the constriction device to increase the constriction of the entire tissue wall portion to move the bile and/or gallstones in the lumen of the biliary duct.
772. The apparatus according to claim 748, wherein the control device is operable to control the constriction device to vary the constriction of the tissue wall portion and to simultaneously control the stimulation device to progressively stimulate the constricted tissue wall portion in the downstream or upstream direction of the lumen of the biliary duct to cause progressive contraction of the tissue wall portion to move the bile and/or gallstones in the lumen of the biliary duct.
773. The apparatus according to claim 748, wherein the control device is operable to control the stimulation device to stimulate the tissue wall portion and to simultaneously control the constriction device to vary the constriction of different areas of the tissue wall portion such that the tissue wall portion is progressively constricted in the downstream or upstream direction of the lumen of the biliary duct, and wherein - the control device is operable to control the stimulation device to progressively stimulate the constricted tissue wall portion to cause progressive contraction thereof in harmony with the progressive constriction of the tissue wall portion performed by the constriction device, or - the control device is operable to control an elongated constriction element of the constriction device extending along the tissue wall portion to progressively constrict the tissue wall portion in the downstream or upstream direction of the lumen of the biliary duct, wherein the elongated constriction element comprises contact surfaces dimensioned to contact a length of the tissue wall portion, when the constriction device constricts the tissue wall portion, and the stimulation device comprises a plurality of stimulation elements distributed along the contact surfaces, such that the stimulation elements stimulate the different areas of the tissue wall portion along the length of the tissue wall portion, when the control device controls the stimulation device to stimulate the tissue wall portion.
774. The apparatus according to claim 748, wherein the constriction device is configured to constrict any one of a series of tissue wall portions of the biliary duct to at least restrict the movement of bile and/or gallstones in the biliary duct, the stimulation device is configured to stimulate the tissue wall portion constricted by the constriction device to close the lumen of the biliary duct, and the control device is operable to control the constriction device to successively constrict the tissue wall portions of the series of tissue wall portions to move the bile and/or gallstones in the lumen of the biliary duct in a peristaltic manner, and wherein the constriction device comprises at least one constriction element that is moveable along the biliary duct to successively constrict the tissue wall portions of the series of tissue wall portions, and the stimulation device comprises at least one stimulation element positioned on the constriction element for stimulating the tissue wall portion constricted by the constriction element.
775. The apparatus according to claim 774, wherein the control device is operable to control the constriction device to cyclically move the constriction element along the tissue wall portions of the series of tissue wall portions.
776. The apparatus according to claim 774, wherein the constriction device comprises a plurality of constriction elements, each of which is moveable along the biliary duct to successively constrict the tissue wall portions of the series of tissue wall portions, wherein the stimulation device comprises stimulation elements positioned on the constriction elements for stimulating the tissue wall portions constricted by the constriction elements, wherein the control device is operable to control the constriction device to cyclically move the constriction elements one after the other along the tissue wall portions of the series of tissue wall portions, wherein the constriction device comprises a rotor carrying the constriction elements, and the control device is operable to control the rotor to rotate such that each constriction element cyclically constricts the tissue wall portions of the series of tissue wall portions, and wherein each constriction element comprises a roller for rolling on the biliary duct to constrict the latter.
777. The apparatus according to claim 748 wherein the constriction device comprises a first constriction element for constricting the tissue wall portion at an upstream end thereof, a second constriction element for constricting the tissue wall portion at an downstream end thereof, and a third constriction element for constricting the tissue wall portion between the upstream and downstream ends thereof, and the control device is operable to control the first, second and third constriction elements to constrict and release the tissue wall portions independently of one another, and wherein - the control device is operable to control the first or second constriction element to constrict the tissue wall portion at the upstream or downstream end thereof to close the lumen of the biliary duct and to control the third constriction element to constrict the tissue wall portion between the upstream and downstream ends thereof, whereby bile and/or gallstones contained in the tissue wall portion between the upstream and downstream ends thereof are moved downstream or upstream in the lumen of the biliary duct, the control device controlling the stimulation device to stimulate the tissue wall portion between the upstream and downstream ends thereof, when the third constriction element constricts the tissue wall portion, or - the control device is operable to control the first constriction element to constrict the tissue wall portion at the upstream end thereof to restrict the movement of bile and/or gallstones in the biliary duct and to control the stimulation device to stimulate the constricted tissue wall portion at the upstream end to close the lumen of the biliary duct, and wherein the control device is operable to control the third constriction element to constrict the tissue wall portion between the upstream and downstream ends thereof, whereby bile and/or gallstones contained in the tissue wall portion between the upstream and downstream ends thereof are moved downstream in the lumen of the biliary duct, or - the control device is operable to control the second constriction element to constrict the tissue wall portion at the downstream end thereof to restrict the movement of bile and/or gallstones in the biliary duct and to control the stimulation device to stimulate the constricted tissue wall portion at the downstream end to close the lumen of the biliary duct, and the control device is operable to control the third constriction element to constrict the tissue wall portion between the upstream and downstream ends thereof, whereby bile and/or gallstones contained in the tissue wall portion between the upstream and downstream ends thereof are moved upstream in the lumen of the biliary duct.
778. The apparatus according to claim 748, wherein the constriction device is adjustable, and further comprising an operation device operating the adjustable constriction device to change the constriction of the patient's tissue wall portion, wherein the operation device mechanically or hydraulically operates the constriction device.
779. The apparatus according to claim 778, wherein the operation device mechanically operates the constriction device, and the constriction device comprises at least two elongated clamping elements extending along the biliary duct on different sides of the biliary duct, and the operation device operates the clamping elements to clamp the tissue wall portion between the clamping elements to constrict the tissue wall portion.
780. The apparatus according to claim 748, wherein the control device is operable to control the constriction device to close the lumen of the biliary duct, either at an upstream end or a downstream end of the tissue wall portion, and to control the constriction device to constrict the remaining part of the tissue wall portion to move the bile and/or gallstones in the lumen of the biliary duct, and wherein the control device is operable to control the stimulation device to stimulate the tissue wall portion as the constriction device constricts the remaining part of the tissue wall portion.
781. The apparatus according to claim 748, wherein the constriction device is configured to constrict the tissue wall portion to restrict but not stop the movement of bile and/or gallstones in the biliary duct, and the control device is operable to control the stimulation device to stimulate the tissue wall portion constricted by the constriction device to close the lumen of the biliary duct, either at an upstream end or a downstream end of the tissue wall portion, and to simultaneously control the constriction device to increase the constriction of the tissue wall portion to cause the bile and/or gallstones in the lumen of the biliary duct to move through the lumen.
782. The apparatus according to claim 748, wherein the constriction device comprises a plurality of separate constriction elements adapted to constrict any tissue wall portions of a series of tissue wall portions, respectively, of the biliary duct, and the control device is operable to control the constriction device to activate the constriction elements in random or in accordance with a predetermined sequence.
783. The apparatus according to claim 782, wherein the stimulation device comprises stimulation elements positioned on the constriction elements, and wherein the control device is operable to control the stimulation device to activate the stimulation elements to stimulate any tissue wall portions of the series of tissue wall portions constricted by the constriction elements.
784. The apparatus according to claim 782, wherein the control device is operable to control the constriction device to activate the constriction elements - to constrict the tissue wall portions of the series of tissue wall portions without completely closing the lumen of the biliary duct, and to control the stimulation device to activate the stimulation elements to stimulate the constricted tissue wall portions one after the other, so that the tissue wall portions of the series of tissue wall portions are successively contracted along the biliary duct to move the bile and/or gallstones in the lumen of the biliary duct, or - to constrict all of the tissue wall portions of the series of tissue wall portions, and to control the stimulation device to activate the stimulation elements to stimulate any constricted tissue wall portions in random or in accordance with a predetermined sequence to close the lumen of the biliary duct.
785. A pregnancy control system for promoting pregnancy comprising a restriction device configured to postoperatively be adjusted to restrict and release an oviduct of the patient.
786. The system according to claim 785, wherein the restriction device is configured to provide a restriction to accumulate at least one egg released from the ovary in the oviduct for a predetermined period of time, and to release the restriction when convenient for the patient to get pregnant.
787. The system according to claim 786, wherein the restriction device is configured to provide a release of the oviduct when pregnancy is wanted.
788. The system according to claim 785, wherein the restriction device is adapted to provide a release of the oviduct when pregnancy is wanted.
789. The system according to claim 785, wherein the restriction device is adapted to be adjusted non-invasively from outside the patient's body to restrict and release the oviduct passageway.
790. The system according to claim 785, wherein the restriction device is adapted to be adjusted by manual manipulation.
791. The system according to claim 785, wherein the restriction device is adapted to be adjusted by electrical or magnetic power.
792. The system according to claim 785, wherein the restriction device is adapted to be adjusted by hydraulic power.
793. The system according to claim 792, wherein the hydraulic power comprising at least one subcutaneously placed reservoir controlled by the patient.
794. The system according to claim 785, wherein the restriction device is adapted to be adjusted reversible.
795. The system according to any one of claims 785-794, wherein said restriction device comprises a more than one restriction area, wherein said restriction device being adapted to change the restriction area over time.
796. The system according to claim 795, wherein the change of the restriction area is adapted to prevent any damage to the oviduct still keeping the oviduct closed accumulating any egg to at a defined time be released to pass down to the uterus, thus increasing the likelihood of pregnancy.
797. The system according to claim 795, comprising a hydraulic restriction device with two or more restriction areas.
798. The system according to claim 797, comprising a hydraulic reservoir connected to said restriction device, wherein the hydraulic restriction device with two or more restriction areas is connected to the reservoir with hydraulic fluid adapted to move fluid to or from the restriction device and further comprising at least one valve to direct the fluid individually to or from the restriction areas to restrict or release the restriction areas individually.
799. The system according to claim 797, comprising two or more hydraulic reservoirs connected one each to the different areas of said restriction device, wherein the hydraulic restriction device with two or more restriction areas is connected to the two or more reservoirs with hydraulic fluid, said reservoirs is adapted to move fluid to or from said restriction areas individually to or from each of the connected restriction areas to restrict or release the restriction in the individual restriction area.
800. The system according to claim 797, wherein each of the hydraulic restriction areas is adapted to be restricted for a predetermined time period with some overlap in time and adapted to first restrict the restriction area closest to the ovary then changing restriction area to the next one towards the uterus.
801. The system according to claim 797, wherein each of the hydraulic restriction areas is adapted to be regulated by manual manipulation of said reservoirs.
802. The system according to claim 796, comprising a stimulation device with two or more restriction areas in combination with a hydraulic or mechanical restriction device.
803. The system according to claim 795, wherein the change of the restriction area is adapted to cause a peristaltic wave like restriction wave in the direction towards the ovary to prevent the egg being transported down to the uterus.
804. The system according to claim 785, wherein the restriction device is adapted to effect a transport of the at least one egg to the uterus upon release of the oviduct.
805. The system according to claim 804, wherein the restriction device is adapted to cause a peristaltic wave like restriction wave in the direction towards the uterus.
806. A system according to any one of claims 785-805, adapted to have more than two restricting areas and varying the restricting area while at least one restricting area is closed when the device being in restriction mode.
807. A system according to claim 806, adapted to restrict the restriction areas in consecutive order starting with the restriction area, part of the oviduct, closest to the ovary and thereafter restrict any new area one step closer to the uterus and further adapted to overlap in time the restriction of two consecutive restriction areas thereby adapted to restrict without interfering with any accumulated egg.
808. The device according to claim 785, wherein the restriction device is adapted to only partly restricting the oviduct and to create peristaltic wave like movements of a part of the oviduct(s) wall to prevent the transport of an egg in an oviduct to the uterus of the human or mammal patient, and therefore accumulate at least one egg released from the ovary in the oviduct for a predetermined period of time, and wherein the sperm is able to reach the egg during the time the egg is accumulated because the oviduct is only partly restricted, and the restriction device further adapted to release the egg, controlled from outside the body, to allow the at least on egg in the oviduct a transport to the uterus.
809. The device according to claim 785, wherein the change of the restriction area is adapted to cause a peristaltic wave like wave in the direction towards the ovary to prevent the egg being transported down to the uterus.
810. The device according to any one of claims 808-809, comprising a hydraulic device adapted to cause said peristaltic wave like restriction wave.
811. The device according to any one of claims 808-810, comprising a mechanical device adapted to cause said peristaltic wave like restriction wave.
812. The device according to any one of claims 808-811, comprising a stimulation device adapted to cause said peristaltic wave like restriction wave.
813. The device according to claim 812, wherein the device is adapted to cause another peristaltic wave like restriction wave in the opposite direction towards the uterus.
814. The device according to any one of claims 808-813, wherein the device is adapted to be adjusted by manual manipulation.
815. The device according to any one of claims 808-813, wherein the device is adapted to be adjusted by electrical or magnetic power.
816. The device according to any one of claims 808-813, wherein the restriction areas is only partly restricted to allow the sperm to reach the egg and the device adapted to prevent the egg to temporary reach the uterus with the peristaltic wave, to accumulate the egg temporary in the oviduct to allow increased likelihood for pregnancy to prolong the time period the egg being reachable by the sperm.
817. The device according to any one of claims 808-813, wherein the restriction areas is completely restricted to prevent the egg to temporary reach the uterus, to accumulate the egg temporary in the oviduct to allow increased likelihood for pregnancy when released.
818. The device according to any one of claims 785-817, wherein the restriction device is adapted to and intended to repeatedly every month repeat the post-operational and non-invasive regulation of the device actively reversible to prevent transport of an egg from the ovary to the uterus in the oviduct of the patient and reverse the function by allowing the normal transport of the egg from the ovary to the uterus.
819. The device according to any one of claims 795-818, comprising a movement device adapted to move the egg out of a varied upcoming new restricted area before a new area is restricted.
820. The device according to claim 819, wherein the movement device is the same device as the restriction device, adapted to work differently when restricting or causing movements of the egg or, wherein the movement device is different device adapted to cause movement of the egg.
821. The device according to any one of claims 819-820, wherein the movement device cases vibration or wave like movements in the oviduct wall thereby causing movements of the egg.
822. The system according to any one of claims 819-821, wherein the movement device comprises at least one of:
a. mechanical movement device, b. a hydraulic movement device, c. a stimulation device, and d. a combination thereof.
a. mechanical movement device, b. a hydraulic movement device, c. a stimulation device, and d. a combination thereof.
823. A pregnancy control apparatus for avoiding pregnancy comprising a restriction device configured to postoperatively be adjusted to restrict and release an oviduct of the patient.
824. The system according to claim 823, wherein the restriction device is configured to provide a restriction of the oviduct to accumulate at least one egg released from the ovary in the oviduct.
825. The system according to claim 824, wherein the restriction device is configured to provide a release of the oviduct only when pregnancy is wanted or not possible.
826. The system according to claim 825, wherein the restriction device is adapted to be adjusted non-invasively from outside the patient's body to restrict and release the oviduct passageway.
827. The system according to claim 826, wherein the restriction device is adapted to be adjusted by manual manipulation.
828. The system according to any one of claims 823-827, wherein the restriction device is adapted to be adjusted by electrical or magnetic power.
829. The system according to any one of claims 823-828, wherein the restriction device is adapted to be adjusted by hydraulic power.
830. The system according to claim 829, wherein the hydraulic power comprises at least one subcutaneous reservoir controlled by the patient.
831. The system according to any one of claims 823-830, wherein the restriction device is adapted to be adjusted reversibly.
832. The system according to any one of claims 823-831, wherein the restriction device is adapted to provide a restriction to accumulate at least one egg released from the ovary in the oviduct for a predetermined period of time, and releasing the restriction when convenient for the patient to avoid pregnancy.
833. The system according to claim 832, wherein the predetermined period of time is between 2 and 30 days.
834. The system according to any one of claims 823-833, wherein said restriction device comprises more than one restriction area, wherein said restriction device being adapted to change the restriction area over time.
835. The system according to claim 834, wherein the change of the restriction area is adapted to prevent any damage to the oviduct still keeping the oviduct closed avoiding any egg to pass down to the uterus, thus avoiding pregnancy.
836. The system according to claim 834, comprising a hydraulic restriction device with two or more restriction areas.
837. The system according to claim 836, comprising a hydraulic reservoir connected to said restriction device, wherein the hydraulic restriction device with two or more restriction areas is connected to the reservoir with hydraulic fluid adapted to move fluid to or from the restriction device and further comprising at least one valve to direct the fluid individually to or from the restriction areas to restrict or release the restriction areas individually.
838. The system according to claim 836, comprising two or more hydraulic reservoirs connected one each to the different areas of said restriction device, wherein the hydraulic restriction device with two or more restriction areas is connected to the two or more reservoirs with hydraulic fluid, said reservoirs is adapted to move fluid to or from said restriction areas individually to or from each of the connected restriction areas to restrict or release the restriction in the individual restriction area.
839. The system according to any one of claims 836-838, wherein each of the hydraulic restriction areas is adapted to be restricted for a predetermined time period with some overlap in time and adapted to first restrict the restriction area closest to the ovary then changing restriction area to the next one towards the uterus.
840. The system according to any one of claims 836-839, wherein each of the hydraulic restriction areas is adapted to be regulated by manual manipulation of said reservoirs.
841. The system according to claim 834, comprising a stimulation device with two or more restriction areas in combination with a hydraulic or mechanical restriction device.
842. The system according to claim 841, wherein the hydraulic or mechanical restriction device is only partly restricting the oviduct and the stimulation device stimulates to completely restrict the oviduct.
843. The system according to claim 842, wherein the stimulation device stimulates different areas of the oviduct to vary the area of the oviduct that is completely restricted.
844. The system according to any one of claims 834-843, wherein the change of the restriction area is adapted to cause a peristaltic wave like restriction wave in the direction towards the ovary to prevent the egg being transported down to the uterus.
845. The system according to any one of claims 834-844, comprising a movement device adapted to move the egg out of a varied upcoming new restricted area before a new area is restricted.
846. The system according to claim 845, wherein the movement device is the same device as the restriction device, adapted to work differently when restricting or causing movements of the egg, or wherein the movement device is a different device than the restriction device, adapted to cause movement of the egg.
847. The system according to any one of claims 845-846, wherein the movement device cases vibration or wave like movements in the oviduct wall thereby causing movements of the egg.
848. The system according to any one of claims 845-847, wherein the movement device comprises at least one of:
a. mechanical movement device, b. a hydraulic movement device, c. a stimulation device, and d. a combination thereof.
a. mechanical movement device, b. a hydraulic movement device, c. a stimulation device, and d. a combination thereof.
849. The system according to any one of claims 823-848, wherein the restriction device comprises at least one of:
a. a mechanical restriction device.
b. a hydraulic restriction device, c. a stimulation device, and d. a combination thereof.
a. a mechanical restriction device.
b. a hydraulic restriction device, c. a stimulation device, and d. a combination thereof.
850. The system according to any of one claims 823-849, comprising a control device adapted to control the restriction device from outside the body of the patient.
851. The system according to claim 850, wherein the control device comprises an internal control unit adapted to be implanted in the body of the patient, wherein the control of the restriction device is made by said internal control unit.
852. The system according to claim 851, comprising a sensor sensing at least one physical parameter and/or a functional parameter of the restriction device.
853. The system according to claim 852, wherein the internal control unit controls the restriction device to restrict said oviduct based on information from said sensor.
854. The system according to claim 853, wherein an internal control unit controls the restriction device to restrict said oviduct based on information from said sensor.
855. The system according to claim 851, comprising a sensor sensing at least one functional parameter of the restriction device, wherein the control device controls the restriction device based on information from said sensor.
856. The system according to claim 852, wherein said sensor is adapted to sense a hormone level or a temperature.
857. The system according to claim 855, wherein said sensor is adapted to sense an electrical parameter or a pressure related to the restriction device.
858. A male contraception apparatus for obtaining temporary sterility of a male mammalian individual comprising an implantable restriction device configured to restrict the patient's vas deference in the region downstream the ampulla during a controlled period, the restriction device thereby being capable of preventing sperms to reach the urethra, and a control device operable to control the operation of the restriction device.
859. The apparatus according to claim 858, wherein the restriction device comprises a constriction device for constricting at least one portion of a tissue wall of vas deference downstream the ampulla to stop the flow in the vas deference.
860. The apparatus according to claim 858, wherein the restriction device comprises a constriction device for constricting at least one portion of a tissue wall of vas deference downstream the ampulla to stop the flow in the vas deference.
861. The apparatus according to claim 860, wherein the constriction device is adjustable, and further comprising an operation device for operating the adjustable constriction device to change the constriction of a wall portion of vas deference.
862. The apparatus according to claim 861, wherein the operation device mechanically operates the constriction device.
863. The apparatus according to claim 861, wherein the operation device hydraulically operates the constriction device.
864. The apparatus according to claim 861, wherein the operation device operates the restriction device in a non-magnetic and/or non-manual manner.
865. The apparatus according to claim 861, wherein the operation device is a manual operation device adapted to be non-invasively operated.
866. The apparatus according to claim 861, wherein the operation device comprises an electrically powered operation device.
867. The apparatus according to claim 866 wherein the operation device comprises a motor.
868. The apparatus according to claim 867 wherein the operation device comprises a servo system.
869. The apparatus according to claim 862, wherein the constriction device comprises at least two elongated clamping elements extending along the organ in the direction of flow in the patient's vas deference on different sides of the organ, and the operation device operates the clamping elements to clamp the wall portion between the clamping elements to constrict the wall portion.
870. The apparatus according to claim 863, wherein the operation device comprises hydraulic means for hydraulically adjusting the constriction device and a reverse servo operatively connected to the hydraulic means.
871. The apparatus according to claim 863, wherein the restriction device comprises a non-inflatable mechanical constriction device and the operation device comprises hydraulic means that hydraulically adjusts the mechanical constriction device.
872. The apparatus according to claim 858, wherein the restriction device comprises a stimulation device for stimulating a wall portion of the tissue wall of vas deference in the region downstream the ampulla to contract said wall portion to influence the flow in vas deference.
873. The apparatus according to claim 872, wherein a control device controls the stimulation device in a first mode to stimulate the constricted wall portion to stop the flow in the vas deference and controls the stimulation device in a second mode to cease the stimulation of the wall portion to allow flow in the vas deference.
874. The apparatus according to claim 873, wherein the control device controls the stimulation device to adjust the intensity of the stimulation of the wall portion in response to at least one of a sensed functional parameter of the apparatus and a physical parameter of the patient.
875. The apparatus according to claim 874, further comprising a sensor for sensing a functional parameter of the apparatus or a physical parameter of the patient's body and wherein the control device controls the stimulation device in response to signals from the sensor.
876. The apparatus according to claim 858 wherein the control device is operable by the patient.
877. The apparatus according to claim 876, wherein the control device comprises a manually operable switch for switching on and off the stimulation device, the switch being adapted for subcutaneous implantation in the patient to be manually operated from outside the patient's body.
878. The apparatus according to claim 876, wherein the control device comprises a hand-held wireless remote control operable by the patient to switch the restriction of the restriction device on and off.
879. The apparatus according to claim 872, wherein the control device controls the stimulation device to intermittently and individually stimulate different areas of the wall portion, such that at least two of the areas are stimulated at different points of time.
880. The apparatus according to claim 879, wherein the control device controls the stimulation device to intermittently stimulate each area of the different areas of the wall portion during successive time periods, each time period being short enough to maintain over time satisfactory blood circulation in the area until the lapse of the time period.
881. The apparatus according to claim 880, wherein the control device controls the stimulation device to cyclically propagate the stimulation of the areas along the wall portion in the same or opposite direction of the flow in the patient's vas deference.
882. The apparatus according to claim 880, wherein the control device controls the stimulation device to intermittently stimulate the areas with the pulses.
883. The apparatus according to claim 880, wherein the wall portion includes muscle fibers and the stimulation device stimulates the wall portion including the muscle fibers with electric pulses, to cause contraction of the muscle fibres to contract the wall portion.
884. The apparatus according to claim 880, wherein the stimulation device comprises at least one electrical element for engaging the wall portion and for stimulating the wall portion with electric pulses.
885. The apparatus according to claim 880, wherein the stimulation device comprises a structure holding the electrical elements in the fixed orientation.
886. The apparatus according to claim 858, wherein said control device controls said stimulation device to cool the constricted wall portion to cause contraction of the wall portion.
887. The apparatus according to claim 886, wherein said control device controls said stimulation device to cool the constricted wall portion to cause contraction thereof, such that the flow in the vas deference is restricted.
888. The apparatus according to claim 873, wherein the control device comprises an internal control unit implantable in the patient for controlling the stimulation device.
889. The apparatus according to claim 888 wherein the internal control unit is programmable.
890. An apparatus according to claim 858, wherein the restriction device comprises a constriction device according to any one of claims 859-871 and a stimulation device according to any one of claims 872-889, and wherein the control device is adapted to control the constriction device and the stimulation device to in combination restrict vas deference.
891. The apparatus according to claim 870, wherein the reverse servo comprises at least two implantable reservoirs comprising hydraulic fluid, wherein the reverse servo comprises a first subcutaneously implantable regulation reservoir, wherein the reverse servo further comprises a second implantable servo reservoir, and wherein the servo reservoir and the regulation reservoir are in fluid connection.
892. The apparatus according to claim 891, wherein the servo reservoir directly controls the expansion/contraction of the constriction device.
893. The apparatus according to claim 891, wherein the servo reservoir indirectly controls the expansion/contraction of the constriction device, wherein the reverse servo further comprising a third reservoir adapted to be implanted in the abdomen or retroperitoneum or pelvic region and being operatively connected to the servo reservoir for displacing hydraulic fluid of said third reservoir to operate the constriction device.
894. The apparatus according to claim 893, wherein the third reservoir has a larger volume than the first reservoir.
895. The apparatus according to claim 893, wherein the third reservoir is in fluid connection with the constriction device.
896. A female sexual dysfunction treatment apparatus, comprising a stimulation device configured to stimulate a female patient's erectile blood flow passageway to increase the amount of blood in the female erectile tissue and thereby obtaining engorgement with blood of the female erectile tissue by affecting the erectile blood flow passageway.
897. The apparatus according to claim 896, comprising a stimulation device that is able to restrict the blood flow passageway leaving the female erectile tissue.
898. The apparatus according to claim 897, wherein said stimulation device engages at least one venous blood vessel leading from said female erectile tissue or corpus cavernosum or vestibular bulbs or a muscle affecting such blood flow that drains the female erectile tissue and is adapted to temporarily and at least partially restrict the cross-sectional area of such erectile blood flow passageway that drains the female erectile tissue.
899. The apparatus according to claim 896, comprising two or more stimulation devices post-operatively and non-invasively adjustable.
900. The apparatus according to claim 897, further comprising an implantable control unit for adjusting the stimulation device to temporarily contract the female erectile tissue to restrict the blood flow leaving the female erectile tissue.
901. The apparatus according to claim 896, comprising a control device comprising an implanted control unit adapted to control and adjust electrical parameters of said stimulation device, wherein said control unit is programmable from outside the female patient's body.
902. The apparatus according to claim 896, wherein the stimulation device comprising at least one electrical electrode to stimulate the female erectile tissue to achieve engorgement of said female erectile tissue.
903. The apparatus according to claim 896, wherein the stimulation device comprises at least one elongated stimulation member adapted to form the stimulation member into at least a substantially closed loop around a portion of the female erectile tissue, the loop defining a stimulation opening.
904. The apparatus according to claim 902, wherein the stimulation device comprises at least two stimulation device electrodes.
905. The apparatus according to claim 896, wherein the stimulation device adapted to increase the arterial blood flow reaching the female erectile tissue causing engorgement with blood of the female erectile tissue.
906. The apparatus according to claim 905, wherein the flow of blood is increased by enlarging the cross-sectional area of the blood flow passageway, comprising said at least one artery.
907. The apparatus according to claim 905, wherein said stimulation device, comprising a heating member causing engorgement with blood of the female erectile tissue.
908. The apparatus according to claim 905, wherein said stimulation device stimulates a muscle related to said blood flow reaching the female erectile tissue.
909. The apparatus according to claim 908, wherein said stimulation device is adapted to stimulate said muscle, to cause relaxation of said muscle to increase said arterial blood flow.
910. The apparatus according to claim 909, wherein said stimulation device is adapted to stimulate said muscle excessively to relax said muscle.
911. The apparatus according to claim 897, wherein said stimulation device stimulates a muscle related to said blood flow leaving the female erectile tissue.
912. The apparatus according to claim 908, wherein said stimulation device is adapted to stimulate said muscle, to cause contraction of said muscle to restrict said erectile blood flow passageway.
913. The apparatus according to claim 897 or 906, wherein said stimulation device is powered.
914. The apparatus according to claim 896, comprising a control device, wherein the control device controls the stimulation device to shift over time the stimulation from one area of one wall portion of the erectile blood flow passageway to another.
915. The apparatus according to claim 914, wherein said control device controls the stimulation device to cyclically propagate the stimulation to areas along the wall in the same or opposite direction of the flow in the patient's erectile blood flow passageway.
916. The apparatus according to claim 896, wherein the control device controls the stimulation device to propagate the stimulation of the areas in accordance with a determined stimulation pattern.
917. The apparatus according to claim 915, wherein the control device controls the stimulation device to intermittently and individually stimulate different areas of the erectile blood flow passageway with pulses.
918. The apparatus according to claim 917, wherein said pulses form pulse trains.
919. The apparatus according to claim 918, wherein the control device controls the stimulation device to vary the off time periods between the individual pulses of each pulse train or to vary the off time periods between the pulse trains.
920. The apparatus according to claim 918, wherein the control device controls the stimulation device to vary the width of each pulse of the pulse trains or to vary the frequency of the pulses of the pulse trains.
921. The apparatus according to claim 896, wherein said stimulation device comprises at least one electrical electrode for engaging at least one portion of the wall of the erectile blood flow passageway and stimulating at least one portion of the wall thereof with electric pulses.
922. The apparatus according to claim 921, wherein the stimulation device comprises a plurality of electrical elements.
923. The apparatus according to claim 922, wherein the stimulation device comprises a structure holding the electrical elements in the fixed orientation.
924. The apparatus according to claim 922, wherein said control device controls said stimulation device to energize said electrical elements, such that said electrical elements are energized one at a time in sequence or groups of said electrical elements are sequentially energized, either randomly or in accordance with a predetermined pattern.
925. The apparatus according to claim 922, wherein said control device controls said stimulation device to successively energize said electrical elements from a position substantially at the center of the constricted wall portion towards both ends of the elongate pattern of electrical elements, when said stimulation device is applied on the erectile blood flow passageway.
926. The system according to any one of claims 896-925, further comprising at least one switch implantable in the patient for manually and non-invasively controlling the apparatus.
927. A female sexual dysfunction treatment apparatus, comprising a device configured to increase the amount of blood in the female erectile tissue and thereby obtaining engorgement with blood of the female erectile tissue.
928. The apparatus according to claim 927, wherein the adjustment device comprises an expandable cavity in the restriction device adapted to contract the female erectile tissue upon expansion of the cavity and release the female erectile tissue upon decreasing volume of the cavity, and the operation device is adapted to distribute hydraulic fluid from the reservoir to expand the cavity, and to distribute hydraulic fluid from the cavity to the reservoir to decrease the volume of the cavity.
929. The apparatus according to claim 928, wherein the reservoir defines a chamber for said predetermined amount of fluid and the operation device is adapted to change the size of the chamber.
930. The apparatus according to claim 929, wherein the reservoir comprises first and second wall portions of the reservoir and wherein said operation device is adapted to provide relative displacement between the first and second wall portions of the reservoir, in order to change the volume of the chamber
931. The apparatus according to claim 930, wherein the operation device is adapted to provide said relative displacement in response to the pressure in the reservoir.
932. The apparatus according to claim 931, wherein the operation device comprises a pressure controlled hydraulic operation device.
933. The apparatus according to claim 932, further comprising an alarm adapted to generate an alarm signal in response to the lapse of a predetermined time period during which the pressure controlling the hydraulic operation device exceeds a predetermined value.
934. The apparatus according to claim 930, wherein the first and second wall portions of the reservoir are displaceable relative to each other by at least one device selected from the group consisting of a magnetic device, a hydraulic device, an electric control device and a manual manipulation device.
935. The apparatus according to claim 930, comprising a conduit placed between said reservoir and said cavity, wherein said fluid is permitted free flow all the way from the reservoir via the conduit to the cavity or the opposite direction.
936. The apparatus according to claim 928, wherein the operation device comprises a pump adapted to pump fluid between the reservoir and the cavity of the restriction device.
937. The apparatus according to claim 936, wherein the pump comprises a first activation member for activating the pump to pump fluid from the reservoir to the cavity of the restriction device and a second activation member for activating the pump to pump fluid from the cavity to the reservoir.
938. The apparatus according to claim 937, wherein at least one of the activation members is adapted to operate or stop to operate when subjected to a predetermined external pressure.
939. The apparatus according to claim 937, wherein at least one of the first and second activating members are operable by at least one device selected from the group consisting of a magnetic device, a hydraulic device, an electric control device and a manual manipulation device.
940. The apparatus according to claim 927 wherein a restriction device comprises an element to be placed on one side of the female erectile tissue, and an adjustment device is adapted to squeeze said female erectile tissue between the element and other human tissue.
941. The apparatus according to claim 940 wherein the restriction device comprises at least one elongated restriction member adapted to form the restriction member into at least a substantially closed loop around a portion of the female erectile tissue, the loop defining a restriction opening, whereby the adjustment device is adapted to adjust the restriction member in the loop to change the size of the restriction opening.
942. The apparatus according to claim 941, wherein the restriction device comprises at least two elongated restriction members to be formed into at least substantially closed loops around the female erectile tissue.
943. The apparatus according to claim 941 or 942, wherein the adjustment device is adapted to adjust the longitudinal extension of the elongated restriction member in said loop to change the size of the restriction opening.
944. The apparatus according to claim 943, wherein the restriction member comprises a main portion and two elongated end portions, and the adjustment device is adapted to establish longitudinal relative displacement between the end portions of the restriction member, such that the size of the restriction opening is adjusted
945. The apparatus according to claim 943, wherein the elongated restriction member is longitudinally resilient and the adjustment device is adapted to longitudinally contract the resilient restriction member.
946. The apparatus according to claim 945, wherein the elongated restriction member comprises a substantially non-resilient main portion and an end portion forming an elongated helical spring.
947. The apparatus according to claim 940, wherein the restriction device comprises at least two frame elements which are foldable towards each other by the adjustment device.
948. The apparatus according to claim 940, wherein the elongated restriction member is elastic and varies in thickness as seen in a cross-section thereof, and the adjustment device is adapted to turn the restriction member around the longitudinal extension thereof.
949. The apparatus according to claim 940, wherein the restriction device comprises at least two elements to be placed on different sides of the female erectile tissue, and the adjustment device is adapted to squeeze the female erectile tissue between the elements to restrict the blood flow leaving the female erectile tissue, and to release the female erectile tissue from the elements to increase the blood flow leaving the female erectile tissue.
950. The apparatus according to claim 940 wherein the restriction device comprises at least two articulated clamping elements to be positioned on opposite or different sides of the female erectile tissue, and the adjustment device is adapted to turn the clamping elements toward each other to clamp the female erectile tissue between the clamping elements to restrict the blood flow leaving the female erectile tissue.
951. The apparatus according to claim 940 wherein the restriction device is adapted to bend a portion of the female erectile tissue.
952. The apparatus according to claim 940, wherein the restriction device is adapted to rotate a portion of the female erectile tissue.
953. The apparatus according to claim 927 comprising an implantable device that comprises a heating member for temporarily raising the temperature of the smooth muscle surrounding the artery thereby increasing the blood flow in said artery.
954. The apparatus according to claim 927, wherein a stimulation device comprises a heating member causing engorgement with blood of the female erectile tissue.
955. The apparatus according to claim 927, further comprising at least one switch implantable in the patient for manually and non-invasively controlling the apparatus.
956. The apparatus according to claim 927, further comprising a hydraulic device having an implantable hydraulic reservoir, which is hydraulically connected to the apparatus, wherein the apparatus is adapted to be non-invasively regulated by manually pressing the hydraulic reservoir.
957. The apparatus according to claim 927, further comprising a wireless remote control for non-invasively controlling the apparatus.
958. The apparatus according to claim 927, further comprising a wireless energy-transmission device for non-invasively energizing implantable energy consuming components of the apparatus with wireless energy.
959. The apparatus according to claim 958, wherein the wireless energy comprises one of the following: an electric field, a magnetic field, a combined electric and magnetic field.
960. The apparatus according to claim 927, further comprising an implantable internal energy source for powering implantable energy consuming components of the apparatus.
961. The apparatus according to claim 960, further comprising an external energy source for transferring energy in a wireless mode, wherein the internal energy source is chargeable by the energy transferred in the wireless mode.
962. The apparatus according to claim 961, further comprising a sensor or measuring device sensing or measuring a functional parameter correlated to the transfer of energy for charging the internal energy source, and a feedback device for sending feedback information from inside the patient's body to the outside thereof, the feedback information being related to the functional parameter sensed by the sensor or measured by the measuring device.
963. The apparatus according to claim 927, further comprising an external data communicator and an implantable internal data communicator communicating with the external data communicator, wherein the internal communicator feeds data related to the apparatus or the patient to the external data communicator and/or the external data communicator feeds data to the internal data communicator.
964. The apparatus according to claim 927, further comprising a motor or a pump for operating the apparatus.
965. The apparatus according to claim 958, further comprising a control device for controlling the transmission of wireless energy from the energy-transmission device, and an implantable internal energy receiver for receiving the transmitted wireless energy, the internal energy receiver being connected to implantable energy consuming components of the apparatus for directly or indirectly supplying received energy thereto, the apparatus further comprising a determination device adapted to determine an energy balance between the energy received by the internal energy receiver and the energy used for the implantable energy consuming components of the apparatus , wherein the control device controls the transmission of wireless energy from the external energy-transm[ssion device, based on the energy balance determined by the determination device.
966. A system for treating a patient having a disorder related to the patient's intestine, comprising an artificial reservoir adapted for receiving and temporarily collecting therein intestinal contents and further adapted to remain within the patient's body when emptying the reservoir, wherein the system further comprises an at least partly artificial flow control device implantable in the patient's body and adapted to control flow of the intestinal contents from the reservoir, wherein the system comprises at least one conduit connected to the reservoir and adapted to be introduced into a surgically divided intestinal opening in the intestine to hold an intestinal wall portion on the outside of the conduit, the system further comprising a flexible sleeve adapted to be placed onto the intestine when the reservoir is implanted, so as to extend over the intestinal wall portion and the conduit such that at least part of the intestinal wall portion is located intermediate the sleeve and the outer surface of the conduit, wherein the sleeve is adapted to increase the strength of the connection between the system and the patient's intestine against forces, resulting from the peristaltic movement of the intestine, which tend to pull on the intestine, when said artificial intestine section is long term implanted.
967. The system of claim 966, wherein the sleeve comprises a non-absorbable structure on the inside of the sleeve towards the intestinal portion for in-growth of fibrotic tissue.
968. The system of claim 966, wherein the flexible sleeve is adapted to be mounted on the outer surface of the conduit rolled upon itself and adapted to be unrolled such that a part of the intestine is located intermediate the sleeve and the conduit,
969. The system of claim 966, wherein said conduit has a bulge formed on the outside thereof adapted to hold a section of the intestine by inserting an end of the conduit into the artificial intestinal opening so that the intestine extends over the bulge from one side of the bulge, and - further comprising a blocking ring adapted to be placed over the intestine towards the bulge from the respective other side of the bulge such that the intestine is located intermediate the conduit's outer surface and the blocking ring to increase the strength of the connection against forces which result from the peristaltic movement of the intestine which tend to pull on the intestine.
970. The system of claim 969, wherein the flexible sleeve is elastic and made of a material providing a friction relative to the blocking ring large enough to allow the blocking ring to move towards the bulge along with the flexible sleeve when forces from the peristaltic movement of the intestine are pulling on the intestine.
971. The system of claim 966, comprising a first passage in flow communication with the reservoir and adapted to being connected to a surgically created first opening of the patient's intestine, said first passage being arranged for transferring intestinal contents to the reservoir, and further comprising a second passage in flow communication with the reservoir, said second passage being arranged for transferring intestinal contents from the reservoir.
972. The system of claim 971, wherein the second passage is adapted to being surgically connected to a surgically created stoma.
973. The system of claim 971, wherein the second passage is adapted to being surgically connected to the patient's anus or to tissue adjacent the patient's anus.
974. The system of claim 971, wherein the second open end portion is adapted to being connected to a portion of a patient's small intestine.
975. The system of claim 971, wherein the second open end portion is adapted to being connected to a portion of a patient's large intestine.
976. The system of claim 971, wherein the second passage is adapted to being surgically connected to a second surgically created opening of the patient's intestine.
977. The system of claim 976, wherein the second passage is adapted to being connected to a lateral opening in a wall of the patient's intestine.
978. The system of claim 971, wherein the first passage is adapted to being connected to a lateral opening in a wall of the patient's intestine.
979. The system of claim 971, wherein at least the first passage is adapted to being bonded, sewn or stapled to the patient's intestine.
980. The system of claim 966, wherein the artificial reservoir comprising a holding device adapted to be mounted to the peritoneum, when implanted, to prevent large movements and movement forces acting on the connection between the intestine section and the patient's intestine against forces resulting from peristaltic movements and movement of the human body.
981. The system of claim 966, wherein the sleeve adapted to increase the strength of the connection between the intestine section and the patient's intestine against axial forces resulting from peristaltic movements of the intestine which tend to pull on the intestine, comprising resorbable non-polymeric material.
982. The system of claim 966, wherein the flow control device comprises at least one valve.
983. The system of claim 982, wherein the at least one valve includes an exit valve preventing intestinal contents flow from the reservoir in its closed position.
984. The system of claim 983, wherein the exit valve is a normally closed valve.
985. The system of claim 982, wherein the flow control device comprises an entry valve allowing intestinal contents to flow towards the reservoir in its open position.
986. The system of claim 985, wherein the entry valve is a normally open valve.
987. The system of claim 985, wherein the exit valve and the entry valve are adapted to cooperate such that when one of the two valves is closed, the respective other valve is open, and vice versa.
988. The system of claim 982, wherein at least one of the valve or valves, respectively, is adapted to being permanently implanted inside the patient's intestine.
989. The system of claim 982, wherein at least one of the valve or valves, respectively, has an upstream open end and has a downstream open end in fluid connection with the upstream open end, wherein the upstream open end is adapted to being connected to a surgically created opening of the patient's intestine and the downstream open end is adapted to being connected to either one of a surgically created opening of the patient's intestine and a surgically created stoma.
990. The system of claim 982, wherein at least one of the valve or valves, respectively, has an upstream open end and has a downstream open end in fluid connection with the upstream open end, wherein the upstream open end is adapted to being connected to a surgically created opening of the patient's intestine and the downstream open end is adapted to being surgically connected to either one of the patient's anus or tissue adjacent the patient's anus.
991. The system of claim 982, wherein at least one of the valve or valves, respectively, is adapted to being implanted inside the patient's body outside a section of the patient's intestine and comprises at least one element adapted to act on the intestine section from the outside thereof so as to prevent intestinal contents flow through the intestine section.
992. The system of claim 966, comprising a passage in flow communication with the reservoir and adapted to being connected to a surgically created lateral opening in a wall of the patient's intestine, said passage being arranged for transferring intestinal contents to and from the reservoir.
993. The system of claim 982, wherein the at least one valve comprises a compartment with a variable volume adapted to open and close the valve by changing the compartment's volume.
994. The system of claim 982, wherein the at least one valve comprises at least one passage for filling and emptying the compartment with hydraulic fluid.
995. The system of claim 991, wherein the at least one valve comprises at least one electrical stimulation device adapted to electrically stimulate muscle or neural tissue of an intestine section so as to cause at least partial contraction of the intestine section.
996. The system of claim 995, wherein the stimulation device is adapted to stimulate different portions of the intestine section over time.
997. The system of claim 996, wherein the stimulation device is adapted to stimulate, over time, the different portions of the intestine section in a wave like manner in a direction opposite to natural intestinal contents flow or in any predetermined stimulation pattern.
998. The system of claim 995, wherein the at least one valve comprises a constriction device for at least partly constricting the intestine section mechanically or hydraulically.
999. The system of claim 998, wherein the stimulation device and the constriction device are adapted to act on the same intestine section so as to keep the intestine section closed.
1000. The system of claim 980, wherein said holding device is adapted to hold a suture or stapler mounted through the peritoneal wall.
1001. The system of claim 980, wherein said holding device comprising a part intended for placement outside the peritoneum, when implanted, adapted to pass through the peritoneal wall and hold said intestinal section.
1002. The system of claim 966, wherein the flow control device comprises a pump for emptying the reservoir.
1003. The system of claim 1002, wherein the pump is adapted for emptying the reservoir by squeezing the reservoir.
1004. The system of claim 1002, wherein the pump and the reservoir are separate from each other and wherein the pump is adapted to being implanted in the patient's body separate from but in close proximity to the reservoir so as to act on the reservoir from the outside thereof.
1005. The system of claim 1002, wherein the pump and the reservoir are fixedly connected to one another.
1006. The system of claim 1005, wherein the reservoir is formed by a bellow, said bellow having an end wall closing the bellow at one end thereof, said end wall making part of the pump such that a volume of the bellow can be reduced upon advancement of said end wall.
1007. The system of claim 1002, wherein the pump and the reservoir are separate from each other and wherein the pump is adapted to being implanted in the patient's body outside the patient's intestine, wherein the pump comprises at least one electrical stimulation device adapted to electrically stimulate muscle or neural tissue of an intestine section so as to cause at least partial contraction of the intestine section, wherein the stimulation device comprises at least one electrode adapted to apply electric pulses to the intestine section.
1008. The system of claim 1007, wherein the stimulation device is adapted to stimulate different portions of the intestine section over time and to pump intestinal contents along the intestine section by, over time, stimulating the different portions of the intestine section in a wave like manner in a direction of natural intestinal contents flow.
1009. The system of claim 1002, wherein the pump comprises a constriction device for at least partly constricting the intestine section.
1010. The system of claim 1009, wherein the constriction device is adapted to pump intestinal contents along the intestine section by, over time, constricting different portions of an intestine section in a wave like manner in a direction of natural intestinal contents flow.
1011. The system of claim 1008, wherein the stimulation device is combined with a constriction device for at least partly constricting the intestine section mechanically so as to pump intestinal contents along the intestine section by, over time, stimulating the different portions of the intestine section in a wave like manner in a direction of natural intestinal contents flow, when constriction of the intestine section caused by the constriction device is released at the respective portions.
1012. The system of claim 1002, wherein the pump is manually drivable and comprises an actuator for manually driving the pump, the actuator being arranged for subcutaneous implantation so as to be operable from outside the patient's body.
1013. The system of claim 966, comprising at least one motor arranged for automatically driving one or more elements of the system including the flow control device.
1014. The system of claim 966, adapted to receive wireless energy, comprising an implanted chargeable accumulator, further comprising a feedback subsystem adapted to wirelessly send feedback information related to the energy to be stored in the implanted accumulator from inside the human body to the outside thereof, wherein the system is adapted to use the feedback information for adjusting the amount of wireless energy transmitted by the energy transmitter.
1015. The system of claim 1014, wherein the feedback information is related to an energy balance which is defined as the balance between wireless energy received inside the human body and energy consumed by the at least one energy consuming part.
1016. The system of claim 1015, wherein the feedback information is related to an energy balance which is defined as the balance between a rate of wireless energy received inside the human body and a rate of energy consumed by the at least one energy consuming part.
1017. The system of claim 966, comprising a manually operable switch for activating any part of the system, the switch being arranged for subcutaneous implantation so as to be operable from outside the patient's body.
1018. The system of claim 966, comprising a physical or functional parameter sensor adapted to directly or indirectly sense a physical parameter of the patient or a functional parameter of the system.
1019. The system of claim 1018, wherein the physical or functional parameter sensor is adapted to sense at least one of the following physical parameters of the patient: a pressure within the reservoir, a pressure within the patient's intestine, an expansion of the reservoir, a distension of an intestinal wall of the patient's intestine, a movement of the intestinal wall.
1020. The system of claim 1018, further comprising an intestinal contents collecting device to be temporarily applied from outside the patient's body.
1021. The system of claim 1020, wherein the collecting device comprises a front open end adapted to be applied towards said exit valve so as to provide a flow passage from the exit valve towards the collecting device.
1022. The system of claim 1021, wherein the collecting device front open end is adapted to be applied to said exit valve so as to open the valve and thereby provide the flow passage towards the collecting device.
1023. The system according to claim 966, wherein the first and second passage is adapted to connect to an divided intestinal portion such that intestinal mesentery connected thereto is opened in such a way that supply of blood through the mesentery to the dissected intestinal area is maintained on both sides of the divided intestinal portion, wherein an upstream part of the intestine with a first intestinal opening and a downstream part of the intestine with a second intestinal opening with the mesentery still maintaining a tissue connection between the upstream and downstream intestine parts and the connection of the first and second passage are adapted to take such mesentery in account to allow free blood supply, when implanted.
1024. The system according to claim 1023, wherein the downstream intestinal part is adapted to be advanced through the abdominal wall and skin and, thereby achieving an intestinal stomy.
1025. The system according to claim 1023, wherein the downstream intestinal part is adapted to be connected to the patient's anus or tissue adjacent the patient's anus, -advancing the downstream end of the upstream natural intestine section through the patient's anus, and -suturing the cross-sectional opening of the upstream natural intestine section to the patient's anus or tissue adjacent the patient's anus.
1026. The system according to claim 1023, wherein the intestinal openings is created in the patient's small intestine.
1027. A system comprising an artificial intestine section adapted to being implanted inside a patient's body along with an accumulator for accumulating energy, wherein said intestine section has a first open end portion and a second open end portion in flow communication with one another, at least the first open end portion being adapted to being connected to a surgically created opening in the patient's intestine, wherein the system comprises at least one conduit connected to the artificial intestine section and adapted to be introduced into a surgically divided intestinal opening in the intestine to hold an intestinal wall portion on the outside of the conduit, the system further comprising a flexible sleeve adapted to be placed onto the intestine, when the intestine section is implanted, so as to extend over the intestinal wall portion and the conduit such that at least part of the intestinal wall portion is located intermediate the sleeve and the outer surface of the conduit, wherein the sleeve is adapted to increase the strength of the connection between the intestine section and the patient's intestine against axial forces resulting from peristaltic movements of the intestine and which tend to pull on the intestine, when said artificial intestine section is long term implanted, and wherein said accumulator is adapted to be charged wirelessly with energy and arranged to supply energy directly or indirectly to at least one energy consuming part of said artificial intestine section.
1028. The system of claim 1027, wherein at least the first open end portion is adapted to being connected to a lateral opening surgically created in a wall of the patient's intestine.
1029. The system of claim 1028, wherein at least the first open end portion comprises a shoulder portion formed around the end portion for lateral connection to the patient's intestinal wall.
1030. The system of claim 1029, wherein at least a part of the shoulder portion extends laterally from the artificial intestine section by 3 mm to 20 mm.
1031. The system of claim 1029, wherein the shoulder portion has a curved cross section, so as to generally conform to an intestinal wall when laterally attached thereto.
1032. The system of claim 1029, wherein the shoulder portion is split into an upper and a lower shoulder portion with a gap between the upper and lower shoulder portions adapted to accommodate intestinal wall tissue therein, wherein the lower shoulder portion is adapted to being placed inside the patient's intestine through a surgically created lateral opening in the intestinal wall and wherein the upper shoulder portion is adapted to being placed outside the intestinal wall.
1033. The system of claim 1027, wherein the sleeve adapted to increase the strength of the connection between the intestine section and the patient's intestine against axial forces resulting from peristaltic movements of the intestine which tend to pull on the intestine, thus comprising non-resorbable material.
1034. The system of claim 1033, wherein the upper shoulder portion and the lower shoulder portion each have a surface area facing the intestinal wall, with the surface area of the upper shoulder portion being larger than the surface area of the lower shoulder portion.
1035. The system of any one of claims 1029-1034, wherein the shoulder portion is adapted to being connected to the patient's intestinal wall by gluing.
1036. The system of claim 1029, wherein the shoulder portion is adapted to being connected to the patient's intestinal wall by sewing or stapling.
1037. The system of claim 1029, wherein the shoulder portion is adapted to being connected to the patient's intestinal wall by stapling.
1038. The system of claim 1027, wherein the artificial intestine section comprising a holding device adapted to be mounted to the peritoneum, when implanted, to prevent large movements and movement forces acting on the connection between the intestine section and the patient's intestine against forces resulting from peristaltic movements and movement of the human body.
1039. The system of claim 1029, wherein a surface to be facing the patient's intestinal wall has an in-growth layer allowing in-growth of living tissue.
1040. The system of claim 1029, wherein the shoulder portion or holding device comprises at least one biocompatible material selected from the following group of materials: titanium, stainless steel, ceramics, biocompatible polymer, other biocompatible polymer material.
1041. The system of claim 1040, wherein the biocompatible polymer material comprises at least one polymer of the following group of polymers:
polytetrafluoroethylene, silicone, polyurethane, expanded polytetrafluoroethylene (ePTFE).
polytetrafluoroethylene, silicone, polyurethane, expanded polytetrafluoroethylene (ePTFE).
1042. The system of claim 1027, wherein at least the first open end portion is adapted to being connected to a cross-sectional opening surgically created in the patient's intestine.
1043. The system of claim 1042, wherein at least the first open end portion comprises - a conduit having an outer surface with at least one bulge extending outwardly from the conduit's outer surface in a circumferential direction of the conduit about at least a part of the conduit's circumference, and - a blocking ring loosely fitting over the outer surface of the conduit with a clearance between the outer surface and the blocking ring for mounting intestinal tissue within the clearance, said blocking ring having an inner cross sectional diameter which is smaller than or substantially identical to an outer cross sectional diameter of the at least one bulge so as to prevent the blocking ring from slipping over the bulge when intestinal tissue is mounted within the clearance.
1044. The system of claim 1043, wherein at least the first open end portion comprises said flexible sleeve adapted to axially extend and closely fit around at least part of said outer surface of the conduit.
1045. The system of claim 1042, wherein the second open end portion comprises - a conduit having an outer surface and - a flexible sleeve adapted to axially extend and closely fit around at least part of said outer surface of the conduit.
1046. The system of claim 1044 or 1045, wherein said flexible sleeve is mounted on said outer surface either folded or rolled upon itself or so as to be foldable upon itself.
1047. The system of claim 1044, wherein at least one of the sleeve and the first open end portion comprises a multilayer material.
1048. The system of claim 1044, wherein at least one of the sleeve and the first open end portion comprises an ingrowth layer allowing ingrowth of living tissue.
1049. The system of claim 1048, wherein the ingrowth layer has a net-like structure.
1050. The system of claim 1049, wherein the ingrowth layer is made from Dacron®.
1051. The system of claim 1042, wherein at least one of the first and second open end portions are adapted to being connected to a surgically created cross-sectional opening in the patient's intestine, so as to form an intermediate intestine section.
1052. The system of claim 1028, wherein at least one of the first and second open end portions are adapted to being connected to a surgically created lateral opening in a wall of the patient's intestine, so as to form a by-pass intestine section.
1053. The system of any one of claims 1051-1052, wherein the second open end portion is adapted to being connected to a portion of a patient's small intestine.
1054. The system of any one of claims 1051-1052, wherein the second open end portion is adapted to being connected to a portion of a patient's large intestine.
1055. The system of claim 1053, wherein the second open end portion is adapted to being connected to an artificial stoma, so as to form an intestine end section.
1056. The system of claim 1053, wherein the second open end portion is adapted to being connected to the patient's rectum or anus or to tissue adjacent the patient's anus, so as to form an intestine end section.
1057. The system of claim 1027, wherein at least one of the sleeves and the first open end portion is made from a biocompatible material.
1058. The system of claim 1057, wherein the biocompatible material of the open-end portion comprises at least one material of the following group of materials:
titanium, stainless steel, ceramics, biocompatible polymer material, other polymer material.
titanium, stainless steel, ceramics, biocompatible polymer material, other polymer material.
1059. The system of claim 1058, wherein the biocompatible polymer material comprises at least one polymer of the following group of polymers:
polytetrafluoroethylene, silicone, polyurethane, expanded polytetrafluoroethylene (ePTFE).
polytetrafluoroethylene, silicone, polyurethane, expanded polytetrafluoroethylene (ePTFE).
1060. The system of claim 1027, wherein said at least one energy consuming part of the artificial intestine section comprises at least one element adapted to directly or indirectly interact with intestinal contents contained in the artificial intestine section between the first and second open end portions thereof.
1061. The system of claim 1060, wherein the energy consuming part comprises a flow control device adapted to control flow of intestinal contents from the artificial intestine section through the second open end portion.
1062. The system of claim 1061, wherein the flow control device is adapted to prevent flow of intestinal contents from the artificial intestine section through the second open end portion.
1063. The system of claim 1061, wherein the flow control device comprises at least one valve, including an exit valve preventing intestinal contents flow through the second open end portion in its closed position, wherein the exit valve is a normally closed valve.
1064. The system of claim 1054, wherein the second open end portion is adapted to being connected to an artificial stoma, so as to form an intestine end section.
1065. The system of claim 1061, wherein the flow control device comprises an entry valve allowing intestinal contents to flow through the first open end portion into the artificial intestine section in its open position, wherein the entry valve is a normally open valve.
1066. The system of claim 1054, wherein the second open end portion is adapted to being connected to the patient's rectum or anus or to tissue adjacent the patient's anus, so as to form an intestine end section.
1067. The system of any one of claims 1063 and 1065, wherein the exit valve and the entry valve are adapted to cooperate such that when one of the two valves is closed, the other valve is open, and vice versa.
1068. The system of claim 1061, wherein the flow control device comprises at least one valve, and wherein the at least one valve comprises a compartment with a variable volume adapted to open and close the valve by changing the compartment's volume.
1069. The system of claim 1068, wherein the at least one valve comprises at least one passage for filling and emptying the compartment with hydraulic fluid.
1070. The system of claim 1068, wherein the compartment has at least one flexible wall defining an opening, the opening being adapted to close upon increase of the compartment's volume.
1071. The system of claim 1063, wherein the at least one valve is a flap valve.
1072. The system of claim 1027, wherein the sleeve adapted to increase the strength of the connection between the intestine section and the patient's intestine against axial forces resulting from peristaltic movements of the intestine which tend to pull on the intestine, comprising resorbable non-polymeric material
1073. The system of claim 1027, further comprising at least one extra valve adapted to control flow of intestinal contents in a natural section of a patient's intestine upstream and/or downstream the artificial intestine section, wherein the extra valve is adapted to being implanted inside the patient's body outside a section of the patient's natural intestine and comprises at least one element adapted to act on the natural intestine section from the outside thereof so as to prevent intestinal contents flow through the natural intestine section.
1074. The system of claim 1073, wherein the extra valve comprises at least one electrical stimulation device adapted to electrically stimulate muscle or neural tissue of the natural intestine section so as to cause at least partial contraction of the natural intestine section.
1075. The system of claim 1073, wherein the stimulation device is adapted to pump intestinal contents along the natural intestine section by, over time, stimulating the different portions of the natural intestine section in a wave like manner in a direction of natural intestinal contents flow.
1076. The system of any one of claims 1060 and 1075, wherein said at least one energy consuming part of the artificial intestine section comprises a pump for advancing intestinal contents through the second open end portion to outside the artificial intestine section.
1077. The system of claim 1027, wherein the artificial intestine section comprises a reservoir between the first and second open end portions for receiving and temporarily collecting therein intestinal contents supplied through the first open end portion, and wherein the pump is adapted for emptying the reservoir through the second open end portion.
1078. The system of claim 1077, wherein the reservoir is formed by a bellow, said bellow having an end wall closing the bellow at one end thereof, said end wall making part of the pump such that a volume of the bellow is reduced upon advancement of said end wall.
1079. The system of claim 1078, wherein the bellow is made of a resilient material so as to urge the bellow into a normally expanded position.
1080. The system of claim 1077, wherein the pump comprises a movable piston, with a front end of the piston affecting the reservoir such that a volume of the reservoir is reduced upon advancement of the piston.
1081. The system of claim 1080, wherein the piston is spring loaded so as to urge the piston into a normally retracted position.
1082. The system of claim 1077, wherein the pump is adapted for being permanently arranged inside the reservoir.
1083. The system of claim 1077, wherein the reservoir has a flexible wall and the pump is adapted for emptying the reservoir by squeezing the reservoir.
1084. The system of claim 1083, wherein the pump includes a constriction device adapted to alternately constrict and release sections of the reservoir so as to pump intestinal contents along the reservoir by, over time, constricting different sections of the reservoir in a wave like manner.
1085. The system of claim 1084, wherein the reservoir has a tube-like form and the pump is a roller pump acting on the tube-like reservoir from the outside thereof.
1086. The system of claim 1027, wherein said at least one energy consuming part of the artificial intestine section comprises at least one motor arranged for automatically driving at least one further energy consuming part of the artificial intestine section.
1087. The system of claim 1086, wherein the system comprises a valve for intestinal flow control, wherein the at least one motor is arranged for driving at least one of the valve or valves, respectively, between closed and open positions.
1088. The system of claim 1086, wherein the at least one motor is arranged for driving a pump.
1089. The system of claim 1086, comprising a manually operable switch for activating the at least one motor, the switch being arranged for subcutaneous implantation so as to be operable from outside the patient's body.
1090. The system of claim 1086, wherein the motor is arranged to be driven by electric or electromagnetic energy.
1091. The system of claim 1027, comprising galvanic coupling elements between the accumulator and the energy consuming part for transmitting energy to the energy consuming part in contacting fashion.
1092. The system of claim 1027, comprising an implantable wireless energy transmitter and an implantable wireless energy receiving device for wirelessly transmitting energy from the accumulator to the energy consuming part.
1093. The system of claim 1092, wherein the energy consuming part is adapted to directly transform the wirelessly transmitted energy from the accumulator into kinetic energy.
1094. The system of claim 1092, wherein the energy consuming part comprises a transforming device for transforming the wirelessly transmitted energy from the accumulator into electric energy.
1095. The system of claim 1027, comprising an implantable energy transforming device for transforming wirelessly transmitted energy from outside the patient's body into energy to be stored in the accumulator and further comprising a wireless energy transmitter adapted to wirelessly transmit energy from outside the patient's body to said implantable energy transforming device.
1096. The system of claim 1095, wherein the implantable energy transforming device transforms wireless energy into electric energy and the energy consuming part is adapted to be driven with the electric energy, as said energy transforming device transforms the wireless energy into the electric energy.
1097. The system of claim 1095, wherein the energy transmitter is adapted to generate an electromagnetic field, electric field or magnetic field.
1098. The system of claim 1027, wherein said holding device is adapted to hold a suture or stapler mounted through the peritoneal wall.
1099. The system of claim 1027, wherein said holding device comprising a part intended for placement outside the peritoneum, when implanted, adapted to pass through the peritoneal wall and hold said intestinal section.
1100. The system of claim 1095, wherein the energy transmitter is adapted to transmit energy by at least one wireless energy signal.
1101. The system of claim 1100, wherein the wireless energy signal comprises an electromagnetic wave signal, including at least one of an infrared light signal, a visible light signal, an ultra violet light signal, a laser signal, a microwave signal, an X-ray radiation signal, and a gamma radiation signal.
1102. The system of claim 1001, wherein the wireless energy signal comprises a sound or ultrasound wave signal.
1103. The system of claim 1100, wherein the wireless energy signal comprises a digital or analog signal or a combination thereof.
1104. The system of claim 1095, comprising a feedback subsystem adapted to wirelessly send feedback information related to the energy to be stored in the accumulator from inside the human body to the outside thereof, wherein the system is adapted to use the feedback information for adjusting the amount of wireless energy transmitted by the energy transmitter.
1105. The system of claim 1104, wherein the feedback information is related to an energy balance which is defined as the balance between an amount of wireless energy received inside the human body and an amount of energy consumed by the at least one energy consuming part.
1106. The system of claim 1105, wherein the feedback information is related to an energy balance which is defined as the balance between a rate of wireless energy received inside the human body and a rate of energy consumed by the at least one energy consuming part.
1107. The system of claim 1027, wherein the accumulator comprises a rechargeable battery.
1108. The system of claim 1027, wherein the accumulator comprises a capacitor.
1109. The system of claim 1027, wherein the accumulator is adapted for being implanted inside the patient's body fixedly connected to the artificial intestine section.
1110. The system of claim 1027, wherein the accumulator is adapted for being implanted inside the patient's body distant to the artificial intestine section.
1111. The system of claim 1027, comprising a primary energy source for charging the accumulator with energy from outside the patient's body.
1112. The system of claim 1111, wherein the primary energy source is adapted to being mounted on the patient's body.
1113. The system of claim 1027, further comprising a control unit adapted to directly or indirectly control one or more elements of the system.
1114. The system of claim 1113, comprising an exit valve, wherein the control unit is adapted to control opening of the exit valve.
1115. The system of claim 1113, comprising an entry valve, wherein the control unit is adapted to control closing of the entry valve.
1116. The system of claim 1115, wherein the control unit is adapted to control opening of the exit valve and closing of the entry valve such that when one of the two valves is closed, the other valve is open, and vice versa.
1117. The system of any one of claims 1113 and 1116, wherein the control unit is adapted to control actuation of the pump.
1118. The system of any one of claims 1113 and 1117, wherein the control unit is operable by the patient.
1119. The system of claim 1113, wherein at least part of the control unit is implantable in the patient's body.
1120. The system of claim 1119, comprising a manually operable switch for activating the control unit, the switch being arranged for subcutaneous implantation so as to be operable from outside the patient's body.
1121. The system of claim 1113, wherein the control unit comprises a first part adapted for implantation in the patient's body and a second part adapted to cooperate with the first part from outside the patient's body.
1122. The system of claim 1121, comprising an implantable energy transforming device for transforming wirelessly transmitted energy from outside the patient's body, and a wireless energy transmitter, wherein the control unit is adapted to transmit data from the second part of the control unit to the implantable first part of the control unit in the same manner as energy is transmitted by said wireless energy transmitter from outside the patient's body to said implantable energy transforming device.
1123. The system of claim 1121, wherein the second part of the control unit is adapted to wirelessly transmit a control signal to the implantable first part of the control unit for controlling the at least one energy consuming part from outside the patient's body.
1124. The system of claim 1121, wherein the implantable first part of the control unit is programmable via the second part of the control unit.
1125. The system of claim 1121, wherein the implantable first part of the control unit is adapted to transmit a feedback signal to the second part of the control unit.
1126. The system of claim 1027, further comprising a physical parameter sensor adapted to directly or indirectly sense a physical parameter of the patient.
1127. The system of claim 1126, wherein the physical parameter sensor is adapted to sense at least one of the following physical parameters of the patient: a pressure within the artificial intestine section, a pressure within the patient's natural intestine, an expansion of the artificial intestine section, a distension of an intestinal wall of the patient's natural intestine, a movement of the patient's intestinal wall.
1128. The system of claim 1027, further comprising a functional parameter sensor adapted to directly or indirectly sense a functional parameter of the system.
1129. The system of claim 1128, wherein the functional parameter sensor is adapted to sense at least one of the following functional parameters of the system: a pressure against a part of the system such as the artificial intestine section, a distension of a part of the system such as a wall of the artificial intestine section, an electrical parameter such as voltage, current or energy balance, a position or movement of a movable part of the system.
1130. The system of claim 1129, comprising an indicator coupled to the sensor, the indicator being adapted to provide a signal when the sensor senses a value for the parameter beyond a predetermined threshold value.
1131. The system of claim 1130, wherein the signal comprises at least one of the following types of signals: a sound signal, a visual signal.
1132. An artificial intestine section adapted to be implanted inside a patient's body, said intestine section having a first open end portion and a second open end portion in flow communication with one another, wherein at least the first open end portion is adapted to being connected to a surgically created lateral opening in a wall of the patient's intestine, wherein the artificial intestine section comprising at least one element adapted to directly or indirectly interact with intestinal contents contained in the artificial intestine section between the first and second open end portions thereof, wherein the at least one element comprises at least an artificial reservoir between the first and second open end portions for receiving and temporarily collecting therein intestinal contents supplied through the first open end portion, wherein said second open end portion is adapted to receive intestinal contents for emptying said reservoir.
1133. The artificial intestine section of claim 1132, wherein the second open end portion is adapted to being connected to a surgically created stoma.
1134. The artificial intestine section of claim 1132, wherein the second open end portion is adapted to being connected to the patient's rectum or anus or to tissue adjacent the patient's anus.
1135. The artificial intestine section of claim 1132, wherein the second open end portion is adapted to being connected to a patient's small intestine.
1136. The artificial intestine section of claim 1132, wherein the second open end portion is adapted to being connected to a patient's large intestine.
1137. The artificial intestine section of claim 1132, wherein both the first and second open end portions are adapted to being connected to a surgically created lateral opening in a wall of the patient's intestine or wherein the first and second open end portions are connected differently, one to a surgically created lateral opening of the intestine and one to a surgically created divided cross-sectional opening.
1138. The artificial intestine section of claim 1132, wherein at least the first open end portion comprises a shoulder portion formed around the end portion for lateral connection to the patient's intestinal wall.
1139. The artificial intestine section of claim 1138, wherein at least a part of the shoulder portion extends laterally from the artificial intestine section by 3 mm to 20 mm.
1140. The artificial intestine section of claim 1138, wherein the shoulder portion has a curved cross section, so as to generally conform to an intestinal wall when laterally attached thereto.
1141. The artificial intestine section of claim 1138, wherein the shoulder portion is split into an upper and a lower shoulder portion with a gap between the upper and lower shoulder portions adapted to accommodate intestinal wall tissue therein.
1142. The artificial intestine section of claim 1141, wherein the lower shoulder portion is adapted to being placed inside the patient's intestine through a surgically created lateral opening in the intestinal wall and wherein the upper shoulder portion is adapted to being placed outside the intestinal wall.
1143. The artificial intestine section of claim 1142, wherein the upper shoulder portion and the lower shoulder portion each have a surface area facing the intestinal wall, with the surface area of the upper shoulder portion being larger than the surface area of the lower shoulder portion.
1144. The artificial intestine section of claim 1132, wherein at least the first open end portion is adapted to being connected to the patient's intestinal wall by gluing.
1145. The artificial intestine section of claim 1132, wherein at least the first open end portion is adapted to being connected to the patient's intestinal wall by sewing or stapling.
1146. The artificial intestine section of claim 1132, wherein the artificial intestine section comprising a holding device adapted to be mounted to the peritoneum, when implanted, to prevent large movements and movement forces acting on the connection between the intestine section and the patient's intestine against forces resulting from peristaltic movements and movement of the human body.
1147. The artificial intestine section of claim 1132, wherein at least the first open end portion is made from a biocompatible material.
1148. The artificial intestine section of claim 1147, wherein the biocompatible material of the open-end portion comprises at least one material of the following group of materials: titanium, stainless steel, ceramics, biocompatible polymer material.
1149. The artificial intestine section of claim 1148, wherein the biocompatible polymer material comprises at least one polymer of the following group of polymers:
polytetrafluoroethylene, silicone, polyurethane, expanded polytetrafluoroethylene (ePTFE).
polytetrafluoroethylene, silicone, polyurethane, expanded polytetrafluoroethylene (ePTFE).
1150. The artificial intestine section of claim 1132, wherein at least the first open end portion comprises a multilayer material.
1151. The artificial intestine section of claim 1132, wherein at least the first open end portion comprises an ingrowth layer allowing ingrowth of living tissue.
1152. The artificial intestine section of claim 1151, wherein the ingrowth layer has a net-like structure.
1153. The artificial intestine section of claim 1152, wherein the ingrowth layer is made from Dacron®.
1154. The artificial intestine section of claim 1132, further comprising at least one separate valve adapted to directly or indirectly interact with intestinal contents contained in the normal intestine.
1155. The artificial intestine section of claim 1132, wherein the at least one element comprises an artificial reservoir between the first and second open end portions for receiving and temporarily collecting therein intestinal contents supplied through the first open end portion is adapted to be emptied to move intestinal contents out through the second open end portion.
1156. The artificial intestine section of claim 1132, wherein the at least one element comprises a flow control device adapted to control flow of intestinal contents from the artificial intestine section through the second open end portion.
1157. The artificial intestine section of claim 1156, wherein the flow control device is adapted to prevent flow of intestinal contents from the artificial intestine section through the second open end portion.
1158. The artificial intestine section of claim 1156, wherein the flow control device comprises at least one valve, including an exit valve preventing intestinal contents flow through the second open end portion in its closed position.
1159. The artificial intestine section of claim 1158, wherein the exit valve is a normally closed valve.
1160. The artificial intestine section of claim 1158, wherein the flow control device comprises an entry valve allowing intestinal contents to flow through the first open end portion into the artificial intestine section in its open position.
1161. The artificial intestine section of claim 1160, wherein the entry valve is a normally open valve.
1162. The artificial intestine section of any one of claims 1159 and 1161, wherein the exit valve and the entry valve are adapted to cooperate such that when one of the two valves is closed, the other valve is open, and vice versa.
1163. The artificial intestine section of claim 1158, wherein the at least one valve comprises a compartment with a variable volume adapted to open and close the valve by changing the compartment's volume.
1164. The artificial intestine section of claim 1164, wherein the at least one valve comprises at least one passage for filling and emptying the compartment with hydraulic fluid.
1165. The artificial intestine section of claim 1132, further comprising at least one extra valve adapted to control flow of intestinal contents in a natural section of a patient's intestine upstream and/or downstream the artificial intestine section, wherein the extra valve is adapted to being implanted inside the patient's body outside a section of the patient's natural intestine and comprises at least one element adapted to act on the natural intestine section from the outside thereof so as to prevent intestinal contents flow through the natural intestine section.
1166. The artificial intestine section of claim 1165, wherein the extra valve comprises at least one of: at least one electrical stimulation device adapted to electrically stimulate muscle or neural tissue of the natural intestine section so as to cause at least partial contraction of the natural intestine section and one hydraulic or mechanic constriction device to restrict the natural intestine section.
1167. The artificial intestine section of claim 1166, wherein the stimulation device or constriction device is adapted to pump intestinal contents along the natural intestine section by, over time, stimulating the different portions of the natural intestine section in a wave like manner in a direction of natural intestinal contents flow.
1168. The artificial intestine section of claim 1156, wherein the flow control device comprises a pump for advancing intestinal contents through the second open end portion to outside the artificial intestine section.
1169. The artificial intestine section of claim 1168, including claim 824, wherein the pump is adapted for emptying the reservoir.
1170. The artificial intestine section of claim 1169, wherein the reservoir is formed by a bellow, said bellow having an end wall closing the bellow at one end thereof, said end wall making part of the pump such that a volume of the bellow is reduced upon advancement of said end wall.
1171. The artificial intestine section of claim 1170, wherein the bellow is made of a resilient material so as to urge the bellow into a normally expanded position.
1172. The artificial intestine section of claim 1169, wherein the pump comprises a movable piston, with a front end of the piston affecting the reservoir such that a volume of the reservoir is reduced upon advancement of the piston.
1173. The artificial intestine section of claim 1169, wherein the pump is adapted for being permanently arranged inside the reservoir.
1174. The artificial intestine section of claim 1169, wherein the reservoir has a flexible wall and the pump is adapted for emptying the reservoir by squeezing the reservoir.
1175. The artificial intestine section of claim 1170, wherein the pump includes a constriction device adapted to alternately constrict and release sections of the reservoir so as to pump intestinal contents along the reservoir by, over time, constricting different sections of the reservoir in a wave like manner.
1176. The artificial intestine section of claim 1175, wherein the reservoir has a tube-like form and the pump is a roller pump acting on the tube-like reservoir from the outside thereof.
1177. The artificial intestine section of claim 1156, wherein the at least one element comprises at least one motor arranged for automatically driving at least one energy consuming parts of the flow control device.
1178. The artificial intestine section of claim 1177, wherein said flow control device comprising at least one valve including, wherein the at least one motor is arranged for driving at least one of the valve or valves, respectively, between closed and open positions.
1179. The artificial intestine section of claim 1177 comprising a pump for moving intestinal contents in said artificial section, wherein the at least one motor is arranged for driving the pump.
1180. The artificial intestine section of claim 1177, comprising a manually operable switch for activating the at least one motor, the switch being arranged for subcutaneous implantation so as to be operable from outside the patient's body.
1181. The artificial intestine section of claim 1146, wherein said holding device is adapted to pass through the peritoneal wall and hold said intestinal section, comprising a flange intended for placement outside the peritoneum or the holding device being adapted to hold sutures and staplers passing through the peritoneal wall, when implanted, to hold said artificial intestine section.
1182. A system comprising the artificial intestine section of claim 1132, and further comprising an energy source for supplying energy directly or indirectly to at least one energy consuming part of the system.
1183. The system of claim 1182, wherein the energy source comprising an implantable accumulator, wherein the accumulator comprises one or more of a rechargeable battery and a capacitor.
1184. The system of claim 1182, wherein the energy source comprises a wireless energy transmitter adapted to wirelessly transmit energy from outside the patient's body to the at least one energy consuming part.
1185. The system of claim 1182, wherein the energy source comprises a wireless energy transmitter adapted to wirelessly transmit energy from outside the patient's body to the at least one energy consuming part, wherein the system further comprising a feedback subsystem adapted to wirelessly send feedback information related to the energy to be stored in the accumulator from inside the human body to the outside thereof, wherein the system is adapted to use the feedback information for adjusting the amount of wireless energy transmitted by the energy transmitter.
1186. The system of claim 1185, wherein the feedback information is related to an energy balance which is defined as the balance between an amount of wireless energy received inside the human body and an amount of energy consumed by the at least one energy consuming part.
1187. The system of claim 1185, wherein the feedback information is related to an energy balance which is defined as the balance between a rate of wireless energy received inside the human body and a rate of energy consumed by the at least one energy consuming part.
1188. A system comprising an artificial intestine piece of claim 1132, further comprising a control unit adapted to directly or indirectly control one or more elements of the system.
1189. The system of claim 1188, comprising an exit valve, wherein the control unit is adapted to control opening of the exit valve.
1190. The system of claim 1189, comprising an entry valve, wherein the control unit is adapted to control closing of the entry valve.
1191. The system of any one of claims 1189 and 1190, wherein the control unit is adapted to control opening of the exit valve and closing of the entry valve such that when one of the two valves is closed, the other valve is open, and vice versa.
1192. The system of claim 1188, comprising a manually operable switch for activating the control unit, the switch being arranged for subcutaneous implantation so as to be operable from outside the patient's body.
1193. The system of claim 1188, wherein the control unit comprising a first and second part, wherein the second part of the control unit is adapted to wirelessly transmit a control signal to an implantable first part of the control unit for controlling the at least one energy consuming part from outside the patient's body.
1194. The system of claim 1193, wherein the implantable first part of the control unit is programmable via the second part of the control unit.
1195. The system of claim 1193, wherein the implantable first part of the control unit is adapted to transmit a feedback signal to the second part of the control unit.
1196. A system comprising an artificial intestine piece of claim 1132, further comprising a physical parameter sensor adapted to directly or indirectly sense a physical parameter of the patient.
1197. The system of claim 1196, wherein the physical parameter sensor is adapted to sense at least one of the following physical parameters of the patient: a pressure within the artificial intestine section, a pressure within the patient's intestine, an expansion of the artificial intestine section, a distension of an intestinal wall of the patient's intestine, a movement of the intestinal wall.
1198. An apparatus for treating a patient having a disorder related to the passageway of the patient's intestines, the apparatus comprising a pump for implantation in the patient operable on at least one selected portion of the intestines to pump intestinal contents through the passageway of the intestines, wherein said pump includes a constriction device adapted to alternately constrict and release the selected portion to at least substantially reduce the volume of the passageway of the intestines along the selected portion and release the selected portion to increase the volume of the passageway of the intestines along the selected portion, such that intestinal contents is displaced through the passageway of the intestines.
1199. The apparatus according to claim 1198, further comprising a control device for controlling said pump to operate said constriction device to alternately constrict and release the selected portion, such that intestinal contents is moved through the passageway of the intestines.
1200. The apparatus according to claim 1199, wherein said control device is operable by the patient.
1201. The apparatus according to claim 1200, wherein said control device comprises a wireless remote control.
1202. The apparatus according to claim 1198, wherein the patient's intestines are surgically modified ending in a natural or an artificial stoma, and said pump is adapted to pump intestinal contents out from the patient's body through the stoma.
1203. The apparatus according to claim 1198, wherein the selected portion of the intestines ends at the patient's anus and said pump is adapted to pump intestinal contents out from the patient's body through the anus.
1204. The apparatus according to claim 1198, further comprising an engagement device attached to said pump and adapted to engage said pump with tissue related to the patient's abdominal cavity.
1205. The apparatus according to claim 1204, wherein said engagement device is adapted to engage said pump with the patient's abdominal wall.
1206. The apparatus according to claim 1198, further comprising an elastic protective tubing at least partially covering the selected portion of the intestines, wherein said constriction device constricts both said protective tubing and the selected portion.
1207. The apparatus according to claim 1198, further comprising an implantable support for supporting the selected portion of the intestines as said constriction device constricts the selected portion.
1208. The apparatus according to claim 1198, wherein said constriction device is adapted to constrict the selected portion against a tissue or a bone of the patient's body.
1209. The apparatus according to claim 1198, further comprising a stimulation device for electrically stimulating muscle or neural tissue of the selected portion of the intestines to cause at least partial contraction of the selected portion.
1210. The apparatus according to claim 1209, wherein said stimulation device comprises at least one electrode adapted to stimulate muscle or neural tissue of the selected portion of the intestinal tissue with electric pulses.
1211. The apparatus according to claim 1209, wherein said stimulation device comprises a plurality of electrodes separate from or integrated with said constriction device.
1212. The apparatus according to claim 1211, wherein said electrodes form a series of electrodes along the selected portion of the intestines.
1213. The apparatus according to claim 1207, further comprising a control device for controlling said stimulation device.
1214. The apparatus according to claim 1213, wherein said stimulation device comprises a plurality of electrodes separate from or integrated with said constriction device, and said control device controls said stimulation device to variably energize said electrodes along the selected portion to cause partial contractions of the selected portion that over time change their positions on the selected portion.
1215. The apparatus according to claim 1214, wherein said control device controls said stimulation device to energize said electrodes in accordance with a preset scheme.
1216. The apparatus according to claim 1214, wherein said control device controls said stimulation device to energize said electrodes, such that a number or groups of said electrodes are progressively energized in a direction upstream or downstream of the intestines.
1217. The apparatus according to claim 1214, wherein said control device controls said stimulation device to energize said electrodes, such that said electrodes are energized one at a time in sequence or groups of said electrodes are sequentially energized, either randomly or in accordance with a predetermined pattern.
1218. The apparatus according to claim 1199, wherein said constriction device comprises at least one constriction element for constricting and releasing the selected portion and said control device controls said constriction element to alternately constrict and release the selected portion.
1219. The apparatus according to claim 1218, further comprising a stimulation device for electrically stimulating muscle or neural tissue of the selected portion of the intestines to cause at least partial contraction of the selected portion, wherein said constriction element is elongated and said control device is adapted to control said stimulation device to successively stimulate the selected portion where said elongated constriction element constricts the selected portion, such that the selected portion constricted by said constriction element is progressively contracted, whereby intestinal contents is displaced in the passageway of the intestines in a peristaltic manner.
1220. The apparatus according to claim 1218, wherein said constriction device comprises a first constriction element for constricting and releasing the selected portion at an upstream end thereof, and a second constriction element for constricting and releasing the selected portion between the upstream and downstream ends thereof, and said control device controls said first and second constriction elements to alternately constrict and release the selected portion independently of one another.
1221. The apparatus according to claim 1220, wherein said control device is adapted to:
i. control said upstream first constriction element to constrict the selected portion to close the passageway of the intestines at the upstream end of the selected portion, and ii. control said second constriction element to constrict the selected portion between the upstream and downstream ends thereof to move intestinal contents contained in the selected portion downstream in the passageway of the intestines.
i. control said upstream first constriction element to constrict the selected portion to close the passageway of the intestines at the upstream end of the selected portion, and ii. control said second constriction element to constrict the selected portion between the upstream and downstream ends thereof to move intestinal contents contained in the selected portion downstream in the passageway of the intestines.
1222. The apparatus according to claim 1220, wherein said control device is adapted to:
control said first and second constriction elements to release the selected portion to allow intestinal contents in the passageway of the intestines upstream of the selected portion to enter the selected portion.
control said first and second constriction elements to release the selected portion to allow intestinal contents in the passageway of the intestines upstream of the selected portion to enter the selected portion.
1223. The apparatus according to claim 1219, further comprising a stimulation device for electrically stimulating muscle or neural tissue of the selected portion of the intestines to cause at least partial contraction of the selected portion.
1224. The apparatus according to claim 1222, wherein said stimulation device comprises a plurality of electrodes forming a series of electrodes along a surface of at least one of said constriction elements of said constriction device, said surface contacting the selected portion of the intestines and said electrodes being adapted to stimulate muscle or neural tissue of the selected portion with electric pulses.
1225. The apparatus according to claim 1222, wherein said stimulation device is adapted to electrically stimulate the selected portion where one of said first constriction element and said second constriction element constricts the selected portion.
1226. The apparatus according to claim 1222, wherein said control device is adapted to:
i. control said upstream first constriction element to gently constrict the selected portion to at least substantially decrease the cross-sectional area of the passageway of the intestines at the upstream end of the selected portion, ii. control said stimulation device to stimulate the selected portion where said first constriction element constricts the selected portion to cause contraction of the selected portion to close the passageway of the intestines at the upstream end of the selected portion, and iii. control said second constriction element to constrict the selected portion between the upstream and downstream ends thereof to move intestinal contents contained in the selected portion downstream in the passageway of the intestines.
i. control said upstream first constriction element to gently constrict the selected portion to at least substantially decrease the cross-sectional area of the passageway of the intestines at the upstream end of the selected portion, ii. control said stimulation device to stimulate the selected portion where said first constriction element constricts the selected portion to cause contraction of the selected portion to close the passageway of the intestines at the upstream end of the selected portion, and iii. control said second constriction element to constrict the selected portion between the upstream and downstream ends thereof to move intestinal contents contained in the selected portion downstream in the passageway of the intestines.
1227. The apparatus according to claim 1226, wherein said control device is adapted to control said stimulation device to stimulate the selected portion where said second constriction element constricts the selected portion to reduce the volume of the passageway of the intestines.
1228. The apparatus according to claim 1227, wherein said control device is adapted to control said stimulation device to successively stimulate the selected portion where said second constriction element constricts the selected portion, such that the selected portion constricted by said second constriction element is progressively contracted, so that intestinal contents is displaced in the passageway of the intestines in a peristaltic manner.
1229. The apparatus according to claim 1218, wherein said constriction device comprises a first constriction element for constricting and releasing the selected portion at an upstream end thereof, a second constriction element for constricting and releasing the selected portion at a downstream end thereof, and a third constriction element for constricting and releasing the selected portion between the upstream and downstream ends thereof, and said control device controls said first, second and third constriction elements to alternately constrict and release the selected portion independently of one another.
1230. The apparatus according to claim 1229, wherein said control device is adapted to:
i. control said upstream first constriction element to constrict the selected portion to close the passageway of the intestines at the upstream end of the selected portion, ii. control said downstream second constriction element to release the selected portion, and iii. control said third constriction element to constrict the selected portion between the upstream and downstream ends thereof to move intestinal contents contained in the selected portion downstream in the passageway of the intestines.
i. control said upstream first constriction element to constrict the selected portion to close the passageway of the intestines at the upstream end of the selected portion, ii. control said downstream second constriction element to release the selected portion, and iii. control said third constriction element to constrict the selected portion between the upstream and downstream ends thereof to move intestinal contents contained in the selected portion downstream in the passageway of the intestines.
1231. The apparatus according to claim 1230, wherein said control device is adapted to:
i. control said downstream second constriction element to constrict the selected portion to close the passageway of the intestines at the downstream end of the selected portion, ii. control said upstream first constriction element to release the selected portion, and iii. control said third constriction element to release the selected portion between the upstream and downstream ends thereof to allow intestinal contents in the passageway of the intestines upstream of the selected portion to enter the selected portion.
i. control said downstream second constriction element to constrict the selected portion to close the passageway of the intestines at the downstream end of the selected portion, ii. control said upstream first constriction element to release the selected portion, and iii. control said third constriction element to release the selected portion between the upstream and downstream ends thereof to allow intestinal contents in the passageway of the intestines upstream of the selected portion to enter the selected portion.
1232. The apparatus according to claim 1229, further comprising a stimulation device for electrically stimulating muscle or neural tissue of the selected portion of the intestines to cause at least partial contraction of the selected portion.
1233. The apparatus according to claim 1232, wherein said stimulation device comprises a plurality of electrodes forming a series of electrodes along a surface of at least one of said constriction elements of said constriction device, said surface contacting the selected portion of the intestines and said electrodes being adapted to stimulate muscle or neural tissue of the selected portion with electric pulses.
1234. The apparatus according to claim 1232, wherein said stimulation device is adapted to electrically stimulate the selected portion where one of said first constriction element and said second constriction element constricts the selected portion.
1235. The apparatus according to claim 1232, wherein said stimulation device is adapted to electrically stimulate the selected portion where said third constriction element constricts the selected portion.
1236. The apparatus according to claim 1232, wherein said control device is adapted to:
i. control said upstream first constriction element to gently constrict the selected portion to at least substantially decrease the cross-sectional area of the passageway of the intestines at the upstream end of the selected portion, ii. control said stimulation device to stimulate the selected portion where said first constriction element constricts the selected portion to cause contraction of the selected portion to close the passageway of the intestines at the upstream end of the selected portion, iii. control said downstream second constriction element to release the selected portion, and iv. control said third constriction element to constrict the selected portion between the upstream and downstream ends thereof to move intestinal contents contained in the selected portion downstream in the passageway of the intestines.
i. control said upstream first constriction element to gently constrict the selected portion to at least substantially decrease the cross-sectional area of the passageway of the intestines at the upstream end of the selected portion, ii. control said stimulation device to stimulate the selected portion where said first constriction element constricts the selected portion to cause contraction of the selected portion to close the passageway of the intestines at the upstream end of the selected portion, iii. control said downstream second constriction element to release the selected portion, and iv. control said third constriction element to constrict the selected portion between the upstream and downstream ends thereof to move intestinal contents contained in the selected portion downstream in the passageway of the intestines.
1237. The apparatus according to claim 1236, wherein said control device is adapted to:
i. control said downstream second constriction element to gently constrict the selected portion to at least substantially decrease the cross-sectional area of the passageway of the intestines at the downstream end of the selected portion, ii. control said stimulation device to stimulate the selected portion where said second constriction element constricts the selected portion to cause contraction of the selected portion to close the passageway of the intestines at the downstream end of the selected portion, iii. control said upstream first constriction element to release the selected portion, and iv. control said third constriction element to release the selected portion between the upstream and downstream ends thereof to allow intestinal contents in the passageway of the intestines upstream of the selected portion to enter the selected portion.
i. control said downstream second constriction element to gently constrict the selected portion to at least substantially decrease the cross-sectional area of the passageway of the intestines at the downstream end of the selected portion, ii. control said stimulation device to stimulate the selected portion where said second constriction element constricts the selected portion to cause contraction of the selected portion to close the passageway of the intestines at the downstream end of the selected portion, iii. control said upstream first constriction element to release the selected portion, and iv. control said third constriction element to release the selected portion between the upstream and downstream ends thereof to allow intestinal contents in the passageway of the intestines upstream of the selected portion to enter the selected portion.
1238. The apparatus according to claim 1236, wherein said control device is adapted to control said stimulation device to stimulate the selected portion where said third constriction element constricts the selected portion to reduce the volume of the passageway of the intestines.
1239. The apparatus according to claim 1238, wherein said control device is adapted to control said stimulation device to successively stimulate the selected portion where said third constriction element constricts the selected portion, such that the selected portion constricted by said third constriction element is progressively contracted, so that intestinal contents is displaced in the passageway of the intestines in a peristaltic manner.
1240. The apparatus according to claim 1218, wherein said constriction element is adapted to be maintained in a rest position, in which said constriction element gently constricts the selected portion to close the passageway of the intestines, when said pump is not in operation.
1241. The apparatus according to claim 1240, further comprising a stimulation device for electrically stimulating muscle or neural tissue of the selected portion of the intestines to cause at least partial contraction of the selected portion.
1242. The apparatus according to claim 1241, wherein said constriction element is adapted to be maintained in a rest position, in which said constriction element gently constricts the selected portion to at least substantially decrease the cross-sectional area of the passageway of the intestines, when said pump is not in operation, and said control device controls said stimulation device to stimulate the selected portion where said constriction element constricts the selected portion to close the passageway of the intestines.
1243. The apparatus according to claim 1241, wherein said rest position allows for sufficient blood circulation in the blood vessels of the selected portion of the intestines, such that the intestinal tissues of the selected portion maintain their integrity following long exposure to said constriction element constricting the selected portion.
1244. The apparatus according to claim 1232, wherein said first, second and third constriction elements are adapted to be maintained in a rest position, in which at least one of said constriction elements gently constricts the selected portion to at least substantially decrease the cross-sectional area of the passageway of the intestines, when said pump is not in operation, and said control device controls said stimulation device to stimulate the selected portion where said constriction element constricts the selected portion to close the passageway of the intestines.
1245. The apparatus according to claim 1244, wherein said rest position allows for sufficient blood circulation in the blood vessels of the selected portion of the intestines, such that the intestinal tissues of the selected portion maintain their integrity following long exposure to said constriction element constricting the selected portion.
1246. The apparatus according to claim 1218, wherein said constriction device comprises a first constriction element for constricting and releasing the selected portion at an upstream end thereof and a second constriction element for constricting and releasing the selected portion at a downstream end thereof, and said control device controls said first and second constriction elements to alternately constrict and release the selected portion independently of each other.
1247. An apparatus according to claim 1246, further comprising a stimulation device for electrically stimulating muscle or neural tissue of the selected portion of the intestines to cause at least partial contraction of the selected portion.
1248. An apparatus according to claim 1247, wherein said stimulation device is adapted to electrically stimulate the selected portion between the upstream and downstream ends thereof to cause contraction of the selected portion to reduce the volume of the passageway of the intestines.
1249. An apparatus according to claim 1248, wherein said control device is adapted to:
i. control said upstream first constriction element to constrict the selected portion to close the passageway of the intestines at the upstream end of the selected portion, ii. control said downstream second constriction element to release the selected portion, and iii. control said stimulation device to successively stimulate the selected portion between the upstream and downstream ends thereof to cause progressive contraction of the selected portion, so that intestinal contents is displaced in the passageway of the intestines in a peristaltic manner.
i. control said upstream first constriction element to constrict the selected portion to close the passageway of the intestines at the upstream end of the selected portion, ii. control said downstream second constriction element to release the selected portion, and iii. control said stimulation device to successively stimulate the selected portion between the upstream and downstream ends thereof to cause progressive contraction of the selected portion, so that intestinal contents is displaced in the passageway of the intestines in a peristaltic manner.
1250. The apparatus according to claim 1249, wherein said control device is adapted to:
i. control said downstream second constriction element to constrict the selected portion to close the passageway of the intestines at the downstream end of the selected portion, ii. control said upstream first constriction element to release the selected portion, and iii. control said stimulation device to cease stimulating the selected portion between the upstream and downstream ends thereof to allow intestinal contents in the passageway of the intestines upstream of the selected portion to enter the selected portion.
i. control said downstream second constriction element to constrict the selected portion to close the passageway of the intestines at the downstream end of the selected portion, ii. control said upstream first constriction element to release the selected portion, and iii. control said stimulation device to cease stimulating the selected portion between the upstream and downstream ends thereof to allow intestinal contents in the passageway of the intestines upstream of the selected portion to enter the selected portion.
1251. The apparatus according to claim 1248, wherein said control device is adapted to:
i.
control said upstream first constriction element to gently constrict the selected portion to at least substantially decrease the cross-sectional area of the passageway of the intestines at the upstream end of the selected portion, ii. control said stimulation device to stimulate the selected portion where said first constriction element constricts the selected portion to cause contraction of the selected portion to close the passageway of the intestines at the upstream end of the selected portion, iii. control said downstream second constriction element to release the selected portion, and iv. control said stimulation device to successively stimulate the selected portion between the upstream and downstream ends thereof to cause progressive contraction of the selected portion, so that intestinal contents is displaced in the passageway of the intestines in a peristaltic manner.
i.
control said upstream first constriction element to gently constrict the selected portion to at least substantially decrease the cross-sectional area of the passageway of the intestines at the upstream end of the selected portion, ii. control said stimulation device to stimulate the selected portion where said first constriction element constricts the selected portion to cause contraction of the selected portion to close the passageway of the intestines at the upstream end of the selected portion, iii. control said downstream second constriction element to release the selected portion, and iv. control said stimulation device to successively stimulate the selected portion between the upstream and downstream ends thereof to cause progressive contraction of the selected portion, so that intestinal contents is displaced in the passageway of the intestines in a peristaltic manner.
1252. The apparatus according to claim 1251, wherein said control device is adapted to:
i. control said downstream second constriction element to gently constrict the selected portion to at least substantially decrease the cross-sectional area of the passageway of the intestines at the downstream end of the selected portion, ii. control said stimulation device to stimulate the selected portion where said second constriction element constricts the selected portion to cause contraction of the selected portion to close the passageway of the intestines at the downstream end of the selected portion, iii. control said upstream first constriction element to release the selected portion, and iv. control said stimulation device to cease stimulating the selected portion between the upstream and downstream ends thereof to allow intestinal contents in the passageway of the intestines upstream of the selected portion to enter the selected portion.
i. control said downstream second constriction element to gently constrict the selected portion to at least substantially decrease the cross-sectional area of the passageway of the intestines at the downstream end of the selected portion, ii. control said stimulation device to stimulate the selected portion where said second constriction element constricts the selected portion to cause contraction of the selected portion to close the passageway of the intestines at the downstream end of the selected portion, iii. control said upstream first constriction element to release the selected portion, and iv. control said stimulation device to cease stimulating the selected portion between the upstream and downstream ends thereof to allow intestinal contents in the passageway of the intestines upstream of the selected portion to enter the selected portion.
352 253. The apparatus according to claim 1199, wherein said constriction device is adapted to constrict any portions of a series of selected portions of the intestines to close the passageway of the intestines, and said control device controls said constriction device to successively constrict the selected portions of the series of selected portions to move intestinal contents downstream in the passageway of the intestines in a peristaltic manner.
1254. The apparatus according to claim 1253, wherein said constriction device comprises at least one constriction element that is moveable along the intestines to successively constrict the selected portions of the series of selected portions.
1255. The apparatus according to claim 1254, wherein said control device controls said constriction device to cyclically move said constriction element along the selected portions of the series of selected portions.
1256. The apparatus according to claim 1253, wherein said constriction device comprises a plurality of constriction elements, each of which is moveable along the intestines to successively constrict the selected portions of the series of selected portions.
1257. The apparatus according to claim 1256, wherein said control device controls said constriction device to cyclically move said constriction elements one after the other along the selected portions of the series of selected portions.
1258. The apparatus according to claim 1257, wherein said constriction device comprises a rotor carrying said constriction elements, and said control device controls said rotor to rotate such that each constriction element cyclically constricts the selected portions of the series of selected portions.
1259. The apparatus according to claim 1258, wherein each constriction element comprises a roller for rolling on the intestines to constrict the selected portions thereof.
1260. The apparatus according to claim 1209, wherein said stimulation device is adapted to electrically stimulate the muscle tissue of any portions of a series of selected portions of the intestines to cause contraction of the intestines, further comprising a control device for controlling said constriction device and said stimulation device to co-operate, such that intestinal contents is moved through the passageway of the intestines.
1261. The apparatus according to claim 1260, wherein said constriction device is adapted to constrict any portions of the series of selected portions to at least substantially decrease the cross-sectional area of the passageway of the intestines, said stimulation device is adapted to stimulate the selected portion constricted by said constriction device to close the passageway of the intestines, and said control device controls said constriction device to successively constrict the selected portions of the series of selected portions to move intestinal contents in the passageway of the intestines in a peristaltic manner while controlling said stimulation device to stimulate the selected portions.
1262. The apparatus according to claim 1261, wherein said control device controls said stimulation device to successively stimulate the selected portions to cause successive contractions thereof in harmony with the successive constrictions of the selected portions performed by the constriction device.
1263. The apparatus according to claim 1261, wherein said constriction device comprises at least one constriction element that is moveable along the intestines to successively constrict the selected portions of the series of selected portions, and said stimulation device comprises at least one electrode positioned on said constriction element and adapted to stimulate muscle tissue of the selected portion of the intestinal tissue with electric pulses.
1264. The apparatus according to claim 1263, wherein said control device controls said constriction device to cyclically move said constriction element along the selected portions of the series of selected portions while controlling said stimulation device to energize said electrode.
1265. The apparatus according to claim 1263, wherein said constriction device comprises a plurality of constriction elements, each of which is moveable along the intestines to successively constrict the selected portions of the series of selected portions, and said stimulation device comprises electrodes positioned on said constriction elements.
1266. The apparatus according to claim 1265, wherein said control device controls said constriction device to cyclically move said constriction elements one after the other along the selected portions of the series of selected portions while controlling said stimulation device to energize said electrodes.
1267. The apparatus according to claim 1266, wherein said constriction device comprises a rotor carrying said constriction elements, and said control device controls said rotor to rotate such that each constriction element cyclically constricts the selected portions of the series of selected portions.
1268. The apparatus according to claim 1267, wherein each constriction element comprises a roller for rolling on the intestines to constrict the selected portions thereof.
1269. The apparatus according to claim 1265, wherein said plurality of electrodes are distributed along a surface in relation to at least one of said constriction elements of said constriction device, said surface contacting the intestines as said constriction element constricts any one of the selected portions.
1270. The apparatus according to claim 1198, wherein said control device controls said constriction device to provide a constriction of the selected portion that is displaced along the intestines to move intestinal contents in the passageway of the intestines.
1271. The apparatus according to claim 1270, wherein said constriction device comprises at least one elongated constriction element extending along the intestines, and said control device controls said constriction device, such that said elongated constriction element progressively constricts the selected portion to move intestinal contents in the passageway of the intestines.
1272. The apparatus according to claim 1271, wherein said elongated constriction element comprises a contact surface dimensioned for contacting a length of the selected portion of the intestines.
1273. The apparatus according to claim 1272, wherein said contact surface is convex, and said control device controls said constriction device, such that said convex contact surface of said constriction element rolls on and progressively constricts the selected portion of the intestines.
1274. The apparatus according to claim 1271, wherein said constriction device comprises two elongated constriction element extending along the intestines at opposite sides thereof, and said control device controls said constriction device, such that elongated constriction elements co-operate with each other to progressively constrict the selected portion to move intestinal contents in the passageway of the intestines.
1275. The apparatus according to claim 1274, wherein said elongated constriction elements comprise contact surfaces dimensioned for contacting a length of the selected portion of the intestines at opposite sides thereof.
1276. The apparatus according to claim 1275, wherein said contact surfaces are convex, and said control device controls said constriction device, such that said convex contact surfaces of said constriction elements rolls on and progressively constricts the selected portion of the intestines.
1277. The apparatus according to claim 1273, wherein said constriction element is adapted to change between a constriction state, in which said convex surface is capable of rolling along and constricting the selected portion of the intestines, and a release state, in which said convex surface is released from the selected portion of the intestines.
1278. The apparatus according to claim 1271, further comprising a stimulation device for electrically stimulating the muscle or neural tissue of the selected portion of the intestines to cause contraction of the intestines, wherein said control device controls said stimulation device to stimulate the selected portion as said elongated constriction element progressively constricts the selected portion.
1279. The apparatus according to claim 1278, wherein said stimulation device comprises at least one electrode adapted to stimulate the muscle or neural tissue of the selected portion of the intestines with electric pulses.
1280. The apparatus according to claim 1279, comprising a plurality of electrodes longitudinally distributed on a surface of said elongated constriction element contacting the selected portion of the intestines.
1281. The apparatus according to claim 1280, wherein said control device controls said stimulation device to energize said electrodes successively along said elongated constriction element to cause progressive contraction of the selected portion of the intestines.
1282. The apparatus according to claim 1198, further comprising at least one implantable releasable closure adapted to engage the selected portion of the intestines to close the passageway of the intestines when said pump is not in operation, and to release the selected portion to open the passageway of the intestines when said pump is in operation.
1283. The apparatus according to claim 1282, wherein said closure is adapted to at least partially constrict the selected portion to close the passageway of the intestines when said pump is not in operation.
1284. The apparatus according to claim 1282, further comprising a stimulation device for electrically stimulating muscle or neural tissue of the selected portion of the intestines to cause at least partial contraction of the selected portion.
1285. The apparatus according to claim 1284, wherein said closure is adapted to at least partially constrict the selected portion to at least substantially decrease the cross-sectional area of the passageway of the intestines, when said pump is not in operation, and said stimulation device is adapted to electrically stimulate muscle or neural tissue of the intestines to cause contraction of the intestines where said closure constricts the intestines to close the passageway of the intestines.
1286. The apparatus according to claim 1285, further comprising a control device for controlling said stimulation device.
1287. The apparatus according to claim 1286, wherein said control device controls said closure and said stimulation device to co-operate, to allow for sufficient blood circulation in the blood vessels of the constricted intestines, such that intestinal tissues maintain their integrity following long exposure to said closure, when said pump is not in operation.
1288. The apparatus according to claim 1285, wherein said stimulation device comprises a plurality of electrodes separate from or integrated with said closure.
1289. The apparatus according to claim 1288, wherein said electrodes form a series of electrodes along the intestines.
1290. The apparatus according to claim 1288, wherein said plurality of electrodes are distributed along a surface of said closure contacting the intestines.
1291. The apparatus according to claim 1198, wherein said constriction device is adapted to be maintained in a rest position, in which it keeps the selected portion at least partially constricted, when said pump is not in operation.
1292. The apparatus according to claim 1291, wherein said constriction device constricts the selected portion in said rest position no more than to allow for sufficient blood circulation in the blood vessels of the constricted intestines, such that intestinal tissues maintain their integrity following long exposure to said constriction device.
1293. The apparatus according to claim 1291, further comprising a stimulation device for electrically stimulating muscle or neural tissue of the selected portion of the intestines to cause at least partial contraction of the selected portion.
1294. The apparatus according to claim 1293, wherein said constriction device constricts the intestines to at least substantially decrease the cross-sectional area of the passageway of the intestines, when said constriction device is in said rest position, and said stimulation device is adapted to electrically stimulate the intestines where said constriction device constricts the intestines to cause contraction of the intestines to close the passageway of the intestines.
1295. The apparatus according to claim 1198, further comprising an artificial intestinal piece adapted to be surgically joined to the patient's intestines to form part of the passageway of the intestines and to form at least part of the selected portion of the intestines to be constricted by said constriction device.
1296. The apparatus according to claim 1295, wherein said artificial intestinal piece is adapted to be integrated with the patient's intestines between two ends thereof.
1297. The apparatus according to claim 1295, wherein said constriction device operates only on the artificial intestinal piece.
1298. The apparatus according to claim 1295, wherein said constriction device constricts said artificial intestinal piece in order to discharge intestinal contents through an intestinal stoma located downstream of said artificial intestinal piece.
1299. The apparatus according to claim 1295, wherein said artificial intestinal piece is adapted to end at a stoma.
1300. The apparatus according to claim 1295, wherein said artificial intestinal piece is adapted to be joined directly or indirectly to the patient's anus.
1301. The apparatus according to claim 1295, wherein said constriction device constricts said artificial intestinal piece to close the passageway of the intestines when the pump is not in operation.
1302. The apparatus according to claim 1298, wherein said constriction device is adapted to radially expand at least a section of the selected portion of the intestines to form an expanded chamber of the passageway of the intestines along the selected portion, and to axially constrict the expanded section of the selected portion to at least substantially reduce the volume of the chamber, such that intestinal contents is displaced through the passageway of the intestines.
1303. The apparatus according to claim 1302, wherein said constriction device is adjustable between a rest position, in which it does not expand the section of the selected portion, and an expansion position, in which it expands the section of the selected portion.
1304. The apparatus according to claim 1303, wherein said constriction device is provided with a material that allows growth of fibrotic tissue for externally joining said constriction device with the wall of the selected portion of the intestines, whereby said constriction device pulls the wall of the selected portion radially outwardly, when said expansion device is in its expansion position, to form the expanded section of the selected portion.
1305. The apparatus according to claim 1302, further comprising a stimulation device for electrically stimulating muscle or neural tissue of the selected portion of the intestines to cause at least partial contraction of the selected portion.
1306. The apparatus according to claim 1305, wherein said stimulation device is adapted to electrically stimulate the expanded section of the selected portion, when said constriction device is in its expansion position, to cause axial contraction of the expanded section of the selected portion.
1307. The apparatus according to claim 1306, wherein said stimulation device comprises at least one electrode adapted to stimulate muscle or neural tissue of the expanded section of the selected portion with electric pulses.
1308. The apparatus according to claim 1307, wherein said stimulation device comprises a plurality of electrodes separate from or integrated with said constriction device.
1309. The apparatus according to claim 1308, wherein said electrodes form at least one series of electrodes extending around the expanded section of the selected portion of the intestines.
1310. The apparatus according to claim 1308, further comprising a control device for controlling said stimulation device to variably energize said electrodes along the expanded section of the selected portion to cause partial contractions of the selected portion that over time change their positions on the selected portion.
1311. The apparatus according to claim 1200 or 1201, wherein said pump is manually operable.
1312. The apparatus according to claim 1311, further comprising a subcutaneously implantable actuator operatively connected to said constriction device of said pump, wherein said actuator is manually actuatable for operating said constriction device.
1313. The apparatus according to claim 1312, wherein said constriction device is hydraulically operable and said actuator is hydraulically connected to said hydraulically operable constriction device.
1314. The apparatus according to claim 1313, wherein said actuator comprises a manually compressible resilient reservoir for hydraulic fluid used for operating said constriction device.
1315. The apparatus according to claim 1314, further comprising a reverse servo hydraulically interconnecting said reservoir and said hydraulically operable constriction device.
1316. The apparatus according to claim 1314, wherein said reservoir is hydraulically connected to said constriction device, such that when said reservoir is manually compressed said constriction device constricts the selected portion between the upstream and downstream ends thereof to move intestinal contents contained in the selected portion downstream in the passageway of the intestines and when said resilient reservoir is manually released and restores its uncompressed shape, said constriction device releases the selected portion between the upstream and downstream ends thereof to allow intestinal contents in the passageway of the intestines upstream of the selected portion to enter the selected portion.
1317. The apparatus according to claim 1316, wherein said constriction device comprises a constriction element and a hydraulic bellows device that operates said constriction element to constrict the selected portion between the upstream and downstream ends thereof, when said bellows device is expanded.
1318. The apparatus according to claim 1317, wherein said compressible resilient reservoir is hydraulically connected to said bellows device, such that said bellows device is expanded when said reservoir is manually compressed and retracted when said reservoir is manually released and restores its uncompressed shape.
1319. The apparatus according to claim 1314, wherein said constriction device comprises a first hydraulically operable sub-device for constricting and releasing the selected portion at an upstream end thereof, a second hydraulically operable sub-device for constricting and releasing the selected portion at a downstream end thereof, and a third hydraulically operable sub-device for constricting and releasing the selected portion between the upstream and downstream ends thereof.
1320. The apparatus according to claim 1319, wherein said reservoir is hydraulically connected to said first, second and third sub-devices, such that when said reservoir is manually compressed said upstream first sub-device constricts the selected portion to close the passageway of the intestines at the upstream end of the selected portion, said downstream second sub-device releases the selected portion, and said third sub-device constricts the selected portion between the upstream and downstream ends thereof to move intestinal contents contained in the selected portion downstream in the passageway of the intestines.
1321. The apparatus according to claim 1320, wherein said reservoir is hydraulically connected to said first, second and third sub-devices, such that when said resilient reservoir is manually released and restores its uncompressed shape, said downstream second sub-device constricts the selected portion to close the passageway of the intestines at the downstream end of the selected portion, said upstream second sub-device releases the selected portion, and said third sub-device releases the selected portion between the upstream and downstream ends thereof to allow intestinal contents in the passageway of the intestines upstream of the selected portion to enter the selected portion.
1322. The apparatus according to claim 1319, wherein said first sub-device of said constriction device comprises a first constriction element and a first hydraulic bellows device that operates said first constriction element to constrict the selected portion at the upstream end when said first bellows device is expanded, said second sub-device of said constriction device comprises a second constriction element and a second hydraulic bellows device that operates said second constriction element to release the selected portion at the downstream end when said second bellows device is expanded, and said third sub-device of said constriction device comprises a third constriction element and a third hydraulic bellows device that operates said third constriction element to constrict the selected portion between the upstream and downstream ends when said third bellows device is expanded, wherein said compressible resilient reservoir is hydraulically connected to said first, second and third bellows devices, such that said bellows devices are expanded when said reservoir is manually compressed and retracted when said reservoir is manually released and restores its uncompressed shape.
1323. The apparatus according to claim 1322, wherein said first bellows device operates said first constriction element to release the selected portion at the upstream end when said first bellows device is retracted, said second bellows device operates said second constriction element to constrict the selected portion at the downstream end when said second bellows device is retracted, and said third bellows device operates said third constriction element to release the selected portion between the upstream and downstream ends when said third bellows device is retracted.
1324. The apparatus according to claim 1312, wherein said constriction device is mechanically operable and said actuator is mechanically connected to said mechanically operable constriction device.
1325. The apparatus according to claim 1199, wherein said pump is powered.
1326. The apparatus according to claim 1325, wherein said control device comprises a manually operable switch for starting and stopping said powered pump, said switch being adapted for subcutaneous implantation in the patient.
1327. The apparatus according to claim 1325, wherein said control device comprises a wireless remote control for controlling said pump.
1328. The apparatus according to claim 1325, further comprising a wireless energy transmitter adapted to transmit wireless energy from outside the patient's body for directly or indirectly powering said pump.
1329. The apparatus according to claim 1328, further comprising an implantable energy-transforming device for transforming the transmitted wireless energy into electric energy.
1330. The apparatus according to claim 1329, wherein said pump is directly powered with the electric energy, as said energy-transforming device transforms the transmitted wireless energy into the electric energy.
1331. The apparatus according to claim 1329, further comprising an implantable accumulator adapted to store the electric energy produced by said energy-transforming device, wherein said control device controls said accumulator to release energy for powering said pump.
1332. The apparatus according to claim 1331, wherein said accumulator comprises a capacitor or a rechargeable battery.
1333. The apparatus according to claim 1331, further comprising an implantable charge meter for measuring the charge of said accumulator, wherein said control device is adapted to produce an indication in response to said charge meter.
1334. The apparatus according to claim 1199, further comprising an implantable sensor adapted to directly or indirectly sense a physical parameter of the patient or a functional parameter of the apparatus.
1335. The apparatus according to claim 1334, wherein said control device is adapted to produce an indication in response to said sensor sensing a value of said physical parameter exceeding a threshold value, when said pump is not in operation.
1336. The apparatus according to claim 1335, wherein said physical parameter is the volume of the intestinal contents in the selected portion of the intestines.
1337. The apparatus according to claim 1335, wherein said physical parameter is the distension of the intestinal wall or the pressure in the selected portion of the intestines.
1338. The apparatus according to claim 1335, wherein said indication comprises a sound signal or displayed information.
1339. The apparatus according to claim 1334, wherein said control device is adapted to produce an indication in response to said sensor sensing a value of said functional parameter of the apparatus exceeding a threshold value, when said pump is in operation.
1340. The apparatus according to claim 1198, further comprising an external data communicator intended to be outside the patient's body and an internal data communicator implantable in the patient for communicating with the external communicator, wherein said internal data communicator feeds data related to the patient back to said external data communicator or said external data communicator feeds data to said internal data communicator.
1341. A system for treating a patient having a disorder related to a patient's intestine and a reservoir for receiving and temporarily collecting therein intestinal contents, the reservoir being formed from surgically modified intestine that has been cut along a mutual contact line of laterally adjacent sections of a bent portion of intestine and connected so that the resulting upper and lower halves of the intestine form an intestinal wall of the reservoir, wherein the system comprises an artificial flow control device implantable in the patient's body and adapted to control flow of the intestinal contents from said reservoir, the flow control device comprising at least one pump adapted to act on said intestinal wall so as to reduce the reservoir's volume, thereby emptying the reservoir.
1342. The system according to claim 1341, wherein the at least one pump comprises a pump adapted to be implanted outside the reservoir with components of the pump adapted for implantation in surgically created folds of said intestinal wall of the reservoir.
1343. The system according to claim 1341, wherein the at least one pump comprises a pump adapted to be implanted outside the reservoir with components of the pump adapted for implantation inside the patient's body adjacent the reservoir.
1344. The system according to claim 1341, wherein the at least one pump comprises a pump comprises an electrical stimulation type pump with at least one electrical stimulation device adapted to electrically stimulate a muscle or neural tissue of said intestinal wall so as to cause at least partial contraction thereof.
1345. The system according to claim 1344, wherein the stimulation device is adapted to apply electric pulses to said intestinal wall.
1346. The system according to claim 1345, wherein the stimulation device comprises at least one electrode adapted to apply the electric pulses to said intestinal wall.
1347. The system according to claim 1344, wherein the electrical stimulation type pump is adapted to pump intestinal contents along the reservoir by, over time, electrically stimulating different portions of said intestinal wall in a direction of natural intestinal contents flow.
1348. The system according to claim 1346, wherein the electrical stimulation apparatus comprises two or more electrodes adapted to electrically stimulate a muscle or neural tissue of said intestinal wall, and wherein said electrical stimulation apparatus comprises at least one holding device carrying said two or more electrodes at different positions relative to the reservoir, when implanted.
1349. The system according to claim 1348, wherein said at least one holding device has a length of 5cm or more.
1350. The system according to claim 1348, wherein at least one of; the at least one holding device with the two or more electrodes is adapted to be invaginated in the intestinal wall or embedded in a flexible web.
1351. The system according to claim 1344, wherein the electrical stimulation apparatus is formed as an integral unit on at least one side of the reservoir.
1352. The system according to claim 1344, wherein the electrical stimulation type pump is adapted to span an area larger than 4.5 cm x 6 cm.
1353. The system according to claim 1348, wherein said two or more electrodes of said electrical stimulation device is adapted to be arranged in two planes to accommodate the reservoir between the two planes.
1354. The system according to claim 1341, comprising a constriction type pump for mechanically or hydraulically constricting the reservoir by acting from outside on said intestinal wall and adapted to pump intestinal contents along a section of the reservoir by, over time, constricting different sections of the reservoir in a direction of natural intestinal contents flow.
1355. The system according to claim 1347, comprising a constriction type pump for mechanically or hydraulically constricting the reservoir by acting from outside on said intestinal wall, wherein the electrical stimulation type pump is combined with the constriction type pump so as to pump intestinal contents along the reservoir by, over time, electrically stimulating different portions of said intestinal wall and simultaneously constricting respective sections of the reservoir in the direction of natural intestinal contents flow.
1356. The system according to claim 1354, wherein the stimulation type pump is adapted to pump intestinal contents along the reservoir in a direction of natural intestinal contents flow by, over time, stimulating different portions of the intestinal wall in a wave like manner when constriction of the reservoir caused by the constriction device is released.
1357. The system according to claim 1341, wherein the at least one pump comprises a pump adapted to act on said intestinal wall from the outside of the reservoir so as to empty the reservoir by squeezing the reservoir from the outside thereof.
1358. The system according to claim 1357, wherein the at least one pump comprises an electrically driven hydraulic pump, a hydraulically acting member for acting on said intestinal wall from the outside of the reservoir, and an artificial reservoir, wherein the electrically driven hydraulic pump is adapted to pump hydraulic fluid from the artificial reservoir to the hydraulically acting member.
1359. The system according to claim 1358, wherein the hydraulically acting member is adapted to be placed in relation to said reservoir made by the intestine to reduce the volume of said reservoir to empty said reservoir, when implanted.
1360. The system according to claim 1358, wherein the hydraulically acting member comprises a plurality of hydraulic chambers.
1361. The system according to claim 1360, wherein the hydraulic chambers are hydraulically interconnected and the first and last chambers are hydraulically connected to the artificial reservoir.
1362. The system according to claim 1361, wherein the hydraulic chambers are interconnected by holes acting as throttles for the fluid.
1363. The system according to claim 1361, comprising one or more actively controlled valves between interconnected hydraulic chambers.
1364. The system according to claim 1360, wherein one or all of the hydraulic chambers are arranged such that they are hydraulically isolated from the respective other hydraulic chambers and connected to the hydraulic pump via individual hydraulic control lines.
1365. The system according to claim 1360, wherein one or all of the hydraulic chambers are arranged such that they can be hydraulically isolated from the respective other chambers by individually controlling respective valves within a hydraulic path.
1366. The system according to claim 1358, wherein the electrically driven hydraulic pump is adapted to evacuate the hydraulically acting member by applying negative pressure.
1367. The system according to claim 1358, comprising at least one valve between the hydraulically acting member and the artificial reservoir, which, when in an appropriate operational position, allows the hydraulic fluid to passively flow from the hydraulically acting member back into the artificial reservoir when the reservoir fills with intestinal contents and which, when in an appropriate other position, prevents the hydraulic fluid to flow from the hydraulically acting member back into the artificial reservoir when the intestinal reservoir is being emptied.
1368. The system according to claim 1357, wherein the at least one pump comprises at least one mechanically acting member for acting on said intestinal wall from the outside of the reservoir and an electrical motor adapted to drive the mechanically acting member for emptying the reservoir.
1369. The system according to claim 1368, wherein the mechanically acting member is a roller adapted to be rolled over the reservoir for emptying the reservoir.
1370. The system according to claim 1369, comprising two of said rollers adapted to act simultaneously on opposite sides of the reservoir.
1371. The system according to claim 1369, comprising at least one of said rollers adapted to act on one side of the reservoir against a counteracting plate adapted to be arranged on an opposite side of the reservoir.
1372. The system according to claim 1369, comprising at least two tracks for guiding the roller when driven by the electrical motor.
1373. The system according to claim 1372, wherein the at least two tracks each have a bent end portion so arranged that it directs away from the reservoir when implanted.
1374. The system according to claim 1341, wherein the flow control device further comprises an exit valve adapted to be implanted inside the patient's body downstream from the reservoir outside a section of the patient's intestine and wherein the exit valve comprises a hydraulic or mechanical constriction device for constricting the intestine section so as to keep the intestine section closed.
1375. The system according to claim 1341, wherein the flow control device further comprises at least one exit valve adapted to be implanted inside the patient's body downstream from the reservoir outside a section of the patient's intestine and comprises at least one electrical stimulation device adapted to electrically stimulate muscle or neural tissue of the intestine section so as to cause at least partial contraction of the intestine section in order to prevent intestinal contents flow through the intestine section.
1376. The system according to claim 1375, wherein the stimulation device of the exit valve comprises at least one electrode adapted to apply electric pulses to the intestine section.
1377. The system according to claim 1375, wherein the exit valve comprises a hydraulic or mechanical constriction device adapted to be implanted inside the patient's body outside a section of the patient's intestine for at least partly constricting the intestine section.
1378. The system according to claim 1377, wherein the stimulation device of the exit valve is combined with the constriction device of the exit valve so that the stimulation device and the constriction device can act on the same intestine section in order to keep the intestine section closed.
1379. The system according to claim 1378, wherein the constriction device of the exit valve in its normal condition constricts the intestine section only partly.
1380. The system according to claim 1378, wherein the stimulation device of the exit valve is adapted to pump intestinal contents along the intestine section in a direction of natural intestinal contents flow by, over time, stimulating different portions of the intestine section in a wave like manner, when constriction of the intestine section caused by the constriction device of the exit valve is released.
1381. The system according to claim 1375, wherein the stimulation device of the exit valve is adapted to stimulate, over time, different portions of the intestine section in a wave like manner in a direction opposite to natural intestinal contents flow.
1382. The system according to claim 1341, wherein the flow control device further comprises an entry valve adapted to be implanted inside the patient's body upstream from the reservoir to control flow of intestinal contents into the reservoir.
1383. The system according to claim 1382, wherein the entry valve is adapted to be implanted outside a section of the patient's intestine and comprises a hydraulic or mechanical constriction device for constricting said intestine section so as to keep the intestine section closed.
1384. The system according to claim 1341, wherein the pump comprises a motor for driving the pump.
1385. The system according to claim 1384, wherein the motor comprises a servo drive.
1386. The system according to claim 1341, comprising a manually operable actuator for activating the motor from outside the patient's body, said actuator being adapted for subcutaneous implantation.
1387. The system according to claim 1341, comprising an energy source including energy storage means for supplying energy directly or indirectly to at least one energy consuming part of the system.
1388. The system according to claim 1387, wherein the energy storage means is adapted for being implanted inside the patient's body.
1389. The system according to claim 1387, wherein the energy source comprises a wireless energy transmitter adapted to wirelessly transmit energy from outside the patient's body to the at least one energy consuming part.
1390. The system according to claim 1387, wherein the energy source comprises a wireless energy transmitter adapted to wirelessly transmit energy from outside the patient's body to the energy storage means.
1391. The system according to claim 1341, comprising a control unit adapted to directly or indirectly control one or more elements of the system.
1392. The system of claim 1341, a first intestinal passage way in flow communication with the reservoir arranged for transferring intestinal contents to the reservoir, and a second intestinal passage way in flow communication with the reservoir, the second passage way being arranged for transferring intestinal contents from the reservoir.
1393. The system of claim 1392, wherein the second passage way is adapted to being surgically connected to a surgically created stoma and wherein said pump is adapted to pump intestinal contents out through said stoma.
1394. The system of claim 1392, wherein the second passage way is adapted to being surgically connected to the patient's anus or to tissue adjacent the patient's anus and wherein said pump is adapted to pump intestinal contents out through the patient's anus or to tissue adjacent the patient's anus.
1395. The system of claim 1392, wherein the reservoir is made of the small intestine, wherein the pump is adapted to act onto to the small intestine to pump intestinal contents out from said reservoir.
1396. The system of claim 1392, wherein the reservoir is made of the large intestine, wherein the pump is adapted to act onto to the large intestine to pump intestinal contents out from said reservoir.
1397. The system of claim 1395 or 1396, wherein the second passage way includes at least to a part the small intestine.
1398. The system of claim 1395 or 1396, wherein the second passage way includes at least to a part the large intestine.
1399. The system of claim 1395 or 1396, wherein the second passage way is connected to an artificial intestinal piece, when implanted.
1400. The system according to claim 1341, wherein the reservoir has an upstream part of the intestine reservoir with a first intestinal opening and a downstream part of the intestine reservoir with a second intestinal opening.
1401. The system according to claim 1400, wherein the downstream intestinal part is adapted to be advanced through the abdominal wall and skin and, thereby achieving an intestinal stoma.
1402. The system according to claim 1400, wherein the downstream intestinal part is adapted to be connected to the patient's anus or tissue adjacent the patient's anus.
1403. The system according to claim 1400, wherein the downstream intestinal part is connected to an artificial intestinal piece, when implanted.
1404. The system according to claim 1403, wherein said artificial intestinal piece comprising a valve for controlling the flow of intestinal contents.
1405. The system according to claim 1403, wherein said artificial intestinal piece is adapted to be connected to the patient's small intestine.
1406. The system according to claim 1403, wherein said artificial intestinal piece is adapted to be connected to the patient's large intestine.
1407. The system of claim 1341, wherein the pump comprising a mounting device adapted to be mounted to the peritoneum.
1408. The system of claim 1407, wherein said mounting device is adapted to pass through the peritoneal wall and hold said intestinal section, comprising a flange intended for placement outside the peritoneum
1409. The system of claim 1407, wherein the mounting device being adapted to hold sutures and staplers passing through the peritoneal wall, when implanted, to hold said artificial intestine section.
1410. A system for treating a patient having a disorder related to the patient's intestine, comprising an artificial reservoir adapted for receiving and temporarily collecting therein intestinal contents and further adapted to remain within the patient's body when emptying the reservoir, wherein the system further comprises an at least partly artificial flow control device implantable in the patient's body and adapted to control flow of the intestinal contents in the intestine, wherein said reservoir comprises a single opening, said opening being adapted to be connected to a surgically created opening in the patient's intestine when implanted so as to be in flow communication with the intestine, wherein the reservoir is adapted for receiving and temporarily collecting therein intestinal contents as well as emptying the intestinal contents from the reservoir through said single opening, the system further comprising an implantable pump for emptying the reservoir, wherein said pump is adapted to be controlled from outside the human body.
1411. The system of claim 1410, further comprising a flexible sleeve adapted to be placed lateral onto the intestine or onto a surgically divided end portion of the intestine, when the reservoir is implanted.
1412. The system of claim 1410, wherein the sleeve comprising a net structure on the inside of the sleeve towards the intestinal portion for in-growth of fibrotic tissue.
1413. The system of claim 1410, wherein the single opening comprising a conduit, wherein said conduit having a bulge formed on the outside thereof adapted to hold a section of the intestine by inserting the conduit into the artificial intestinal lateral or end opening so that the intestine extends over the bulge from one side of the bulge, and -further comprising a blocking ring adapted to be placed over the intestine towards the bulge from the respective other side of the bulge such that the intestine is located intermediate the conduit's outer surface and the blocking ring to improve the strength of the connection against forces which result from the peristaltic movement of the intestine tending to pull on the intestine.
1414. The system of claim 1413, wherein the flexible sleeve is elastic and made of a material having a friction large enough to allow the blocking ring to move towards the bulge to block forces from the peristaltic movement of the intestine tending to pull on the intestine, when at least part of the intestine is located intermediate the sleeve and the conduit.
1415. The system of claim 1413, wherein the single opening of the reservoir comprises a first passage in flow communication with the reservoir and adapted to being connected to a surgically created opening of the patient's intestine, said first passage being arranged for transferring intestinal contents to the reservoir, and a second passage identical with the first passage due to the single opening of the reservoir arranged for transferring intestinal contents from the reservoir.
1416. The system of claim 1415, wherein the second passage is adapted to being surgically connected to a surgically created stoma.
1417. The system of claim 1415, wherein the second passage is adapted to being surgically connected to the patient's anus or to tissue adjacent the patient's anus.
1418. The system of claim 1415, wherein the single opening is adapted to being connected to a portion of a patient's small intestine.
1419. The system of claim 1415, wherein the single opening is adapted to being connected to a portion of a patient's large intestine.
1420. The system of claim 1415, wherein the flow control device comprising at least one valve for closing the normal intestine.
1421. The system of claim 1420, wherein the second passage is adapted to being connected to a lateral opening in a wall of the patient's intestine.
1422. The system of claim 1415, wherein the first passage is adapted to being connected to a lateral opening in a wall of the patient's intestine.
1423. The system of claim 1415, wherein at least the first passage is adapted to being bonded to the patient's intestine.
1424. The system of claim 1415, wherein at least the first passage is adapted to be sewn or stapled to the patient's intestine.
1425. The system of claim 1410, comprising a holding device adapted to be mounted to the peritoneum to hold at least one of the reservoir or pump.
1426. The system of claim 1410, wherein the flow control device comprises at least one valve adapted to be placed onto the intestine downstream the connection between the single opening and the intestine, when implanted.
1427. The system of claim 1426, wherein the at least one valve includes an exit valve preventing intestinal contents flow from the reservoir out from the body.
1428. The system of claim 1427, wherein the exit valve is a normally closed valve.
1429. The system of claim 1426, wherein the flow control device comprises an entry back flow valve adapted to be placed upstream the connection between the single opening and the intestine allowing intestinal contents to flow towards the reservoir in its open position, when implanted.
1430. The system of claim 1429, wherein the entry valve is a normally open valve.
1431. The system of claim 1429, wherein the exit valve and the entry valve are adapted to cooperate such that when one of the two valves is closed, the respective other valve is open, and vice versa.
1432. The system of claim 1426, wherein at least one of the valve or valves, respectively, is adapted to being permanently implanted inside the patient's intestine.
1433. The system of claim 1411, wherein the sleeve adapted to increase the strength of the connection between the reservoir and the patient's intestine against axial forces resulting from peristaltic movements of the intestine which tend to pull on the intestine, comprising non-resorbable material.
1434. The system of claim 1411, wherein the sleeve adapted to increase the strength of the connection between the intestine section and the patient's intestine against axial forces resulting from peristaltic movements of the intestine which tend to pull on the intestine, comprising resorbable non-polymeric material.
1435. The system of claim 1410, wherein said flow control device comprising at least one valve, wherein at least one of the valve or valves, respectively, is adapted to being implanted inside the patient's body outside a section of the patient's intestine and comprises at least one element adapted to act on the intestine section from the outside thereof so as to prevent intestinal contents flow through the intestine section.
1436. The system of claim 1410, comprising a passage in flow communication with the reservoir and adapted to being connected to one of; a surgically created lateral opening in a wall of the patient's intestine, when implanted, and in a surgically divided end opening of the intestine, when the intestine with the surgically divided end opening is sutured on its lateral side to downstream intestine, said passage being arranged for transferring intestinal contents to and from the reservoir.
1437. The system of claim 1426, wherein the at least one valve comprises a compartment with a variable volume adapted to open and close the valve by changing the compartment's volume.
1438. The system of claim 1437, wherein the at least one valve comprises at least one passage for filling and emptying the compartment with hydraulic fluid.
1439. The system of claim 1435, wherein the at least one valve comprises at least one electrical stimulation device adapted to electrically stimulate muscle or neural tissue of an intestine section so as to cause at least partial contraction of the intestine section.
1440. The system of claim 1439, wherein the stimulation device is adapted to stimulate different portions of the intestine section over time.
1441. The system of claim 1440, wherein the stimulation device is adapted to stimulate, over time, the different portions of the intestine section in a wave like manner in a direction opposite to natural intestinal contents flow or in any predetermined stimulation pattern.
1442. The system of claim 1439, wherein the at least one valve comprises a constriction device for at least partly constricting the intestine section mechanically or hydraulically.
1443. The system of claim 1442, wherein the stimulation device and the constriction device are adapted to act on the same intestine section so as to keep the intestine section closed.
1444. The system of claim 1425, wherein said holding device is adapted to pass through the peritoneal wall and hold said intestinal section, comprising a flange intended for placement outside the peritoneum.
1445. The system of claim 1475, wherein the holding device being adapted to hold sutures and staplers passing through the peritoneal wall, when implanted, to hold said artificial intestine section.
1446. The system of claim 1410, wherein the flow control device comprises a pump for emptying the reservoir.
1447. The system of claim 1446, wherein the pump is adapted for emptying the reservoir by squeezing the reservoir.
1448. The system of claim 1446, wherein the pump and the reservoir are separate from each other and wherein the pump is adapted to being implanted in the patient's body separate from but in close proximity to the reservoir so as to act on the reservoir from the outside thereof.
1449. The system of claim 1446, wherein the pump and the reservoir are fixedly connected to one another.
1450. The system of claim 1449, wherein the reservoir is formed by a bellow, said bellow having an end wall closing the bellow at one end thereof, said end wall making part of the pump such that a volume of the bellow can be reduced upon advancement of said end wall.
1451. The system of claim 1446, wherein the pump and the reservoir are separate from each other and wherein the pump is adapted to being implanted in the patient's body outside the patient's intestine, wherein the pump comprises at least one electrical stimulation device adapted to electrically stimulate muscle or neural tissue of an intestine section so as to cause at least partial contraction of the intestine section, wherein the stimulation device comprises at least one electrode adapted to apply electric pulses to the intestine section.
1452. The system of claim 1451, wherein the stimulation device is adapted to stimulate different portions of the intestine section over time and to pump intestinal contents along the intestine section by, over time, stimulating the different portions of the intestine section in a wave like manner in a direction of natural intestinal contents flow.
1453. The system of claim 1446, wherein the pump comprises a constriction device for at least partly constricting the intestine section.
1454. The system of claim 1453, wherein the constriction device is adapted to pump intestinal contents along the intestine section by, over time, constricting different portions of an intestine section in a wave like manner in a direction of natural intestinal contents flow.
1455. The system of claim 1452, wherein the stimulation device is combined with a constriction device for at least partly constricting the intestine section mechanically so as to pump intestinal contents along the intestine section by, over time, stimulating the different portions of the intestine section in a wave like manner in a direction of natural intestinal contents flow, when constriction of the intestine section caused by the constriction device is released at the respective portions.
1456. The system of claim 1446, wherein the pump is manually drivable and comprises an actuator for manually driving the pump, the actuator being arranged for subcutaneous implantation so as to be operable from outside the patient's body.
1457. The system of claim 1410, comprising at least one motor arranged for automatically driving one or more elements of the system including the flow control device.
1458. The system of claim 1410, adapted to receive wireless energy, comprising an implanted chargeable accumulator, further comprising a feedback subsystem adapted to wirelessly send feedback information related to the energy to be stored in the implanted accumulator from inside the human body to the outside thereof, wherein the system is adapted to use the feedback information for adjusting the amount of wireless energy transmitted by the energy transmitter.
1459. The system of claim 1458, wherein the feedback information is related to an energy balance which is defined as the balance between wireless energy received inside the human body and energy consumed by the at least one energy consuming part.
1460. The system of claim 1459, wherein the feedback information is related to an energy balance which is defined as the balance between a rate of wireless energy received inside the human body and a rate of energy consumed by the at least one energy consuming part.
1461. The system of claim 1410, comprising a manually operable switch for activating any part of the system, the switch being arranged for subcutaneous implantation so as to be operable from outside the patient's body.
1462. The system of claim 1410, comprising a physical or functional parameter sensor adapted to directly or indirectly sense a physical parameter of the patient or a functional parameter of the system.
1463. The system of claim 1462, wherein the physical or functional parameter sensor is adapted to sense at least one of the following physical parameters of the patient: a pressure within the reservoir, a pressure within the patient's intestine, an expansion of the reservoir, a distension of an intestinal wall of the patient's intestine, a movement of the intestinal wall.
1464. The system of claim 1410, further comprising an intestinal contents collecting device to be temporarily applied from outside the patient's body.
1465. The system of claim 1464, wherein the collecting device comprises a front open end adapted to be applied towards said exit valve so as to provide a flow passage from the exit valve towards the collecting device.
1466. The system of claim 1465, wherein the collecting device front open end is adapted to be applied to said exit valve so as to open the valve and thereby provide the flow passage towards the collecting device.
1467. The system according to claim 1410, wherein the first and second passage is adapted to connect to an divided intestinal portion such that intestinal mesentery connected thereto is opened in such a way that supply of blood through the mesentery to the dissected intestinal area is maintained on both sides of the divided intestinal portion, wherein an upstream part of the intestine with a first intestinal opening and a downstream part of the intestine with a second intestinal opening with the mesentery still maintaining a tissue connection between the upstream and downstream intestine parts and the connection of the first and second passage are adapted to take such mesentery in account to allow free blood supply, when implanted.
1468. The system according to claim 1467, wherein the downstream intestinal part is adapted to be advanced through the abdominal wall and skin and, thereby achieving an intestinal stoma.
1469. The system according to claim 1467, wherein the downstream intestinal part is adapted to be connected to the patient's anus or tissue adjacent the patient's anus.
1470. The system according to claim 1467, wherein the intestinal openings is created in the patient's small intestine.
1471. The system according to claim 1467, wherein the intestinal openings is created in the patient's large intestine.
1472. A stimulation device for treating a vascular aneurysm of a human or mammal patient comprising:
at least one implantable electrode adapted to be placed in close connection to the aneurysm, the at least one electrode being adapted to provide an electrical stimulation pulse on a wall portion of the aneurysm.
at least one implantable electrode adapted to be placed in close connection to the aneurysm, the at least one electrode being adapted to provide an electrical stimulation pulse on a wall portion of the aneurysm.
1473. The device according to claim 1472, wherein the at least one electrode is adapted to stimulates multiple stimulation points.
1474. The device according to claim 1472, wherein at least two electrodes are provided and wherein groups of stimulation points are controllable to be individually stimulated.
1475. The device according to claim 1472, further comprising a pulse generator adapted to generate positive and negative electrical stimulation pulses.
1476. The device according to claim 1472, wherein the electrical stimulation pulses have a constant current.
1477. The device according to claim 1472, further comprising a stimulation device for delivering the electrical stimulation pulse as pulse train stimulation with breaks to allow the vessel to rest.
1478. The device according to claim 1472, further comprising a stimulation device for delivering the electrical stimulation pulse at different time intervals.
1479. The device according to claim 1472, further comprising a stimulation device for delivering the electrical stimulation pulse as a pulse width modulated stimulation pulse.
1480. The device according to claim 1472, further comprising a stimulation device for delivering the electrical stimulation pulse during the systolic phase.
1481. The device according to claim 1472, further comprising a monitoring system for detecting an expansion of the aneurysm.
1482. The device according to claim 1481, wherein said monitoring system increases intensity and or position of the stimulation, when detecting an expansion of the aneurysm.
1483. A system comprising a device according to claim 1472.
1484. The system according to claim 1483, further comprising at least one switch implantable in the patient for manually and non-invasively controlling the device.
1485. The system according to claim 1483, further comprising a hydraulic device having an implantable hydraulic reservoir, which is hydraulically connected to the device, wherein the device is adapted to be non-invasively regulated by manually pressing the hydraulic reservoir.
1486. The system according to claim 1483, further comprising a wireless remote control for non-invasively controlling the device.
1487. The system according to claim 1486, wherein the wireless remote control comprises at least one external signal transmitter and/or receiver, further comprising an internal signal receiver and/or transmitter implantable in the patient for receiving signals transmitted by the external signal transmitter or transmitting signals to the external signal receiver.
1488. The system according to claim 1486, wherein the wireless remote control transmits at least one wireless control signal for controlling the device.
1489. The system according to claim 1488, wherein the wireless control signal comprises a frequency, amplitude, or phase modulated signal or a combination thereof.
1490. The system according to claim 1488, wherein the wireless remote control transmits an electromagnetic carrier wave signal for carrying the control signal.
1491. The system according to claim 1483, further comprising a wireless energy-transmission device for non-invasively energizing implantable energy consuming components of the device with wireless energy.
1492. The system according to claim 1491, wherein the wireless energy comprises a wave signal selected from the following: a sound wave signal, an ultrasound wave signal, an electromagnetic wave signal, an infrared light signal, a visible light signal, an ultra violet light signal, a laser light signal, a micro wave signal, a radio wave signal, an x-ray radiation signal and a gamma radiation signal.
1493. The system according to claim 1491, wherein the wireless energy comprises one of the following: an electric field, a magnetic field, a combined electric and magnetic field.
1494. The system according to claim 1488, wherein the control signal comprises one of the following: an electric field, a magnetic field, a combined electric and magnetic field.
1495. The system according to claim 1488 or 1492, wherein the signal comprises an analogue signal, a digital signal, or a combination of an analogue and digital signal.
1496. The system according to claim 1483, further comprising an implantable internal energy source for powering implantable energy consuming components of the device.
1497. The system according to claim 1496, further comprising an external energy source for transferring energy in a wireless mode, wherein the internal energy source is chargeable by the energy transferred in the wireless mode.
1498. The system according to claim 1497, further comprising a sensor or measuring device sensing or measuring a functional parameter correlated to the transfer of energy for charging the internal energy source, and a feedback device for sending feedback information from inside the patient's body to the outside thereof, the feedback information being related to the functional parameter sensed by the sensor or measured by the measuring device.
1499. The system according to claim 1483, further comprising a feedback device for sending feedback information from inside the patient's body to the outside thereof, the feedback information being related to at least one of a physical parameter of the patient and a functional parameter related to the device.
1500. The system according to claim 1483, further comprising a sensor and/or a measuring device and an implantable internal control unit for controlling the device in response to information being related to at least one of a physical parameter of the patient sensed by the sensor or measured by the measuring device and a functional parameter related to the device sensed by the sensor or measured by the measuring device.
1501. The system according to claim 1500, wherein the physical parameter is a pressure or a motility movement.
1502. The system according to claim 1483, further comprising an external data communicator and an implantable internal data communicator communicating with the external data communicator, wherein the internal communicator feeds data related to the device or the patient to the external data communicator and/or the external data communicator feeds data to the internal data communicator.
1503. The system according to claim 1483, further comprising a motor or a pump for operating the device.
1504. The system according to claim 1483, further comprising a hydraulic operation device for operating the device.
1505. The system according to claim 1483, further comprising an operation device for operating the device, wherein the operation device comprises a servo designed to decrease the force needed for the operation device to operate the device instead the operation device acting a longer way, increasing the time for a determined action.
1506. The system according to claim 1491, further comprising an operation device for operating the device, wherein the wireless energy is used in its wireless state to directly power the operation device to create kinetic energy for the operation of the device, as the wireless energy is being transmitted by the energy-transmission device.
1507. The system according to claim 1491, further comprising an energy-transforming device for transforming the wireless energy transmitted by the energy-transmission device from a first form into a second form energy.
1508. The system according to claim 1507, wherein the energy-transforming device directly powers implantable energy consuming components of the device with the second form energy, as the energy-transforming device transforms the first form energy transmitted by the energy-transmission device into the second form energy.
1509. The system according to claim 1507, wherein the second form energy comprises at least one of a direct current, pulsating direct current and an alternating current.
1510. The system according to claim 1507, further comprising an implantable accumulator, wherein the second form energy is used at least partly to charge the accumulator.
1511. The system according to claim 1507, wherein the energy of the first or second form comprises at least one of magnetic energy, kinetic energy, sound energy, chemical energy, radiant energy, electromagnetic energy, photo energy, nuclear energy thermal energy, non-magnetic energy, non-kinetic energy, non-chemical energy, non-sonic energy, non-nuclear energy and non-thermal energy.
1512. The system according to claim 1483, further comprising implantable electrical components including at least one voltage level guard and/or at least one constant current guard.
1513. The system according to claim 1491, further comprising a control device for controlling the transmission of wireless energy from the energy-transmission device, and an implantable internal energy receiver for receiving the transmitted wireless energy, the internal energy receiver being connected to implantable energy consuming components of the device for directly or indirectly supplying received energy thereto, the system further comprising a determination device adapted to determine an energy balance between the energy received by the internal energy receiver and the energy used for the implantable energy consuming components of the device , wherein the control device controls the transmission of wireless energy from the external energy-transmission device, based on the energy balance determined by the determination device.
1514. The system according to claim 1513, wherein the determination device is adapted to detect a change in the energy balance, and the control device controls the transmission of wireless energy based on the detected energy balance change.
1515. The system according to claim 1513, wherein the determination device is adapted to detect a difference between energy received by the internal energy receiver and energy used for the implantable energy consuming components of the device, and the control device controls the transmission of wireless energy based on the detected energy difference.
1516. The system according to claim 1491, wherein the energy-transmission device comprises a coil placed externally to the human body, further comprising an implantable energy receiver to be placed internally in the human body and an electric circuit connected to power the external coil with electrical pulses to transmit the wireless energy, the electrical pulses having leading and trailing edges, the electric circuit adapted to vary first time intervals between successive leading and trailing edges and/or second time intervals between successive trailing and leading edges of the electrical pulses to vary the power of the transmitted wireless energy, the energy receiver receiving the transmitted wireless energy having a varied power.
1517. The system according to claim 1516, wherein the electric circuit is adapted to deliver the electrical pulses to remain unchanged except varying the first and/or second time intervals.
1518. The system according to claim 1516, wherein the electric circuit has a time constant and is adapted to vary the first and second time intervals only in the range of the first time constant, so that when the lengths of the first and/or second time intervals are varied, the transmitted power over the coil is varied.
1519. The system according to claim 1499, further comprising an implantable internal energy receiver for receiving wireless energy, the energy receiver having an internal first coil and a first electronic circuit connected to the first coil, and an external energy transmitter for transmitting wireless energy, the energy transmitter having an external second coil and a second electronic circuit connected to the second coil, wherein the external second coil of the energy transmitter transmits wireless energy which is received by the first coil of the energy receiver, the system further comprising a power switch for switching the connection of the internal first coil to the first electronic circuit on and off, such that feedback information related to the charging of the first coil is received by the external energy transmitter in the form of an impedance variation in the load of the external second coil, when the power switch switches the connection of the internal first coil to the first electronic circuit on and off.
1520. The system according to claim 1499, further comprising an implantable internal energy receiver for receiving wireless energy, the energy receiver having an internal first coil and a first electronic circuit connected to the first coil, and an external energy transmitter for transmitting wireless energy, the energy transmitter having an external second coil and a second electronic circuit connected to the second coil, wherein the external second coil of the energy transmitter transmits wireless energy which is received by the first coil of the energy receiver, the system further comprising a feedback device for communicating out the amount of energy received in the first coil as a feedback information, and wherein the second electronic circuit includes a determination device for receiving the feedback information and for comparing the amount of transferred energy by the second coil with the feedback information related to the amount of energy received in the first coil to obtain the coupling factors between the first and second coils.
1521. The system according to claim 1520, wherein the energy transmitter regulates the transmitted energy in response to the obtained coupling factor.
1522. The system according to claim 1520, wherein external second coil is adapted to be moved in relation to the internal first coil to establish the optimal placement of the second coil, in which the coupling factor is maximized.
1523. The system according to claim 1522, wherein the external second coil is adapted to calibrate the amount of transferred energy to achieve the feedback information in the determination device, before the coupling factor is maximized.
Priority Applications (1)
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| CA3086685A CA3086685C (en) | 2007-10-11 | 2008-10-10 | Apparatus for controlling flow in a bodily organ |
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| PCT/SE2008/000568 WO2009048379A2 (en) | 2007-10-11 | 2008-10-10 | Apparatus for controlling flow in a bodily organ |
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Families Citing this family (113)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US6471635B1 (en) * | 2000-02-10 | 2002-10-29 | Obtech Medical Ag | Anal incontinence disease treatment with controlled wireless energy supply |
| US6464628B1 (en) * | 1999-08-12 | 2002-10-15 | Obtech Medical Ag | Mechanical anal incontinence |
| ATE403404T1 (en) | 2000-02-10 | 2008-08-15 | Potencia Medical Ag | MECHANICAL DEVICE FOR TREATING IMPOTENCY |
| CA2397279C (en) | 2000-02-10 | 2009-04-21 | Surgical Development Ag | Controlled urinary incontinence treatment |
| EP1255513B1 (en) * | 2000-02-14 | 2005-05-25 | Potencia Medical AG | Penile prosthesis |
| CN1196451C (en) | 2000-02-14 | 2005-04-13 | 波滕西亚医疗公司 | Male impotence prosthesis apparatus with wireless energy supply |
| US7766973B2 (en) * | 2005-01-19 | 2010-08-03 | Gi Dynamics, Inc. | Eversion resistant sleeves |
| US8262063B2 (en) * | 2005-04-28 | 2012-09-11 | B.V. Holmatro Industrial Equipment | Tool with hydraulic valve system |
| ITTO20060413A1 (en) * | 2006-06-07 | 2007-12-08 | Arrigo Lessana | REPLACEMENT DEVICE OF THE TENDONE ROPES OF AN ATRIOVENTRICULAR VALVE |
| EP2162090A1 (en) * | 2007-07-04 | 2010-03-17 | Nanopowers S.A. | Artificial contractile structure and apparatus comprising such structure |
| US8992409B2 (en) | 2007-10-11 | 2015-03-31 | Peter Forsell | Method for controlling flow in a bodily organ |
| US8696543B2 (en) * | 2007-10-11 | 2014-04-15 | Kirk Promotion Ltd. | Method for controlling flow of intestinal contents in a patient's intestines |
| US9555241B2 (en) * | 2007-10-11 | 2017-01-31 | Peter Forsell | Method of obtaining male contraception |
| US8795153B2 (en) * | 2007-10-11 | 2014-08-05 | Peter Forsell | Method for treating female sexual dysfunction |
| US9949871B2 (en) * | 2007-10-11 | 2018-04-24 | Peter Forsell | Method for controlling flow of eggs in a uterine tube |
| ES2914892T3 (en) * | 2007-10-11 | 2022-06-17 | Implantica Patent Ltd | Apparatus for the treatment of female sexual dysfunction |
| PL2214607T3 (en) * | 2007-10-11 | 2022-02-07 | Implantica Patent Ltd. | System for thermal treatment of hypertension, hypotension or aneurysm |
| BRPI0817871B8 (en) | 2007-10-11 | 2021-06-22 | Implantica Patent Ltd | device for controlling the flow in an organ of the body |
| CA2739840A1 (en) | 2007-10-11 | 2009-04-16 | Peter Forsell | An apparatus for male contraception |
| WO2009048400A1 (en) | 2007-10-11 | 2009-04-16 | Milux Holding Sa | Method for controlling flow in a bodily organ |
| US10307597B2 (en) * | 2007-10-11 | 2019-06-04 | Peter Forsell | Method for controlling flow of urine in a patient's urethra, ureter, renal pelvis or bladder |
| WO2009048372A1 (en) * | 2007-10-11 | 2009-04-16 | Milux Holding Sa | Device, method and system for monitoring and treatment of aneurysm |
| US10195325B2 (en) * | 2007-10-11 | 2019-02-05 | Peter Forsell | Method for controlling flow of sperms in a uterine tube |
| CN101896136B (en) * | 2007-10-12 | 2013-09-18 | 米卢克斯控股股份有限公司 | Apparatus for treating intestinal disorder |
| ES2619193T3 (en) * | 2007-10-12 | 2017-06-23 | Kirk Promotion Ltd. | Ostomy accessory |
| US8961448B2 (en) * | 2008-01-28 | 2015-02-24 | Peter Forsell | Implantable drainage device |
| WO2009096858A1 (en) | 2008-01-29 | 2009-08-06 | Milux Holding Sa | Method and instrument for treating obesity |
| US8874215B2 (en) | 2008-10-10 | 2014-10-28 | Peter Forsell | System, an apparatus, and a method for treating a sexual dysfunctional female patient |
| EP2349170B1 (en) | 2008-10-10 | 2023-09-27 | Implantica Patent Ltd. | Apparatus for the treatment of female sexual dysfunction |
| WO2010042058A1 (en) | 2008-10-10 | 2010-04-15 | Milux Holding S.A. | An improved artificial valve |
| EP2349078A4 (en) | 2008-10-10 | 2018-02-07 | Kirk Promotion LTD. | Fastening means for implantable medcial control assembly |
| CA2776450C (en) | 2008-10-10 | 2018-08-21 | Peter Forsell | Heart help device, system, and method |
| ES2896623T3 (en) | 2008-10-10 | 2022-02-24 | Medicaltree Patent Ltd | Cardiac assist device and system |
| US9949812B2 (en) | 2009-07-17 | 2018-04-24 | Peter Forsell | Vaginal operation method for the treatment of anal incontinence in women |
| US10952836B2 (en) | 2009-07-17 | 2021-03-23 | Peter Forsell | Vaginal operation method for the treatment of urinary incontinence in women |
| US8594806B2 (en) | 2010-04-30 | 2013-11-26 | Cyberonics, Inc. | Recharging and communication lead for an implantable device |
| US20110277778A1 (en) * | 2010-05-14 | 2011-11-17 | Tyco Healthcare Group Lp | System and Method for Diverticulitis Treatment |
| CN101884528A (en) * | 2010-06-13 | 2010-11-17 | 天津九安医疗电子股份有限公司 | Blood pressure measuring device |
| US9901433B2 (en) | 2010-07-02 | 2018-02-27 | Myopowers Medical Technologies France | Medical device comprising an artificial contractile structure |
| EP2401985A1 (en) * | 2010-07-02 | 2012-01-04 | MyoPowers Medical Technologies SA | Medical device comprising an artificial contractile structure |
| USD737445S1 (en) * | 2010-07-09 | 2015-08-25 | Cheiron Japan Co. | Urination control device |
| RU2485908C2 (en) * | 2010-12-07 | 2013-06-27 | Компания с ограниченной ответственностью Глобитек 2000 | Method of creating hemostasis with possibility of blood flow recovery in tubular elastic structures of organism and devices for its realisation |
| US8432632B2 (en) | 2011-05-23 | 2013-04-30 | International Business Machines Corporation | Magnetic disk drive using a non-volatile storage device as cache for modified tracks |
| WO2013016349A2 (en) * | 2011-07-25 | 2013-01-31 | Neograft Technologies, Inc. | Vessel treatment methods and devices for use in a graft device |
| WO2013109778A1 (en) * | 2012-01-17 | 2013-07-25 | Sigma Instruments Holdings, Llc | System and method for treating soft tissue with force impulse and electrical stimulation |
| US10238483B2 (en) * | 2011-09-16 | 2019-03-26 | 3Dt Holdings, Llc | Devices and methods for assisting valve function, replacing venous valves, and predicting valve treatment success |
| WO2013042118A1 (en) * | 2011-09-20 | 2013-03-28 | A.A. Cash Technology Ltd | Methods and devices for occluding blood flow to an organ |
| WO2013091730A1 (en) * | 2011-12-23 | 2013-06-27 | Myopowers Medical Technologies Sa | Medical device comprising an artificial contractile structure |
| CN103182102B (en) * | 2011-12-31 | 2016-03-30 | 北京万生人和科技有限公司 | Urine drainage system, drainage controlling device, drain control system |
| WO2013111137A2 (en) | 2012-01-26 | 2013-08-01 | Rainbow Medical Ltd. | Wireless neurqstimulatqrs |
| JP2013158589A (en) * | 2012-02-08 | 2013-08-19 | Toshiba Corp | Medical image diagnosis apparatus |
| WO2013120082A1 (en) | 2012-02-10 | 2013-08-15 | Kassab Ghassan S | Methods and uses of biological tissues for various stent and other medical applications |
| US10064651B2 (en) | 2012-03-15 | 2018-09-04 | Inpress Technologies, Inc. | Uterine hemorrhage controlling system and method |
| EP2874568B1 (en) | 2012-07-20 | 2018-01-10 | Cook Medical Technologies LLC | Implantable medical device having a sleeve |
| US9343923B2 (en) | 2012-08-23 | 2016-05-17 | Cyberonics, Inc. | Implantable medical device with backscatter signal based communication |
| AU2013315590A1 (en) | 2012-09-11 | 2015-04-30 | Sparq Laboratories, Llc | Systems and methods for haptic stimulation |
| US9935498B2 (en) | 2012-09-25 | 2018-04-03 | Cyberonics, Inc. | Communication efficiency with an implantable medical device using a circulator and a backscatter signal |
| CN110496036A (en) * | 2012-09-26 | 2019-11-26 | 奥博迪克斯股份有限公司 | Fluid means and its method |
| WO2014087337A1 (en) | 2012-12-06 | 2014-06-12 | Bluewind Medical Ltd. | Delivery of implantable neurostimulators |
| EP2953580A2 (en) | 2013-02-11 | 2015-12-16 | Cook Medical Technologies LLC | Expandable support frame and medical device |
| CN103142283B (en) * | 2013-02-18 | 2015-04-15 | 西安交通大学 | Electromagnetic controllable occlusion system for celiac great vessels |
| FR3005847B1 (en) * | 2013-05-21 | 2015-05-08 | Uromems | METHOD AND DEVICE FOR DETECTING SLOW LEAKAGE IN AN IMPLANTABLE HYDRAULIC OCCLUSIVE SYSTEM |
| FR3005846B1 (en) * | 2013-05-21 | 2018-03-23 | Uromems | METHOD AND DEVICE FOR DETECTING THE ATROPHY OF A NATURAL CONDUIT SURROUNDED BY AN OCCLUSION SYSTEM |
| WO2015042558A1 (en) * | 2013-09-23 | 2015-03-26 | Board Of Regents, The University Of Texas System | Wireless tissue stimulation devices |
| CN103655018B (en) * | 2013-12-20 | 2015-11-18 | 广东工业大学 | The steam-powered urethra valve of a kind of ultrasonic vaporisation |
| CN103637860B (en) * | 2013-12-23 | 2015-06-24 | 上海交通大学 | Open-close control system for artificial anal sphincter prosthesis |
| US11806266B2 (en) | 2014-03-19 | 2023-11-07 | Purewick Corporation | Apparatus and methods for receiving discharged urine |
| CN105213066B (en) * | 2014-06-25 | 2017-04-19 | 中国人民解放军第二军医大学 | Synthesized patch with wireless stimulation function and used for resisting reflux esophagitis |
| CN104055548B (en) * | 2014-07-10 | 2016-03-02 | 张自雄 | The device that chamber is suitable for cervical region endoscopic surgery is built by Magnetic force tracting activity |
| US10070956B2 (en) | 2014-09-24 | 2018-09-11 | Boston Scientific Scimed, Inc. | Inflatable penile prosthesis cylinders |
| FR3028749B1 (en) * | 2014-11-25 | 2020-10-09 | Uromems | IMPLANTABLE OCCLUSIVE SYSTEM |
| US10004896B2 (en) | 2015-01-21 | 2018-06-26 | Bluewind Medical Ltd. | Anchors and implant devices |
| US9764146B2 (en) | 2015-01-21 | 2017-09-19 | Bluewind Medical Ltd. | Extracorporeal implant controllers |
| US10940079B2 (en) | 2015-05-19 | 2021-03-09 | Sparq Laboratories, Llc | Male and female sexual aid with wireless capabilities |
| US9782589B2 (en) | 2015-06-10 | 2017-10-10 | Bluewind Medical Ltd. | Implantable electrostimulator for improving blood flow |
| US10105540B2 (en) | 2015-11-09 | 2018-10-23 | Bluewind Medical Ltd. | Optimization of application of current |
| US9713707B2 (en) | 2015-11-12 | 2017-07-25 | Bluewind Medical Ltd. | Inhibition of implant migration |
| CN113057762A (en) | 2015-12-07 | 2021-07-02 | 桑诺维私人有限公司 | Devices and methods for pressure responsive remodeling of blood vessels |
| US10578094B2 (en) | 2016-05-04 | 2020-03-03 | Curium Us Llc | Pump for operation in radioactive environment |
| US9750591B1 (en) * | 2016-07-29 | 2017-09-05 | Sam Sultan | Systems and methods for assisting patients in emptying their bladder efficiently |
| CA3034778A1 (en) | 2016-08-24 | 2018-03-01 | Alydia Health, Inc. | Uterine hemorrhage controlling system and method |
| CN106510894A (en) * | 2016-10-24 | 2017-03-22 | 温州医科大学附属第医院 | Program-controlled implantable micro-electrical stimulation synthetic sling for treating uracratia |
| US10164443B2 (en) * | 2016-11-08 | 2018-12-25 | Korea Electric Power Corporation | Method of controlling frequency of power system |
| US10124178B2 (en) | 2016-11-23 | 2018-11-13 | Bluewind Medical Ltd. | Implant and delivery tool therefor |
| US11896823B2 (en) | 2017-04-04 | 2024-02-13 | Btl Healthcare Technologies A.S. | Method and device for pelvic floor tissue treatment |
| US10687676B2 (en) * | 2017-06-09 | 2020-06-23 | Hamilton Sundstrand Corporation | Microgravity urine collection and storage |
| US20180353764A1 (en) | 2017-06-13 | 2018-12-13 | Bluewind Medical Ltd. | Antenna configuration |
| US10722340B2 (en) | 2017-07-31 | 2020-07-28 | Ethicon Llc | Magnetic sphincter replacement device with internal seals |
| US10729533B2 (en) | 2017-07-31 | 2020-08-04 | Ethicon Llc | Absorbable polymer with drug elution for a magnet sphincter assist device |
| US10405865B2 (en) * | 2017-07-31 | 2019-09-10 | Ethicon Llc | Method for assisting a sphincter |
| US10716658B2 (en) | 2017-07-31 | 2020-07-21 | Ethicon Llc | Absorbable polymer for a magnetic sphincter assist device |
| EP3687420A4 (en) * | 2017-09-29 | 2021-04-14 | Helsinki Surgical Instruments AB | A device for applying external pressure on a surface of an anatomical object |
| US10881578B2 (en) | 2017-10-30 | 2021-01-05 | Bryan DeVore | Traction apparatus |
| US10842552B2 (en) | 2017-11-17 | 2020-11-24 | Gyrus Acmi, Inc. | Vessel sealing device |
| CN108543165B (en) * | 2018-02-27 | 2021-06-18 | 宁波胜杰康生物科技有限公司 | Carrier-based muscle function auxiliary device |
| CA3098570C (en) | 2018-05-01 | 2023-09-26 | Purewick Corporation | Fluid collection devices, related systems, and related methods |
| AU2019262941B2 (en) | 2018-05-01 | 2022-03-03 | Purewick Corporation | Fluid collection devices, systems, and methods |
| USD887010S1 (en) | 2018-05-11 | 2020-06-09 | Thal Smith-Martin | Magnetic therapy device |
| US11033276B2 (en) | 2018-06-14 | 2021-06-15 | Sano V Pte Ltd | Methods for embedding an implant in blood vessels |
| US11051931B2 (en) * | 2018-10-31 | 2021-07-06 | Cilag Gmbh International | Active sphincter implant to re-route flow through gastrointestinal tract |
| WO2020168216A1 (en) * | 2019-02-17 | 2020-08-20 | El Azouzi Youssef | Flow restricting stent-graft |
| US11219462B2 (en) | 2019-03-25 | 2022-01-11 | Laminar, Inc. | Devices, systems, and methods for treating the left atrial appendage |
| US11684702B2 (en) * | 2019-05-24 | 2023-06-27 | Conmed Corporation | Gap control in electrosurgical instruments using expanded polytetrafluoroethylene |
| CN110840507B (en) * | 2019-11-22 | 2021-08-20 | 北京泌康医疗科技有限公司 | Urinary incontinence automatic control system with multipoint alternate switching function and internal machine thereof |
| CN110974482A (en) * | 2019-11-22 | 2020-04-10 | 北京泌康医疗科技有限公司 | Urinary incontinence automatic control system with wireless transmission function and internal machine thereof |
| US11628052B2 (en) * | 2020-05-13 | 2023-04-18 | Jt Godfrey, Llc | Device for use with body tissue sphincters |
| CN111773459B (en) * | 2020-07-17 | 2023-02-17 | 江苏大学 | Flexible traveling wave driven heart micropump and driving method thereof |
| US20220062026A1 (en) * | 2020-09-02 | 2022-03-03 | Purewick Corporation | Systems and methods including a male fluid collection device and a securement element |
| US11801186B2 (en) | 2020-09-10 | 2023-10-31 | Purewick Corporation | Urine storage container handle and lid accessories |
| CN112138280B (en) * | 2020-09-19 | 2023-06-02 | 西安交通大学医学院第一附属医院 | Therapeutic apparatus with infinite electric stimulation function for resisting gastroesophageal reflux disease |
| EP4349306A2 (en) | 2021-01-19 | 2024-04-10 | Purewick Corporation | Variable fit fluid collection devices |
| JP2023553620A (en) | 2021-02-26 | 2023-12-25 | ピュアウィック コーポレイション | Fluid collection device having a drainage basin between a pipe opening and a barrier, and related systems and methods |
| US11400299B1 (en) | 2021-09-14 | 2022-08-02 | Rainbow Medical Ltd. | Flexible antenna for stimulator |
Family Cites Families (290)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US3357432A (en) | 1965-02-09 | 1967-12-12 | Edwards Lab Inc | Anastomotic coupling |
| SE344275B (en) | 1966-02-10 | 1972-04-10 | R Gruenert | |
| GB1222731A (en) | 1968-07-01 | 1971-02-17 | Bireswar Bysakh | Vibrator device |
| US3705575A (en) * | 1969-09-26 | 1972-12-12 | Lynn Euryl Edwards | Incontinence device for female use |
| US3750194A (en) | 1971-03-16 | 1973-08-07 | Fairchild Industries | Apparatus and method for reversibly closing a natural or implanted body passage |
| DE2220117C3 (en) | 1972-04-25 | 1975-01-09 | Bleier, Waldemar, Dr.Med., 6630 Saarlouis | Clip for long-term reversible or permanent interruption of express parents and vas deferens within the human or animal organism as well as instruments for setting the clip |
| US3817237A (en) | 1972-08-24 | 1974-06-18 | Medtronic Inc | Regulatory apparatus |
| US3863622A (en) | 1973-01-09 | 1975-02-04 | Robert Enno Buuck | Incontinence system and methods of implanting and using same |
| US3875928A (en) | 1973-08-16 | 1975-04-08 | Angelchik Jean P | Method for maintaining the reduction of a sliding esophageal hiatal hernia |
| FR2248015A1 (en) | 1973-10-17 | 1975-05-16 | Rhone Poulenc Ind | Artificial ureter or urethra - watertight flexible tube has helical rib in outside wall to prevent creasing |
| US4146029A (en) | 1974-04-23 | 1979-03-27 | Ellinwood Jr Everett H | Self-powered implanted programmable medication system and method |
| US4026305A (en) | 1975-06-26 | 1977-05-31 | Research Corporation | Low current telemetry system for cardiac pacers |
| US4050449A (en) | 1976-02-25 | 1977-09-27 | Medical Products Development Corporation | Apparatus for exercising muscles of a female patient's pelvic diaphragm |
| US4153059A (en) | 1977-10-25 | 1979-05-08 | Minnesota Mining And Manufacturing Company | Urinary incontinence stimulator system |
| US4245623A (en) | 1978-06-06 | 1981-01-20 | Erb Robert A | Method and apparatus for the hysteroscopic non-surgical sterilization of females |
| US4190040A (en) | 1978-07-03 | 1980-02-26 | American Hospital Supply Corporation | Resealable puncture housing for surgical implantation |
| US4246893A (en) | 1978-07-05 | 1981-01-27 | Daniel Berson | Inflatable gastric device for treating obesity |
| AU539132B2 (en) | 1979-10-30 | 1984-09-13 | Juan Voltas Baro and Hector Ortiz Hurtado | Device to obtain continence |
| US4419985A (en) | 1980-08-28 | 1983-12-13 | Medical Engineering Corporation | Apparatus for reversibly closing a body passage |
| US4342308A (en) | 1980-10-02 | 1982-08-03 | Medical Engineering Corporation | Penile erectile system |
| US4408597A (en) | 1982-04-23 | 1983-10-11 | The United States Of America As Represented By The Administrator Of The National Aeronautics And Space Administration | Prosthetic occlusive device for an internal passageway |
| IL67773A (en) | 1983-01-28 | 1985-02-28 | Antebi E | Tie for tying live tissue and an instrument for performing said tying operation |
| US4602625A (en) | 1983-03-04 | 1986-07-29 | Medical Engineering Corporation | Penile erectile system |
| US4559931A (en) | 1983-03-21 | 1985-12-24 | Fischell Robert | Manually actuated fully implantable penile erection device |
| DE3317118C2 (en) | 1983-05-06 | 1986-08-28 | Richard Wolf Gmbh, 7134 Knittlingen | Device for the treatment of the female incontinentia urinae |
| US4584994A (en) | 1983-09-30 | 1986-04-29 | Charles Bamberger | Electromagnetic implant |
| US4587954A (en) | 1983-12-29 | 1986-05-13 | Habley Medical Technology Corporation | Elastomeric prosthetic sphincter |
| US4538607A (en) | 1984-02-06 | 1985-09-03 | Ab Fixfabriken | Tracheostomy valve |
| WO1986001395A1 (en) | 1984-09-05 | 1986-03-13 | Intra Optics Laboratories Pty. Ltd. | Control of blood flow |
| US4728328A (en) | 1984-10-19 | 1988-03-01 | Research Corporation | Cuffed tubular organic prostheses |
| EP0200286A3 (en) | 1985-02-28 | 1987-01-14 | Quotidian No. 100 Pty. Limited | Control of blood flow |
| US4634443A (en) | 1985-07-05 | 1987-01-06 | Habley Medical Technology Corporation | Single circuit elastofluidic sphincter |
| US4696288A (en) | 1985-08-14 | 1987-09-29 | Kuzmak Lubomyr I | Calibrating apparatus and method of using same for gastric banding surgery |
| US4780064A (en) | 1986-02-10 | 1988-10-25 | Flow Industries, Inc. | Pump assembly and its method of operation |
| DE3618390C1 (en) | 1986-05-31 | 1987-11-26 | Fresenius Ag | Injection site for medical fluids |
| JPS6318177A (en) | 1986-07-11 | 1988-01-26 | Isuzu Motors Ltd | Suction system for internal combustion engine |
| US4723538A (en) | 1986-10-16 | 1988-02-09 | Stewart Edward T | Penile constrictor ring |
| US4711231A (en) | 1986-11-03 | 1987-12-08 | Aaron N. Finegold | Implantable prosthesis system |
| US4822348A (en) | 1987-05-13 | 1989-04-18 | Donn Casey | Surgical clips |
| US4829990A (en) | 1987-06-25 | 1989-05-16 | Thueroff Joachim | Implantable hydraulic penile erector |
| US4786276A (en) | 1987-07-01 | 1988-11-22 | Habley Medical Technology Corporation | Triple cushion sphincteric web |
| US4773403A (en) | 1987-08-17 | 1988-09-27 | Medical Engineering Corporation | Penile prosthesis |
| US4822341A (en) | 1987-11-20 | 1989-04-18 | Impra, Inc. | Vascular access fistula |
| US4942668A (en) | 1988-05-11 | 1990-07-24 | Zircon International, Inc. | Digital inclinometer |
| JPH01305945A (en) | 1988-06-02 | 1989-12-11 | Olympus Optical Co Ltd | Energy supply device |
| US4878889A (en) | 1988-06-24 | 1989-11-07 | American Medical Systems, Inc. | Artificial sphincter device |
| AU4191989A (en) | 1988-08-24 | 1990-03-23 | Marvin J. Slepian | Biodegradable polymeric endoluminal sealing |
| US5123428A (en) | 1988-10-11 | 1992-06-23 | Schwarz Gerald R | Laparoscopically implanting bladder control apparatus |
| US4982731A (en) | 1988-10-26 | 1991-01-08 | The Regents Of The University Of California | Implantable system and method for augmenting penile erection |
| US4961747A (en) | 1988-12-05 | 1990-10-09 | General Electric Company | Implantable articifical bladder system |
| SU1635980A1 (en) | 1988-12-27 | 1991-03-23 | Всесоюзный научный центр хирургии АМН СССР | Device for esophagus stenosis endoprosthesis installation |
| JPH02211170A (en) | 1989-02-10 | 1990-08-22 | Olympus Optical Co Ltd | Implantation type injection liquid pump |
| US4976735A (en) | 1989-04-20 | 1990-12-11 | Griffith Donald P | Prosthetic bladder and method of prosthesis implantation |
| CN1047447A (en) | 1989-05-23 | 1990-12-05 | 杨西群 | Fallopian tube blockage embolus and installation system thereof |
| JPH0363047A (en) | 1989-07-31 | 1991-03-19 | Olympus Optical Co Ltd | Energy feeding apparatus for medical tool kept in human body |
| US5876425A (en) | 1989-09-22 | 1999-03-02 | Advanced Bionics Corporation | Power control loop for implantable tissue stimulator |
| US4958630A (en) | 1989-10-06 | 1990-09-25 | Advanced Surgical Intervention, Inc. | Method and apparatus for treating impotence |
| US5048511A (en) | 1989-10-06 | 1991-09-17 | Advanced Surgical Intervention, Inc. | Method and apparatus for treating impotence |
| US5324263A (en) | 1989-11-02 | 1994-06-28 | Danforth Biomedical, Inc. | Low profile high performance interventional catheters |
| FR2653993B1 (en) | 1989-11-03 | 1992-01-10 | Synthelabo | HYDRAULIC PRESSURE INVERTER FOR THE CONTROL OF AN ARTIFICIAL SPHINCTER, AND IMPLANTABLE PROSTHESIS COMPRISING SAID INVERTER. |
| US4983177A (en) | 1990-01-03 | 1991-01-08 | Wolf Gerald L | Method and apparatus for reversibly occluding a biological tube |
| US5350360A (en) | 1990-03-01 | 1994-09-27 | Michigan Transtech Corporation | Implantable access devices |
| US5074868A (en) | 1990-08-03 | 1991-12-24 | Inamed Development Company | Reversible stoma-adjustable gastric band |
| US5261898A (en) | 1990-11-13 | 1993-11-16 | Polin Stanton G | Temporary colostomy apparatus |
| US5226429A (en) | 1991-06-20 | 1993-07-13 | Inamed Development Co. | Laparoscopic gastric band and method |
| AU8391391A (en) | 1991-07-15 | 1993-02-23 | Reebok International Ltd. | Inflation mechanism |
| US5250020A (en) | 1991-09-12 | 1993-10-05 | Mentor Corporation | Unitary inflatable penile prosthesis |
| US5160338A (en) | 1991-11-13 | 1992-11-03 | Inamed Development Co. | Device for removing implantable articles |
| US5304206A (en) | 1991-11-18 | 1994-04-19 | Cyberonics, Inc. | Activation techniques for implantable medical device |
| SE503716C2 (en) | 1991-12-12 | 1996-08-12 | Nobel Biocare Ab | Device for stabilizing the nipple base of an intestinal reservoir |
| FR2688693A1 (en) | 1992-03-19 | 1993-09-24 | Ferriere Xavier | Artificial sphincter, especially urethral (urinary) sphincter |
| US6302910B1 (en) | 1992-06-23 | 2001-10-16 | Sun Medical Technology Research Corporation | Auxiliary artificial heart of an embedded type |
| FR2692777A1 (en) | 1992-06-26 | 1993-12-31 | Alfieri Patrick | Remote control unit for implant esp. artificial sphincter in human body - uses oscillator, amplifier, and transmitting antenna to send energy to tuned receiving antenna on implant |
| US5447526A (en) | 1992-12-24 | 1995-09-05 | Karsdon; Jeffrey | Transcutaneous electric muscle/nerve controller/feedback unit |
| US5632753A (en) | 1992-12-31 | 1997-05-27 | Loeser; Edward A. | Surgical procedures |
| US5449368A (en) | 1993-02-18 | 1995-09-12 | Kuzmak; Lubomyr I. | Laparoscopic adjustable gastric banding device and method for implantation and removal thereof |
| US5437605A (en) | 1993-05-27 | 1995-08-01 | Helmy; Ali M. | Remote controllable penile prosthetic system |
| US5518504A (en) | 1993-12-28 | 1996-05-21 | American Medical Systems, Inc. | Implantable sphincter system utilizing lifting means |
| US5454840A (en) | 1994-04-05 | 1995-10-03 | Krakovsky; Alexander A. | Potency package |
| US5453079A (en) | 1994-06-15 | 1995-09-26 | Schwaninger; Claude L. | Blood flow valve for treatment of male sexual impotence |
| AU701572B2 (en) | 1994-07-11 | 1999-02-04 | Dacomed Corporation | Vessel occlusive prosthesis |
| US5509888A (en) * | 1994-07-26 | 1996-04-23 | Conceptek Corporation | Controller valve device and method |
| US5562598A (en) | 1994-09-20 | 1996-10-08 | Whalen Biomedical Inc. | Artificial urethral sphincter |
| DK0788351T3 (en) | 1994-11-10 | 2003-05-26 | Univ Kentucky Res Found | Implantable, refillable device for speed-controlled drug delivery directly to an internal part of the body |
| US5591217A (en) | 1995-01-04 | 1997-01-07 | Plexus, Inc. | Implantable stimulator with replenishable, high value capacitive power source and method therefor |
| US5704915A (en) | 1995-02-14 | 1998-01-06 | Therex Limited Partnership | Hemodialysis access device |
| JPH08336069A (en) | 1995-04-13 | 1996-12-17 | Eastman Kodak Co | Electronic still camera |
| US6176240B1 (en) | 1995-06-07 | 2001-01-23 | Conceptus, Inc. | Contraceptive transcervical fallopian tube occlusion devices and their delivery |
| US5702431A (en) | 1995-06-07 | 1997-12-30 | Sulzer Intermedics Inc. | Enhanced transcutaneous recharging system for battery powered implantable medical device |
| GR1002392B (en) | 1995-07-14 | 1996-07-05 | Stapler for trapping the free end of a vessel with staples of the male-female type and joining thereof to the vessel implant | |
| US6102922A (en) | 1995-09-22 | 2000-08-15 | Kirk Promotions Limited | Surgical method and device for reducing the food intake of patient |
| EP0836444A1 (en) | 1996-05-05 | 1998-04-22 | Influence Medical Technologies Ltd. | Implantable pump and prosthetic devices |
| US5690691A (en) * | 1996-05-08 | 1997-11-25 | The Center For Innovative Technology | Gastro-intestinal pacemaker having phased multi-point stimulation |
| CN2275859Y (en) | 1996-06-14 | 1998-03-11 | 广东省计划生育科学技术研究所 | Fallopian tube contraceptive device and its laying up apparatus |
| DK0846474T3 (en) | 1996-10-30 | 2003-09-22 | Nihon Kohden Corp | Urinary incontinence prevention device |
| US6091995A (en) * | 1996-11-08 | 2000-07-18 | Surx, Inc. | Devices, methods, and systems for shrinking tissues |
| FR2756485A1 (en) | 1996-11-29 | 1998-06-05 | Cusset Claude | PROSTHETIC URINARY SPHINCTER WITH EXTERNAL CONTROL |
| WO1998037926A1 (en) | 1997-02-26 | 1998-09-03 | Alfred E. Mann Foundation For Scientific Research | Battery-powered patient implantable device |
| US5938669A (en) | 1997-05-07 | 1999-08-17 | Klasamed S.A. | Adjustable gastric banding device for contracting a patient's stomach |
| US6056762A (en) | 1997-05-22 | 2000-05-02 | Kensey Nash Corporation | Anastomosis system and method of use |
| ES2238759T3 (en) | 1997-06-05 | 2005-09-01 | Adiana, Inc. | APPARATUS FOR THE OCLUSION OF THE UTERINE TRUMPS. |
| US6332466B1 (en) | 1997-07-08 | 2001-12-25 | Inbae Yoon | Ovarian capsules and methods of surgical contraception by ovarian encapsulation |
| IL133902A0 (en) * | 1997-07-16 | 2001-04-30 | Impulse Dynamics Ltd | Smooth muscle controller |
| DE19732982A1 (en) * | 1997-07-31 | 1999-02-18 | Michael Huelser | Intestine end closure device |
| US6135945A (en) | 1997-08-04 | 2000-10-24 | Sultan; Hashem | Anti-incontinence device |
| US6039748A (en) | 1997-08-05 | 2000-03-21 | Femrx, Inc. | Disposable laparoscopic morcellator |
| US6050982A (en) | 1997-11-03 | 2000-04-18 | Wheeler; Alton D. | Concealed colostomy apparatus and method |
| US5995874A (en) | 1998-02-09 | 1999-11-30 | Dew Engineering And Development Limited | Transcutaneous energy transfer device |
| ES2149091B1 (en) | 1998-03-10 | 2001-05-16 | Gil Vernet Vila Jose Maria | DEVICE FOR FIXING AND ADJUSTABLE SUPPORT AT HEIGHT OF INTERNAL ANATOMICAL ORGANS. |
| US6319191B1 (en) * | 1998-03-26 | 2001-11-20 | Precision Medical Devices, Inc. | Implantable body fluid flow control device |
| US5910149A (en) | 1998-04-29 | 1999-06-08 | Kuzmak; Lubomyr I. | Non-slipping gastric band |
| US6074341A (en) | 1998-06-09 | 2000-06-13 | Timm Medical Technologies, Inc. | Vessel occlusive apparatus and method |
| AU761192B2 (en) | 1998-06-10 | 2003-05-29 | Converge Medical, Inc. | Sutureless anastomosis systems |
| WO1999065563A1 (en) | 1998-06-19 | 1999-12-23 | Genetronics, Inc. | Electrically assisted transdermal method and apparatus for the treatment of erectile dysfunction |
| US6213960B1 (en) * | 1998-06-19 | 2001-04-10 | Revivant Corporation | Chest compression device with electro-stimulation |
| US6210347B1 (en) | 1998-08-13 | 2001-04-03 | Peter Forsell | Remote control food intake restriction device |
| US6460543B1 (en) | 1998-08-13 | 2002-10-08 | Obtech Medical Ag | Non-injection port food intake restriction device |
| US6067991A (en) | 1998-08-13 | 2000-05-30 | Forsell; Peter | Mechanical food intake restriction device |
| FR2783153B1 (en) | 1998-09-14 | 2000-12-01 | Jerome Dargent | GASTRIC CONSTRICTION DEVICE |
| IL127481A (en) | 1998-10-06 | 2004-05-12 | Bio Control Medical Ltd | Incontinence treatment device |
| AU1116000A (en) | 1998-10-15 | 2000-05-01 | Cardio Technologies, Inc. | Passive defibrillation electrodes for use with cardiac assist device |
| US6964643B2 (en) | 1998-11-18 | 2005-11-15 | Nugyn, Inc. | Devices and methods for treatment of incontinence |
| WO2000028939A2 (en) | 1998-11-18 | 2000-05-25 | Urometrics, Inc. | Clitoral treatment devices and methods |
| US6097984A (en) | 1998-11-25 | 2000-08-01 | Medtronic, Inc. | System and method of stimulation for treating gastro-esophageal reflux disease |
| US6486207B2 (en) | 1998-12-10 | 2002-11-26 | Nexmed (Holdings), Inc. | Compositions and methods for amelioration of human female sexual dysfunction |
| US6309384B1 (en) | 1999-02-01 | 2001-10-30 | Adiana, Inc. | Method and apparatus for tubal occlusion |
| DE19909427C1 (en) | 1999-02-23 | 2000-05-25 | Bimek Clemens | Contraceptive semen blocker for men has valve positioned in sperm duct and actuated by external pressure |
| EP1187656A1 (en) * | 1999-05-26 | 2002-03-20 | Impulse Dynamics N.V. | Local cardiac motion control using applied electrical signals and mechanical force |
| US6516227B1 (en) | 1999-07-27 | 2003-02-04 | Advanced Bionics Corporation | Rechargeable spinal cord stimulator system |
| AUPQ202699A0 (en) | 1999-08-04 | 1999-08-26 | University Of Melbourne, The | Prosthetic device for incontinence |
| US6454701B1 (en) | 1999-08-12 | 2002-09-24 | Obtech Medical Ag | Heartburn and reflux disease treatment apparatus with energy transfer device |
| US6503189B1 (en) | 1999-08-12 | 2003-01-07 | Obtech Medical Ag | Controlled anal incontinence disease treatment |
| US6482145B1 (en) | 2000-02-14 | 2002-11-19 | Obtech Medical Ag | Hydraulic anal incontinence treatment |
| US6464628B1 (en) | 1999-08-12 | 2002-10-15 | Obtech Medical Ag | Mechanical anal incontinence |
| MXPA02001220A (en) * | 1999-08-12 | 2004-05-21 | Blomberg Axel | Medical implant apparatus with wireless energy transmission. |
| US6454698B1 (en) | 1999-08-12 | 2002-09-24 | Obtech Medical Ag | Anal incontinence treatment with energy transfer device |
| US6471635B1 (en) | 2000-02-10 | 2002-10-29 | Obtech Medical Ag | Anal incontinence disease treatment with controlled wireless energy supply |
| US6454699B1 (en) | 2000-02-11 | 2002-09-24 | Obtech Medical Ag | Food intake restriction with controlled wireless energy supply |
| US6453907B1 (en) | 1999-08-12 | 2002-09-24 | Obtech Medical Ag | Food intake restriction with energy transfer device |
| US6116193A (en) | 1999-11-05 | 2000-09-12 | Goeckner; Troy C. | Sow breeding saddle |
| US20030208212A1 (en) * | 1999-12-07 | 2003-11-06 | Valerio Cigaina | Removable gastric band |
| US6600953B2 (en) | 2000-12-11 | 2003-07-29 | Impulse Dynamics N.V. | Acute and chronic electrical signal therapy for obesity |
| AU2001236522A1 (en) | 2000-01-25 | 2001-08-07 | Harridan Medical | Device for preventing fecal incontinence |
| US6454700B1 (en) | 2000-02-09 | 2002-09-24 | Obtech Medical Ag | Heartburn and reflux disease treatment apparatus with wireless energy supply |
| WO2001058388A1 (en) | 2000-02-10 | 2001-08-16 | Potencia Medical Ag | Urinary incontinence treatment with wireless energy supply |
| ATE403404T1 (en) | 2000-02-10 | 2008-08-15 | Potencia Medical Ag | MECHANICAL DEVICE FOR TREATING IMPOTENCY |
| US6463935B1 (en) | 2000-02-10 | 2002-10-15 | Obtech Medical Ag | Controlled heartburn and reflux disease treatment |
| US6470892B1 (en) | 2000-02-10 | 2002-10-29 | Obtech Medical Ag | Mechanical heartburn and reflux treatment |
| EP1563814B1 (en) | 2000-02-10 | 2007-06-13 | Potencia Medical AG | Mechanical impotence treatment apparatus |
| CA2397279C (en) | 2000-02-10 | 2009-04-21 | Surgical Development Ag | Controlled urinary incontinence treatment |
| US6450946B1 (en) | 2000-02-11 | 2002-09-17 | Obtech Medical Ag | Food intake restriction with wireless energy transfer |
| DE60125351T2 (en) | 2000-02-11 | 2007-05-16 | Potencia Medical Ag | URINARY INCONTINENCE TREATMENT DEVICE |
| DE60131726T2 (en) | 2000-02-11 | 2008-11-06 | Potencia Medical Ag | CONTROLLED IMPOTENA TREATMENT |
| BR0108141B1 (en) | 2000-02-11 | 2010-05-04 | impotence treatment apparatus with an energy transforming device | |
| EP1259201A2 (en) | 2000-02-11 | 2002-11-27 | Obtech Medical AG | Food intake restriction apparatus with controlled wireless energy supply |
| EP1792583A1 (en) * | 2000-02-11 | 2007-06-06 | Potencia Medical AG | Urinary incontinence treatment apparatus |
| US20030100929A1 (en) | 2000-02-14 | 2003-05-29 | Peter Forsell | Controlled penile prosthesis |
| WO2001050833A2 (en) | 2000-02-14 | 2001-07-19 | Potencia Medical Ag | Hydraulic urinary incontinence treatment apparatus |
| DE60116599T2 (en) | 2000-02-14 | 2006-11-16 | Potencia Medical Ag | Device for the treatment of male sexual impotence |
| US6475136B1 (en) | 2000-02-14 | 2002-11-05 | Obtech Medical Ag | Hydraulic heartburn and reflux treatment |
| CN1196451C (en) | 2000-02-14 | 2005-04-13 | 波滕西亚医疗公司 | Male impotence prosthesis apparatus with wireless energy supply |
| EP1255513B1 (en) | 2000-02-14 | 2005-05-25 | Potencia Medical AG | Penile prosthesis |
| US6400988B1 (en) | 2000-02-18 | 2002-06-04 | Pacesetter, Inc. | Implantable cardiac device having precision RRT indication |
| US6170484B1 (en) | 2000-03-10 | 2001-01-09 | Du Xiong Feng | Female contraceptive device |
| US6650943B1 (en) | 2000-04-07 | 2003-11-18 | Advanced Bionics Corporation | Fully implantable neurostimulator for cavernous nerve stimulation as a therapy for erectile dysfunction and other sexual dysfunction |
| US6976950B2 (en) | 2000-04-14 | 2005-12-20 | Solace Therapeutics, Inc. | Implantable valved pressure attenuation device |
| US6398718B1 (en) * | 2000-06-15 | 2002-06-04 | Innoventions, Inc. | Intravesicular device |
| US6576010B2 (en) | 2000-07-20 | 2003-06-10 | Izaak A. Ulert | Circular artificial heart |
| US6746461B2 (en) | 2000-08-15 | 2004-06-08 | William R. Fry | Low-profile, shape-memory surgical occluder |
| US6862479B1 (en) | 2000-08-30 | 2005-03-01 | Advanced Bionics Corporation | Spinal cord stimulation as a therapy for sexual dysfunction |
| SE517887C2 (en) | 2000-11-20 | 2002-07-30 | Sinova Ab | Containers for collecting intestinal contents in the abdominal cavity |
| US6612977B2 (en) | 2001-01-23 | 2003-09-02 | American Medical Systems Inc. | Sling delivery system and method of use |
| DE10104806A1 (en) | 2001-01-26 | 2002-08-14 | Univ Eberhard Karls | Vessel prosthesis for humans or animals uses connector at main body sleeve end as flat and expanded sleeve joined by transition surface and pressed to vessel at connector by flexible encircling band. |
| US6761700B2 (en) | 2001-02-09 | 2004-07-13 | Orqis Medical Corporation | Extra-corporeal vascular conduit |
| US6885895B1 (en) | 2001-04-26 | 2005-04-26 | Advanced Bionics Corporation | Methods and systems for electrical and/or drug stimulation as a therapy for erectile dysfunction |
| SE0102312D0 (en) | 2001-06-28 | 2001-06-28 | Obtech Medical Ag | Urinary dysfunction treatment apparatus |
| SE0102313D0 (en) | 2001-06-28 | 2001-06-28 | Obtech Medical Ag | Intestine dysfunction treatment apparatus |
| EP1275344A1 (en) | 2001-07-09 | 2003-01-15 | Bioring SA | Device for vascular anastomosis, maintenance and protection |
| US6675809B2 (en) | 2001-08-27 | 2004-01-13 | Richard S. Stack | Satiation devices and methods |
| US6845776B2 (en) | 2001-08-27 | 2005-01-25 | Richard S. Stack | Satiation devices and methods |
| US6736809B2 (en) | 2001-09-26 | 2004-05-18 | Cryocath Technologies Inc. | Method and device for treatment of aneurysms |
| AU2002246427B2 (en) | 2002-04-09 | 2008-10-09 | Jae Hwang Kim | Indwelling fecal diverting device |
| US7001367B2 (en) | 2002-04-16 | 2006-02-21 | Arkinstall William W | Valved ostomy drainage device |
| EP1553892A1 (en) | 2002-05-09 | 2005-07-20 | Thomas D. Egan | Gastric bypass prosthesis |
| US6749556B2 (en) * | 2002-05-10 | 2004-06-15 | Scimed Life Systems, Inc. | Electroactive polymer based artificial sphincters and artificial muscle patches |
| US20040010180A1 (en) * | 2002-05-16 | 2004-01-15 | Scorvo Sean K. | Cardiac assist system |
| US6997888B2 (en) | 2002-07-08 | 2006-02-14 | Rehrig Glenn A | Libido stimulating device and method of using |
| US20040242956A1 (en) * | 2002-07-29 | 2004-12-02 | Scorvo Sean K. | System for controlling fluid in a body |
| US20040034275A1 (en) | 2002-07-29 | 2004-02-19 | Peter Forsell | Multi-material incontinence treatment constriction device |
| US6979351B2 (en) | 2002-08-02 | 2005-12-27 | Potencia Medical Ag | Implantable ceramic valve pump assembly |
| US20040064110A1 (en) | 2002-10-01 | 2004-04-01 | Peter Forsell | Injection port |
| US20040220516A1 (en) | 2002-11-04 | 2004-11-04 | Stephen Solomon | Food extraction apparatus and method |
| US7141071B2 (en) | 2002-12-23 | 2006-11-28 | Python Medical, Inc. | Implantable digestive tract organ |
| AU2003206301A1 (en) | 2003-01-31 | 2004-08-23 | Potencia Medical Ag | Careful impotence treatment apparatus |
| EP1587457B1 (en) | 2003-01-31 | 2007-11-14 | Potencia Medical AG | Impotence treatment apparatus with connection device |
| US20040172084A1 (en) * | 2003-02-03 | 2004-09-02 | Knudson Mark B. | Method and apparatus for treatment of gastro-esophageal reflux disease (GERD) |
| US7081087B2 (en) | 2003-02-05 | 2006-07-25 | Carmella Jannuzzi | Sexual aid device |
| ATE454864T1 (en) | 2003-03-28 | 2010-01-15 | Gi Dynamics Inc | TUBE FOR DELAYED INTRODUCTION OF ENZYMES INTO THE INTESTINAL |
| US20040215283A1 (en) * | 2003-04-23 | 2004-10-28 | Antoine Camps | Electrical stimulation of the colon to treat chronic constipation |
| CN1856338B (en) * | 2003-07-21 | 2012-11-14 | 超治疗有限公司 | Gastrointestinal methods and apparatus for use in treating disorders and controlling blood sugar |
| US7155295B2 (en) * | 2003-11-07 | 2006-12-26 | Paracor Medical, Inc. | Cardiac harness for treating congestive heart failure and for defibrillating and/or pacing/sensing |
| CA2555011C (en) | 2004-02-02 | 2013-03-26 | Ams Research Corporation | Enhancing tissue ingrowth for contraception |
| US8052669B2 (en) | 2004-02-25 | 2011-11-08 | Femasys Inc. | Methods and devices for delivery of compositions to conduits |
| EP1720584B1 (en) | 2004-03-02 | 2020-11-18 | Peter William Walsh | A vessel or sac wall treatment and a cardiac assist device |
| US20060195139A1 (en) | 2004-03-23 | 2006-08-31 | Michael Gertner | Extragastric devices and methods for gastroplasty |
| US6949067B1 (en) | 2004-05-11 | 2005-09-27 | Dann Jeffrey A | Device and method for enhancing female sexual stimulation |
| US20050266042A1 (en) | 2004-05-27 | 2005-12-01 | Medtronic Vascular, Inc. | Methods and apparatus for treatment of aneurysmal tissue |
| US7390294B2 (en) | 2004-05-28 | 2008-06-24 | Ethicon Endo-Surgery, Inc. | Piezo electrically driven bellows infuser for hydraulically controlling an adjustable gastric band |
| US7894913B2 (en) | 2004-06-10 | 2011-02-22 | Medtronic Urinary Solutions, Inc. | Systems and methods of neuromodulation stimulation for the restoration of sexual function |
| WO2006014496A2 (en) | 2004-07-06 | 2006-02-09 | Amrish Walke | Obesity treatment devices |
| US7274960B2 (en) | 2004-08-05 | 2007-09-25 | Medtronic Vascular, Inc. | Method and apparatus for treating aneurysms by electrostimulation |
| AU2005280005A1 (en) | 2004-08-25 | 2006-03-09 | Pavad Medical, Inc. | Artificial sphincter |
| AU2005296053B2 (en) | 2004-10-18 | 2011-03-10 | Covidien Lp | Compression anastomosis device and method |
| US7722529B2 (en) | 2004-12-28 | 2010-05-25 | Palo Alto Investors | Expandable vessel harness for treating vessel aneurysms |
| US20060149129A1 (en) | 2005-01-05 | 2006-07-06 | Watts H D | Catheter with multiple visual elements |
| TW200635566A (en) | 2005-01-25 | 2006-10-16 | Vnus Med Tech Inc | Structures for permanent occlusion of a hollow anatomical structure |
| US20060173238A1 (en) | 2005-01-31 | 2006-08-03 | Starkebaum Warren L | Dynamically controlled gastric occlusion device |
| CA2596300C (en) | 2005-02-15 | 2011-11-22 | Yale University | Intrauterine fallopian tube occlusion device and method for use |
| CA2507142A1 (en) | 2005-04-25 | 2006-10-25 | Mohammad Nadeem Qadir | Apparatus, devices and methods for contraception, conception and pregnancy |
| US7310557B2 (en) * | 2005-04-29 | 2007-12-18 | Maschino Steven E | Identification of electrodes for nerve stimulation in the treatment of eating disorders |
| US7899540B2 (en) | 2005-04-29 | 2011-03-01 | Cyberonics, Inc. | Noninvasively adjustable gastric band |
| US7835796B2 (en) * | 2005-04-29 | 2010-11-16 | Cyberonics, Inc. | Weight loss method and device |
| SE528738C2 (en) | 2005-06-16 | 2007-02-06 | Sinova Safetech Innovation Ab | intestinal Implants |
| US20070016262A1 (en) * | 2005-07-13 | 2007-01-18 | Betastim, Ltd. | Gi and pancreatic device for treating obesity and diabetes |
| US8118750B2 (en) | 2005-10-21 | 2012-02-21 | Medtronic, Inc. | Flow sensors for penile tumescence |
| US20070142699A1 (en) * | 2005-12-16 | 2007-06-21 | Acoustx Corporation | Methods and implantable apparatuses for treating an esophageal disorder such as gastroesophageal reflux disease |
| US8195296B2 (en) | 2006-03-03 | 2012-06-05 | Ams Research Corporation | Apparatus for treating stress and urge incontinence |
| WO2007124128A2 (en) | 2006-04-20 | 2007-11-01 | Liquidia Technologies, Inc. | Biological vessel flow control devices and methods |
| JP2009534133A (en) | 2006-04-24 | 2009-09-24 | コンティネンス コントロール システムズ インターナショナル プロプライエタリー リミテッド | Method and apparatus for coping with erectile dysfunction |
| US20070255336A1 (en) * | 2006-04-28 | 2007-11-01 | Medtronic, Inc. | Gastric constriction device with selectable electrode combinations |
| US20070255335A1 (en) | 2006-04-28 | 2007-11-01 | Medtronic, Inc. | Controller for gastric constriction device with selectable electrode configurations |
| US20070265675A1 (en) | 2006-05-09 | 2007-11-15 | Ams Research Corporation | Testing Efficacy of Therapeutic Mechanical or Electrical Nerve or Muscle Stimulation |
| US7991476B2 (en) | 2006-05-22 | 2011-08-02 | Empire Bio-Medical Devices, Inc. | Method and device for enhanced blood flow |
| US7452326B2 (en) | 2006-10-13 | 2008-11-18 | British Columbia Institute Of British Columbia | User-friendly vibrostimulation device |
| US20080103544A1 (en) | 2006-10-28 | 2008-05-01 | Weiner Richard L | Method of treating female sexual dysfunction |
| US7846160B2 (en) | 2006-12-21 | 2010-12-07 | Cytyc Corporation | Method and apparatus for sterilization |
| US8442639B2 (en) | 2007-02-13 | 2013-05-14 | Cardiac Pacemakers, Inc. | Systems and methods for electrical stimulation of blood vessels |
| US9259233B2 (en) | 2007-04-06 | 2016-02-16 | Hologic, Inc. | Method and device for distending a gynecological cavity |
| US8469908B2 (en) | 2007-04-06 | 2013-06-25 | Wilson T. Asfora | Analgesic implant device and system |
| PL2214607T3 (en) | 2007-10-11 | 2022-02-07 | Implantica Patent Ltd. | System for thermal treatment of hypertension, hypotension or aneurysm |
| BRPI0817871B8 (en) | 2007-10-11 | 2021-06-22 | Implantica Patent Ltd | device for controlling the flow in an organ of the body |
| US8696543B2 (en) | 2007-10-11 | 2014-04-15 | Kirk Promotion Ltd. | Method for controlling flow of intestinal contents in a patient's intestines |
| SI2211796T1 (en) | 2007-10-11 | 2021-11-30 | Implantica Patent Ltd. | Apparatus for controlling flow of eggs in an uterine tube |
| WO2009048398A1 (en) | 2007-10-11 | 2009-04-16 | Milux Holding Sa | Method for controlling flow in a stomach |
| WO2009048388A1 (en) | 2007-10-11 | 2009-04-16 | Milux Holding Sa | An apparatus for male contraception |
| WO2009048400A1 (en) | 2007-10-11 | 2009-04-16 | Milux Holding Sa | Method for controlling flow in a bodily organ |
| EP3821848A1 (en) | 2007-10-11 | 2021-05-19 | Implantica Patent Ltd. | Apparatus for the treatment of gallstones |
| US20090248033A1 (en) | 2007-10-11 | 2009-10-01 | Milux Holding S.A. | Method for the treatment of gallstones |
| CA2739840A1 (en) | 2007-10-11 | 2009-04-16 | Peter Forsell | An apparatus for male contraception |
| PT2214578T (en) | 2007-10-11 | 2021-07-05 | Implantica Patent Ltd | Apparatus for controlling flow of sperms in an uterine tube |
| WO2009048371A1 (en) | 2007-10-11 | 2009-04-16 | Milux Holding Sa | A device for treatment of aneurysm |
| EP2211985B1 (en) | 2007-10-11 | 2021-09-29 | Implantica Patent Ltd. | A device for the treatment of aneurysm |
| WO2009048375A1 (en) | 2007-10-11 | 2009-04-16 | Milux Holding Sa | Apparatus for controlling flow of urine in bladder or urethra |
| EP2211789B1 (en) | 2007-10-11 | 2023-06-07 | Implantica Patent Ltd. | Apparatus and method for controlling food flow through a compartmentalized stomach of a patient |
| CA2940228C (en) | 2007-10-11 | 2022-08-09 | Milux Holding S.A. | Implantable intestinal contents flow control device |
| WO2009048372A1 (en) | 2007-10-11 | 2009-04-16 | Milux Holding Sa | Device, method and system for monitoring and treatment of aneurysm |
| EP3925661A1 (en) | 2007-10-11 | 2021-12-22 | Implantica Patent Ltd. | Apparatus and system for the treatment of female sexual dysfunction |
| US8795153B2 (en) | 2007-10-11 | 2014-08-05 | Peter Forsell | Method for treating female sexual dysfunction |
| US8992409B2 (en) | 2007-10-11 | 2015-03-31 | Peter Forsell | Method for controlling flow in a bodily organ |
| MX2010003936A (en) | 2007-10-11 | 2010-09-24 | Milux Holding Sa | System for treating a patient having an intestinal disorder. |
| US9480551B2 (en) | 2007-10-11 | 2016-11-01 | Peter Forsell | Implantable tissue connector |
| BRPI0817870B8 (en) | 2007-10-11 | 2021-06-22 | Implantica Patent Ltd | aneurysm treatment device |
| WO2009048382A1 (en) | 2007-10-11 | 2009-04-16 | Milux Holding Sa | Apparatus for treating female sexual dysfunction |
| EP3922212A1 (en) | 2007-10-11 | 2021-12-15 | Implantica Patent Ltd | Apparatus for controlling flow of blood in a vessel |
| US9949871B2 (en) | 2007-10-11 | 2018-04-24 | Peter Forsell | Method for controlling flow of eggs in a uterine tube |
| CA3119280A1 (en) | 2007-10-11 | 2009-04-16 | Implantica Patent Ltd. | A device for treatment of aneurysm |
| WO2009048387A2 (en) | 2007-10-11 | 2009-04-16 | Milux Holding Sa | System and method for embryo control |
| US9555241B2 (en) | 2007-10-11 | 2017-01-31 | Peter Forsell | Method of obtaining male contraception |
| WO2009048401A1 (en) | 2007-10-11 | 2009-04-16 | Milux Holding Sa | A method for the treatment of aneurysm |
| WO2009048368A1 (en) | 2007-10-11 | 2009-04-16 | Milux Holding Sa | Apparatus and method for controlling food flow through the stomach of a patient |
| EP2205182B1 (en) | 2007-10-11 | 2015-12-23 | Kirk Promotion LTD. | Artificial intestine section |
| CA2739945A1 (en) | 2007-10-11 | 2009-04-16 | Peter Forsell | Device and method for embryo control |
| WO2009048395A1 (en) | 2007-10-11 | 2009-04-16 | Milux Holding Sa | Method for controlling flow of blood in a vessel |
| DK2214578T3 (en) | 2007-10-11 | 2021-07-05 | Implantica Patent Ltd | APPARATUS FOR CONTROLLING THE FLOW OF SPERM IN AN OVERSEAS |
| US10195325B2 (en) | 2007-10-11 | 2019-02-05 | Peter Forsell | Method for controlling flow of sperms in a uterine tube |
| EP2211770B8 (en) | 2007-10-11 | 2022-03-30 | Implantica Patent Ltd. | Apparatus for controlling flow of intestinal contents in a patient's intestines |
| US10307597B2 (en) | 2007-10-11 | 2019-06-04 | Peter Forsell | Method for controlling flow of urine in a patient's urethra, ureter, renal pelvis or bladder |
| CN101883539B (en) | 2007-10-11 | 2013-12-04 | 米卢克斯控股股份有限公司 | Implantable tissue connector |
| EP3925573A1 (en) | 2007-10-11 | 2021-12-22 | Implantica Patent Ltd. | A system for treating a sexual dysfunctional female patient |
| WO2009048396A1 (en) | 2007-10-11 | 2009-04-16 | Milux Holding Sa | Method for controlling food flow in vertical banded gastroplasty |
| CN101896136B (en) | 2007-10-12 | 2013-09-18 | 米卢克斯控股股份有限公司 | Apparatus for treating intestinal disorder |
| US7998057B2 (en) | 2008-02-25 | 2011-08-16 | Melissa Mia Kain | Erogenic stimulator with expandable bulbous end |
| US7987853B2 (en) | 2008-04-25 | 2011-08-02 | Conceptus, Inc. | Devices and methods for occluding a fallopian tube |
| EP2349106B1 (en) | 2008-10-10 | 2017-01-11 | Kirk Promotion LTD. | System for the treatment of male sexual dysfunction |
| JP2012505021A (en) | 2008-10-10 | 2012-03-01 | ミルックス・ホールディング・エスエイ | Temporary contraceptive device for men |
| AU2009301392B9 (en) | 2008-10-10 | 2018-05-24 | Implantica Patent Ltd. | Stimulation of sexually responsive tissue of the vulva |
| US8874215B2 (en) | 2008-10-10 | 2014-10-28 | Peter Forsell | System, an apparatus, and a method for treating a sexual dysfunctional female patient |
| EP2349076B1 (en) | 2008-10-10 | 2018-06-13 | Kirk Promotion LTD. | A system, an apparatus for treating a sexual dysfunctional female patient |
| EP2349170B1 (en) | 2008-10-10 | 2023-09-27 | Implantica Patent Ltd. | Apparatus for the treatment of female sexual dysfunction |
| CA2758118C (en) | 2009-04-07 | 2019-05-21 | Catholic Healthcare West | Uterine electrical stimulation system and method |
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