Operable implant comprising an electric motor and a gear system

Abstract

An operable implant adapted for implantation into a patient's body. The operable implant comprises an operating device and a body-engaging portion, the operating device comprising an electric motor including a stationary part containing a plurality of coils and a movable part containing a plurality of magnets, such that sequential energization of the coils magnetically propels the magnets and, thereby, the movable part. The operating device further comprises an encapsulation adapted to hermetically encapsulate the coils of the stationary part, thereby forming a seal between the stationary part and the movable part, which is propelled by the contained magnets, such that the coils of the stationary part are sealed from bodily fluids when implanted.

Description

[0001] This application is a divisional application of the invention patent application with application number 201480026512.3, application date March 14, 2014, and invention name “Operable implant comprising an electric motor and a gear system”. Technical Field

[0002] The present invention relates to the field of operable implants and devices, systems and methods for powering and communicating with operable implants. Background Art

[0003] Providing reliable operating devices for powered and operable implants has proven difficult. The human body's hostile environment affects all parts of an implant, and moving parts are particularly sensitive to body fluids and fibrotic tissue growth. Fibrotic tissue will eventually surround and encapsulate all foreign matter in the body, which risks affecting the function of the implant. Therefore, a more reliable, general-purpose operating device for operable implants would be advantageous. Summary of the Invention

[0004] An operable implant is provided, suitable for implantation into a patient's body. The operable implant includes an operating device and a body engaging portion. The operating device includes a first unit, which includes: a receiving unit for receiving wireless energy; and a first gear system, which is suitable for receiving mechanical work with a first force and a first speed, and outputting mechanical work with a different second force and a different second speed. The operating device further includes a second unit, which includes: an electric motor suitable for converting electrical energy into mechanical work; and a spacing element, which includes: a wire for transmitting electrical energy from the first unit to the second unit; and a mechanical transmission member suitable for transmitting mechanical work from the electric motor in the second unit to the gear system in the first unit. The spacing element is suitable for separating the first and second units so that the receiving unit is substantially not affected by the second unit when receiving wireless energy.

[0005] According to one embodiment, the receiving unit includes at least one coil adapted to convert received wireless energy in the form of a magnetic field into electrical energy. The receiving unit may include at least one first coil having a first number of windings and at least one second coil having a second, different number of windings.

[0006] According to one embodiment, the gear system includes: an operable element; a first gear having a hollow cylindrical shape and including a first number of teeth on an outer side of its periphery; and a second gear having a hollow cylindrical shape and including a greater number of teeth on an inner surface thereof than the first gear. The operable element may be adapted to engage an inner side of the first gear so that the outer side of the first gear is pressed against the inner side of the second gear, thereby causing the teeth of the first gear and the teeth of the second gear to engage with each other in at least one position, the at least one position being separate from a position in which the teeth do not engage with each other, wherein operation of the operable element advances the position, thereby causing relative rotation between the first gear and the second gear.

[0007] According to one embodiment, the operable element comprises at least one of: a planetary gear, a structure or a wheel that at least partially uses friction to interconnect with the first gear.

[0008] According to one embodiment, the second unit includes a second gear system adapted to receive as input the mechanical work having a second different force and a second different speed output from the first gear system, and to output mechanical work having a third different force and a third different speed. The gear system of the second unit may be connected in series with the gear system of the first unit via the mechanical transmission member of the spacing element.

[0009] In one embodiment, the first unit may include: a second gear system adapted to receive mechanical work of a first force and speed as input and output mechanical work of a different force and speed. The second gear system may be connected in series with the first gear system.

[0010] In any embodiment herein, the first unit may be adapted to be placed in at least one of the following locations: subcutaneously, subcutaneously in the abdominal wall, or in the abdomen.

[0011] In any embodiment, the electric motor may include magnetic material, and during the wireless energy transfer, the first unit may remain substantially unaffected by the magnetic material in the second unit.

[0012] In any embodiment, the first gear system may include a third gear, wherein an inner side of the third gear may include the same number of teeth as an outer side of the first gear, wherein the teeth of the third gear are adapted to interengage with the teeth of the first gear, thereby causing the third gear to rotate relative to the second gear with the at least one interengaged position.

[0013] In any embodiment, the second unit may include at least one fixing portion for fixing the second unit to at least one of fibrosis, fascia, and muscle layer facing inside the subcutaneous space of the patient.

[0014] In any embodiment, the distance element may be adapted to at least one of: be positioned through the muscle layer of the abdominal wall, and be secured to the muscle fascia facing the subcutaneous space.

[0015] According to one embodiment, the distance element is flexible such that the first unit and the second unit can be moved relative to each other.

[0016] In any embodiment, the mechanical transmission member may include a mechanical transmission member selected from the following: a hydraulic pipe for transmitting hydraulic force, a rotating shaft for transmitting rotational force, a flexible member for transmitting rotational force, a wire, a belt, a rod, a worm gear, and a gear for changing the direction of the rotational force by approximately 90 degrees.

[0017] The operable implant may further comprise an enclosure adapted to sealingly enclose the operable implant.

[0018] According to one embodiment, the medical device may further include: a metal package adapted to package at least one of the second unit and the distance element. The metal package may be a titanium package, an aluminum package, and / or a stainless steel package.

[0019] At least one of the first unit and the second unit may include a battery adapted to store the electric energy received at the receiving unit.

[0020] The electric motor may include an electric motor selected from the following: an alternating current (AC) electric motor, a direct current (DC) electric motor, a linear electric motor, an axial electric motor, a piezoelectric motor, a three-phase motor, a motor with more than one phase, a bimetallic motor, and a memory metal motor.

[0021] According to one embodiment, the implantable system further comprises: a control unit for controlling at least one parameter of at least one of: the operating device; and the body engaging part.

[0022] In one embodiment, the electric motor may be an alternating current (AC) electric motor, and the control unit may include a frequency converter for changing an AC frequency to control the AC motor.

[0023] The first unit of the operable implant may include: a hydraulic pump adapted to transfer mechanical work into hydraulic power for powering the hydraulically operable body engaging portion. The hydraulic pump may be connected to a force output of the first gear system or the second gear system. The hydraulic pump may be a hydraulic pump selected from the group consisting of: at least one reservoir that functions as a pump by utilizing a wall moved by mechanical work; at least one reservoir that functions as a pump by changing volume to move a fluid; at least one non-valve-type pump; at least one valve-type pump; at least one peristaltic pump; at least one diaphragm pump; at least one gear pump; and at least one bellows pump.

[0024] According to one embodiment, the first unit comprises a reservoir for supplying fluid to the hydraulically operable body engaging part.

[0025] The operable implant may comprise a third unit comprising a second reservoir for supplying fluid to the hydraulically operable body engaging portion.The reservoir may be operable and may comprise at least one movable wall portion.

[0026] The reservoir may comprise at least one of: at least one bellows-shaped portion, a shape suitable for allowing movement even when covered with fibrous matter, and a plate-shaped surface, in each case enabling movement of the at least one movable wall portion.

[0027] In any embodiment, the reservoir may be fluidly connected to the hydraulically operable body engaging portion, the reservoir may be adapted to operate the hydraulically operable body engaging portion by movement of the at least one movable wall portion.The reservoir may be circular and torus-shaped.

[0028] The operable implant may further comprise a threaded member arranged to move a wall portion of the reservoir.

[0029] In one embodiment, the operable implant further comprises: at least one of a pressure sensor, a flow sensor, and a position sensor, wherein at least one of the pressure sensor, the flow sensor, and the position sensor is arranged to be connected to at least one of the pump and the reservoir for determining the pressure and / or volume in the reservoir and the pressure or flow from the hydraulic pump.

[0030] The first unit of the operable implant of any embodiment may comprise an injection port for supplying fluid to at least one of: the reservoir, the hydraulically operable body engaging portion.

[0031] According to one embodiment, at least one of the first unit and the distance element may be free from at least one of: a metallic component and a magnetizable component.

[0032] At least one of the first and second units and the distance element may be free from magnetic components.

[0033] The first unit of the operable implant may comprise a communication unit adapted to wirelessly communicate with an external unit on the outside of the patient's body.

[0034] The operable element may be adapted to deflect the first gear and to maintain the deflected first gear such that teeth of the first gear engage with teeth of the second gear in at least one of one, two, three, four, or more positions, wherein the two, three, or four positions are angularly spaced apart positions that are interspaced from positions where the teeth do not engage with each other.

[0035] Further provided is an operable implant for implantation into a patient's body. The operable implant includes an operating device and a body-engaging portion. The operating device includes an electric motor comprising a set of coils arranged in a circular pattern around a rotational axis of the electric motor; a set of magnets connected to a rotatable structure, the rotatable structure at least partially overlapping the coils axially, such that sequential energization of the coils magnetically urges the magnets and causes the rotatable structure to rotate about the rotational axis; and a gear system comprising an operable element; a first gear having a hollow cylindrical shape and including a first number of teeth on an outer periphery thereof; and a second gear having a hollow cylindrical shape and including a greater number of teeth on an inner surface thereof than the first gear. The operable element may be adapted to engage an inner side of the first gear such that the outer side of the first gear presses against the inner side of the second gear, thereby causing the teeth of the first gear to interengage with the teeth of the second gear in at least one position that is interspaced from a position where the teeth do not interengage, wherein operation of the operable element advances the position, thereby causing relative rotation between the first and second gears. The second gear has a smaller diameter than the rotatable structure and is disposed at least partially in the same axial plane, such that the rotatable structure at least partially axially overlaps the second gear, and the gear system is disposed at least partially within the electric motor. Placing the gear system at least partially within the electric motor results in a very compact and efficient design.

[0036] The operable element may be adapted to offset the first gear and to maintain the offset first gear so that the teeth of the first gear engage with the teeth of the second gear in at least one of one position, two positions, three positions, four positions or more, wherein the two, three, and four positions are angularly separated positions that are separate from positions where the teeth do not engage with each other.

[0037] According to one embodiment of the operable implant, the operable element is adapted to offset the first gear and to maintain the offset first gear so that the teeth of the first gear engage with the teeth of the second gear at at least two angularly separated positions, wherein the angularly separated positions are separate from the positions at which the teeth do not engage with each other.

[0038] The operable implant may include at least one of a planetary gear, a structure or a wheel that uses at least in part friction to interconnect with the first gear.

[0039] According to one embodiment, the operating device further includes a second gear system, the second gear system including: an operable element; a first gear having a hollow cylindrical shape and including a first number of teeth on an outer side of a periphery thereof; and a second gear having a hollow cylindrical shape and including a greater number of teeth on an inner surface thereof than the first gear, wherein the operable element is adapted to engage an inner side of the first gear so that the outer side of the first gear is pressed against the inner side of the second gear, thereby causing the teeth of the first gear and the teeth of the second gear to engage with each other in at least one position, the at least one position being separate from a position in which the teeth do not engage with each other, wherein operation of the operable element causes the position to advance, thereby causing relative rotation between the first gear and the second gear, wherein the first gear of the first gear system is directly or indirectly connected to the operable element of the second gear system, such that the first gear system is connected in series with the second gear system, such that the first gear system receives mechanical work having a first force and a first speed and outputs mechanical work having a different second force and a different second speed, and the second gear system receives the mechanical work output from the first gear system as input and outputs mechanical work having a different third force and a different third speed.

[0040] In any of the embodiments herein, the first and second gear systems may be coaxially positioned along an axis of rotation of the first and second gear systems.

[0041] The second gear of at least one of the first and second gear systems may have a smaller diameter than the rotatable structure and be at least partially disposed in the same axial plane, such that the rotatable structure at least partially axially overlaps the second gear of at least one of the first and second gear systems, thereby causing at least one of the first and second gear systems to be at least partially disposed within the electric motor.

[0042] The first gear and the second gear of the second gear system may have a larger diameter than the rotatable structure and be at least partially disposed in the same axial plane, such that the first gear and the second gear of the second gear system at least partially axially overlap the rotatable structure, thereby causing the electric motor to be at least partially disposed within the second gear system.

[0043] According to one embodiment, the operable implant further comprises a radially extending connection structure connecting the first gear of the first gear system directly or indirectly to the operable element of the second gear system, thereby transmitting force from the first gear system to the second gear system.

[0044] The first gear system of the operable implant may include a third gear having an inner side including the same number of teeth as an outer side of the first gear, wherein the teeth of the third gear are adapted to interengage with the teeth of the third gear, thereby causing the third gear to rotate relative to the second gear with the angularly separated position.

[0045] In any embodiment, the first gear of the first gear system may be indirectly connected to the operable element of the second gear system via the third gear.

[0046] The rotatable structure of the operable element may be arranged radially on the inside of the circularly distributed coils, or radially on the outside of the circularly distributed coils.

[0047] According to one embodiment, the operable implant further comprises a coil enclosure adapted to encapsulate the coil such that the coil remains encapsulated during operation of the operation device.

[0048] According to one embodiment, the first gear of at least one of the first gear system and the second gear system may be directly or indirectly connected to a threaded member adapted to convert a radially rotating force into an axially reciprocating force.

[0049] The threaded member of the operable implant may be directly or indirectly connected to a movable wall portion of a first reservoir for varying the volume of the first reservoir.

[0050] The threaded member may be directly or indirectly connected to a movable wall portion of the second reservoir to change the volume of the second reservoir. Movement of the movable wall portion of the first reservoir in a first direction by the threaded member causes the first reservoir to expand and increase the volume in the reservoir; wherein movement of the movable wall portion of the second reservoir in the first direction by the threaded member causes the second reservoir to contract and decrease the volume in the second reservoir.

[0051] The first reservoir can be fluidly connected to a first hydraulically operable body engaging portion in any embodiment, and the second reservoir can be fluidly connected to a second hydraulically operable body engaging portion in any embodiment. Operation of the electric motor in a first direction causes, through the gear system and its direct or indirect connection to the threaded member, fluid to be transferred from the first reservoir to the first hydraulically operable body engaging portion and fluid to be transferred from the second hydraulically operable body engaging portion to the second reservoir.

[0052] In any embodiment, the reservoir is at least one of circular and torus-shaped.

[0053] According to one embodiment of the medical device, the operating device may include a circular reservoir surrounding the operating device, and the circular reservoir may include a movable wall portion, which is suitable for compressing and expanding the circular reservoir to thereby change the volume of the reservoir, and the movable wall portion can be connected to the operating device so that operation of the operating device changes the volume of the circular reservoir.

[0054] According to one embodiment of the operable implant, a portion of the wall of the reservoir comprises at least one of: a bellows structure, a shape suitable for allowing movement even when covered with fibrous material, and a plate-shaped surface, in all cases enabling movement of the at least one movable wall portion, enabling compression and / or expansion of the reservoir.

[0055] According to one embodiment, the operable implant further comprises a peristaltic pump comprising a hollow member for fluid delivery and an operable compression member adapted to engage and compress the hollow member. The first gear of the operable implant may be directly or indirectly coupled to the compression member such that operation of the electric motor operates the compression member to deliver fluid into the hollow member. The operable compression member may be coupled to the third gear of any embodiment herein.

[0056] The hollow member of the peristaltic pump may form a ring or a portion of a ring, the ring or the portion of the ring being adapted to at least partially surround the operating device in the same axial plane, wherein the operating device is adapted to push the compression member so that the compression member compresses the hollow member towards the outer periphery of the ring or the portion of the ring.

[0057] According to one embodiment, the operating device includes an alternating current (AC) motor, and the operating device further includes a frequency converter for changing an AC frequency to control the AC motor.

[0058] According to one embodiment of the operable implant, the operable implant further comprises a separate unit comprising a receiving unit adapted to receive wireless energy transmitted from outside the body. The receiving unit may comprise at least one coil adapted to convert the received wireless energy in the form of a magnetic field, an electric field, or an electromagnetic field into electrical energy.

[0059] In various embodiments, the receiving unit may include: at least one first coil having a first number of windings; and at least one second coil having a second, different number of windings.

[0060] According to one embodiment, the separation unit is adapted to be placed in at least one of the following locations: subcutaneously and subcutaneously in the abdominal wall.

[0061] The operable implant according to any of the aforementioned embodiments may further comprise at least one fixation portion for fixing at least a portion of the operable implant to at least one of a fibrous, fascial, and muscle layer toward the inside of the patient's subcutaneous space.

[0062] The operable implant according to any of the aforementioned embodiments may further include a spacing element connecting the operation device and the separation unit, wherein the spacing element may include an electrical conductor adapted to transmit electrical energy between the separation unit and the operation device. The spacing element may be adapted to be placed through the abdominal wall muscle layer and / or fixed to the muscle fascia facing the subcutaneous space.

[0063] According to one embodiment, the distance element may be flexible such that the first unit and the second unit can be moved relative to each other.

[0064] In any embodiment, the separation unit may include a reservoir for supplying fluid to the hydraulic implant.

[0065] In any embodiment herein, the spacing element may include a fluid conduit for transferring fluid from the operating device to the separation unit or vice versa to control the size of the reservoir. The spacing element may further include a mechanical transmission member adapted to transfer mechanical work from the operating device to the separation unit. The mechanical transmission member may include a mechanical transmission member selected from the following: a hydraulic pipe for transferring hydraulic pressure, a rotating shaft for transferring rotational force, a flexible member for transferring rotational force, a wire, a belt, a rod, a worm gear, and a gear for changing the direction of rotational force by approximately 90 degrees.

[0066] The operable implant may further comprise: an enclosure adapted to hermetically enclose the operation device and the separation unit, such that the operation device and the separation unit are sealed against body fluids when implanted.

[0067] At least one of the operating device and the separation unit may comprise a battery adapted to store electrical energy received at the receiving unit.The separation unit may comprise an injection port for supplying fluid to the reservoir and / or the hydraulically operable body engaging portion.

[0068] The separation unit is separated from the energy receiving unit and may be free from metal components, and / or magnetizable components, and / or magnetic components, so that the components of the separation unit are not interfered with by wireless energy transfer.

[0069] The separation unit may further comprise: a control unit for controlling at least one parameter of at least one of: an operating device, and a body engaging portion.

[0070] The separate unit may comprise a communication unit adapted to wirelessly communicate with an external unit on the outside of the patient's body.

[0071] In one embodiment, the operable implant may include a hydraulic pump selected from: at least one reservoir having walls that move through mechanical work to act as a pump; at least one reservoir that changes volume to move fluid to act as a pump; at least one non-valve pump; at least one valve pump; at least one peristaltic pump; at least one diaphragm pump; at least one gear pump; and at least one bellows pump.

[0072] The operable implant may include an electric motor selected from the following motors: an alternating current (AC) electric motor; a direct current electric motor; a linear electric motor; an axial electric motor; a piezoelectric motor; a three-phase motor; a motor with more than one phase; a bimetallic motor; and a memory metal motor.

[0073] An operable implant suitable for implantation in a patient's body, the operable implant comprising an operating device and a body engaging portion, wherein the operating device comprises: an axial electric motor comprising: a set of coils distributed in a circle around the rotation axis of the electric motor; a set of magnets connected to a radially extending rotatable structure, the rotatable structure at least partially radially overlapping the magnets, so that sequential energization of the coils magnetically pushes the magnets axially and rotates the rotatable structure around the rotation axis. The operable implant further comprises a gear system comprising: an operable element; a first gear having the shape of a hollow cylinder and including a first number of teeth on an outer periphery thereof; and a second gear having the shape of a hollow cylinder and including a greater number of teeth on an inner surface thereof than the first gear, wherein the operable element is adapted to engage an inner side of the first gear such that the outer side of the first gear is pressed against the inner side of the second gear, thereby causing the teeth of the first gear to interengage with the teeth of the second gear in at least one position that is interspaced from a position where the teeth do not interengage, wherein operation of the operable element advances the position, thereby causing relative rotation between the first gear and the second gear. The gear system and the axial electric motor are coaxially positioned along the rotational axis of the electric motor, which results in a compact design with few moving parts.

[0074] The operable element may comprise at least one of a planetary gear, a structure or a wheel that interconnects with the first gear at least in part using friction.

[0075] According to one embodiment, the first set of coils, which are distributed in a circle around the axis of rotation of the electric motor, is located on a magnetizable core structure. The radially extending rotatable structure comprises a rotatable disc, the magnetizable core structure and the rotatable disc being coaxially positioned and connected to a drive shaft connected to the operable element.

[0076] According to one embodiment, the operating device further comprises a second magnetizable core structure comprising a second set of coils, wherein the second magnetizable core structure is coaxially positioned to at least partially overlap the magnets of the rotatable disk such that the first set of coils pushes the magnets on a first side thereof and the second set of coils pushes the magnets on a second side thereof.

[0077] According to one embodiment, the circular configuration of at least one of the first and second sets of coils has a peripheral diameter that is smaller than an inner diameter of the first gear, wherein the first and second sets of coils are located in the same axial plane as the first gear, thereby positioning the axial electric motor at least partially within the gear system.

[0078] According to one embodiment, said rotatable disc is directly connected to said operable element.

[0079] The operable implant may further comprise a coil enclosure adapted to encapsulate the coil such that the coil remains encapsulated and separated from the magnet during operation of the operation device.

[0080] According to one embodiment, the operable element is adapted to offset the first gear and to maintain the offset first gear such that the teeth of the first gear engage with the teeth of the second gear in one of one, two, three, four, or more positions, wherein the two, three, or four positions are angularly separated positions that are separate from positions in which the teeth do not engage with each other.

[0081] The operating device of the operable implant may further include a second gear system, the second gear system comprising: an operable element; a first gear having a hollow cylindrical shape and including a first number of teeth on an outer periphery thereof; and a second gear having a hollow cylindrical shape and including a greater number of teeth on an inner surface thereof than the first gear, wherein the operable element is adapted to engage an inner side of the first gear such that the outer side of the first gear is pressed against the inner side of the second gear, thereby causing the teeth of the first gear and the teeth of the second gear to engage with each other in at least one position, the at least one position being separate from a position in which the teeth do not engage with each other, wherein operation of the operable element advances the position, thereby causing relative rotation between the first gear and the second gear. The first gear of the first gear system is directly or indirectly connected to the operable element of the second gear system, such that the first gear system is connected in series with the second gear system, such that the first gear system receives mechanical work having a first force and a first speed and outputs mechanical work having a different second force and a different second speed, while the second gear system receives the mechanical work output from the first gear system as input and outputs mechanical work having a third force and a different third speed.

[0082] The first and second gear systems may be coaxially positioned along an axis of rotation of the first and second gear systems.

[0083] The operable implant may further comprise a radially extending connection structure connecting the first gear of the first gear system directly or indirectly to the operable element of the second gear system, thereby transmitting force from the first gear system to the second gear system.

[0084] In any embodiment, the first gear system may include a third gear, the inner side of the third gear may include the same number of teeth as the outer side of the first gear. The teeth of the third gear may be adapted to interengage with the teeth of the third gear, thereby causing the third gear to rotate relative to the second gear with the angularly separated position.

[0085] According to one embodiment, the first gear of the first gear system is indirectly connected to the operable element of the second gear system via the third gear of any embodiment.

[0086] The first gear of the first gear system may be directly or indirectly connected to a threaded member adapted to convert a radially rotating force into an axially reciprocating force.

[0087] According to one embodiment, the threaded member may be connected directly or indirectly to a movable wall of the first or second reservoir for varying the volume of said reservoir.

[0088] According to one embodiment, the movable wall of the first reservoir is moved in a first direction by the threaded member so that the first fluid reservoir expands and the volume in the first fluid reservoir increases; the movable wall of the second reservoir is moved in the first direction by the threaded member so that the second reservoir contracts and the volume in the second reservoir decreases.

[0089] The first reservoir of the operable implant can be fluidically connected to a first hydraulically operable body engaging part, and the second reservoir is fluidically connected to a second hydraulically operable body engaging part, wherein operation of the electric motor in a first direction causes: fluid to be delivered from the first reservoir to the first hydraulically operable body engaging part; and fluid to be delivered from the second hydraulically operable body engaging part to the second reservoir through the gear system and its direct or indirect connection to the threaded member.

[0090] In any embodiment herein, the reservoir may be a circular or torus-shaped reservoir. In one embodiment, the operating device comprises a circular reservoir surrounding the operating device, the circular reservoir comprising a movable wall portion adapted to compress and expand the circular reservoir to thereby change the volume of the reservoir, wherein the movable wall portion is connected to the operating device such that operation of the operating device changes the volume of the circular reservoir.

[0091] A portion of the wall of the reservoir may comprise at least one of: a bellows structure, a shape adapted to allow movement even when covered with fibrous material, and a plate-shaped surface, in all cases enabling movement of the at least one movable wall portion, enabling compression and / or expansion of the reservoir.

[0092] According to one embodiment, the operable implant further comprises a peristaltic pump comprising a hollow member for fluid delivery and an operable compression member adapted to engage and compress the hollow member. The first gear is directly or indirectly connected to the compression member such that operation of the motor operates the compression member to deliver fluid into the hollow member.

[0093] According to one embodiment, the operable compression member is connected to the third gear of any embodiment herein.

[0094] According to one embodiment, the hollow member of the peristaltic pump forms a ring or a portion of a ring, the ring or the portion of the ring being adapted to at least partially surround the operating device at least partially in the same axial plane. The operating device is adapted to push the compression member so that the compression member compresses the hollow member towards the outer periphery of the ring or the portion of the ring.

[0095] According to one embodiment, the operating device includes an alternating current (AC) motor, and the operating device further includes a frequency converter for changing an AC frequency to control the AC motor.

[0096] In any of the embodiments herein, the operable implant may further comprise a separate unit comprising a receiving unit adapted to receive wireless energy transmitted from outside the body. The separate unit may be adapted to be placed in at least one of the following locations: subcutaneously and subcutaneously in the abdominal wall. The separate unit may comprise a reservoir for supplying fluid to the hydraulic implant.

[0097] According to one embodiment, the receiving unit includes at least one coil adapted to convert received wireless energy in the form of a magnetic field or an electromagnetic field into electrical energy. The receiving unit includes: at least one first coil having a first number of windings; and at least one second coil having a second, different number of windings.

[0098] The operable implant may further include at least one fixation portion for fixing at least a portion of the operable implant to at least one of a fibrous, fascial, and muscle layer toward the inside of the patient's subcutaneous space.

[0099] The operable implant may further comprise a distance element connecting the operation device and the separation unit, and the distance element may comprise an electrical conductor adapted to transmit electrical energy between the separation unit and the operation device.

[0100] The distance element may be adapted to be placed through the abdominal wall muscle layer and / or fixed to the muscle fascia facing the subcutaneous space.

[0101] The distance element may be flexible such that the first unit and the second unit can move relative to each other.

[0102] In any embodiment, the spacing element may include a fluid conduit for delivering fluid from the operating device, or vice versa, to control the size of the reservoir.

[0103] The spacing element may further include a mechanical transmission member adapted to transmit mechanical work from the operating device to the separation unit. The mechanical transmission member may be selected from the following: a hydraulic pipe for transmitting hydraulic pressure, a rotating shaft for transmitting rotational force, a flexible member for transmitting rotational force, a wire, a belt, a rod, a worm gear, and a gear for changing the direction of rotational force by approximately 90 degrees.

[0104] The operable implant may further comprise: an enclosure adapted to hermetically enclose the operation device and the separation unit, such that the operation device and the separation unit are sealed against body fluids when implanted.

[0105] At least one of the operating device and the separation unit may include a battery adapted to store the electric energy received at the receiving unit.

[0106] In any embodiment, the separation unit may comprise an injection port for supplying fluid to at least one of: one or the reservoir, and the hydraulically operable body engaging portion.

[0107] In one embodiment, the separation unit is separate from the energy receiving unit and may be free from at least one of the following: a metal component, a magnetizable component, and a magnetic component.

[0108] The separation unit may further comprise: a control unit for controlling at least one parameter of at least one of: an operating device, and a body engaging portion.

[0109] The separate unit may comprise a communication unit adapted to wirelessly communicate with an external unit on the outside of the patient's body.

[0110] According to one embodiment, the coil package in any embodiment herein may comprise a material selected from the group consisting of: carbon material, boron material, a material mixture, Materials, material alloys, metal materials, titanium, aluminum, ceramic materials, polymer materials, polyurethane, polyetheretherketone, silicon, and Silicon coating.

[0111] In any of the foregoing embodiments, the operating device of the operable implant may include an electric motor selected from the following: an alternating current (AC) electric motor; a direct current electric motor; a linear electric motor; an axial electric motor; a piezoelectric motor; a three-phase motor; a motor with more than one phase; a bimetallic motor; and a memory metal motor.

[0112] There is further provided an operable implant suitable for implantation into a patient's body. The operable implant comprises an operating device and a body engaging portion. The operating device may comprise an electric motor comprising a stationary part comprising a plurality of coils and a movable part comprising a plurality of magnets, such that sequential energization of the coils magnetically propels the magnets and thereby the movable part. The operating device may further comprise an encapsulation adapted to sealingly encapsulate the coils of the stationary part such that a seal is formed between the stationary part and the movable part, which is propelled by the contained magnets, thereby sealing the coils of the stationary part from body fluids when implanted.

[0113] According to one embodiment, the operating device further comprises: a control unit for controlling at least one of the operating device and the body engaging portion, wherein the packaging body is adapted to enclose the coil and the control unit.

[0114] The operating device of the operable implant may further comprise: at least one circuit adapted to indirectly receive energy drawn from wireless energy supplied from outside the patient's body, wherein the enclosure is adapted to enclose the coil and the circuit.

[0115] According to one embodiment, the operable implant comprises a separate wireless energy receiving unit comprising at least one coil adapted to convert received wireless energy in the form of a magnetic, electric or electromagnetic field into electrical energy.

[0116] According to one embodiment, the operable implant may comprise a spacing element adapted to create a spacing between the receiving unit and the electric motor such that the receiving unit remains substantially unaffected by metallic and / or magnetic parts of the stationary or movable parts of the electric motor.

[0117] In any embodiment, the electric motor can be an axial electric motor, wherein: the coils are distributed in a circle around the rotation axis of the implantable electric motor, so that the central axis of the coil spiral extends in the axial direction of the implantable electric motor and is parallel to the rotation axis; the movable part includes: a rotor extending radially, the magnets are distributed in a circle around the rotation axis on the rotor, the magnets face the coils in the axial direction, so that the magnets at least partially overlap with the coils in the radial direction, so that the sequential energization of the coils magnetically pushes the magnets axially and causes the rotor to rotate around the rotation axis of the electric motor.

[0118] In an alternative embodiment, the electric motor may be a radial electric motor, the coils may be distributed in a circle around the rotation axis of the implantable electric motor, so that the central axis of the coil's spiral extends in the radial direction of the rotation axis of the implantable electric motor, basically perpendicular to the rotation axis; the movable part may include: a rotor extending in the axial direction, the magnets are distributed in a circle around the rotation axis on the rotor, the magnets face the coils in the radial direction, so that the magnets at least partially overlap with the coils in the axial direction, so that the sequential energization of the coils magnetically pushes the magnets and causes the rotor to rotate around the rotation axis of the electric motor.

[0119] In an alternative embodiment, the electric motor is a linear electric motor, wherein: the coils are distributed linearly along the direction of movement of the movable part; and the movable part includes: magnets distributed linearly along the direction of movement of the movable part, so that sequential energization of the coils magnetically pushes the magnets and causes the movable part to move linearly.

[0120] The implantable electric motor may be an alternating current (AC) electric motor, and the control unit may include a frequency converter for changing the AC frequency to control the AC electric motor.

[0121] According to one embodiment, the implantable electric motor further comprises a second enclosure adapted to enclose the movable part such that the movable part is sealed against body fluids when implanted.

[0122] The second packaging body may be sealingly connected to the first packaging body so that the packaging body walls between the movable part and the stationary part are joined to simultaneously seal the first packaging body and the second packaging body. The first packaging body and / or the second packaging body may comprise a material selected from the following materials: a carbon material, a boron material, a material mixture, Materials, material alloys, metal materials, titanium, aluminum, ceramic materials, polymer materials, polyurethane, polyetheretherketone, silicon, and Silicon coating.

[0123] According to one embodiment, the second encapsulation is sealingly connected to the first encapsulation such that the movable part and the distance element between the movable part and the stationary part are both sealed by the second encapsulation.

[0124] The operable implant according to any of the preceding embodiments may further comprise a gear system adapted to receive as input mechanical work having a first force and speed from the rotating part of the electric motor and to output mechanical work having a different force and speed.

[0125] The gear system may further include: an operable element; a first gear having a hollow cylindrical shape and including a first number of teeth on an outer side of its periphery; and a second gear having a hollow cylindrical shape and including a greater number of teeth on an inner surface thereof than the first gear. The operable element is adapted to engage an inner side of the first gear so that the outer side of the first gear is pressed against the inner side of the second gear, thereby engaging the teeth of the first gear and the teeth of the second gear in at least one position, the at least one position being separate from a position in which the teeth do not engage with each other, wherein operation of the operable element advances the position, thereby causing relative rotation between the first gear and the second gear.

[0126] According to one embodiment, the second gear wheel has a smaller diameter and is at least partially arranged in the same axial plane as at least one of the movable part and the stationary part, so that at least one of the movable part and the stationary part at least partially overlaps the second gear wheel in the axial direction, so that the gear system is at least partially arranged within the electric motor.

[0127] The operable implant may be adapted to offset the first gear and to maintain the offset first gear so that the teeth of the first gear engage with the teeth of the second gear in at least one of one position, two positions, three positions, four positions, or more, wherein the two, three, and four positions are angularly separated positions that are separate from positions where the teeth do not engage with each other.

[0128] According to one embodiment, the operable element is adapted to offset the first gear and to maintain the offset first gear so that the teeth of the first gear engage with the teeth of the second gear in at least two angularly separated positions, wherein the angularly separated positions are separate from positions where the teeth do not engage with each other.

[0129] In any embodiment herein, the operating device may further include a second gear system, the second gear system comprising: an operable element; a first gear having a hollow cylindrical shape and including a first number of teeth on an outer periphery thereof; and a second gear having a hollow cylindrical shape and including a greater number of teeth on an inner surface thereof than the first gear, wherein the operable element is adapted to engage an inner side of the first gear such that the outer side of the first gear is pressed against the inner side of the second gear, thereby causing the teeth of the first gear and the teeth of the second gear to engage with each other in at least one position, the at least one position being separate from a position in which the teeth do not engage with each other, wherein operation of the operable element advances the position, thereby causing relative rotation between the first gear and the second gear. The first gear of the first gear system is directly or indirectly connected to the operable element of the second gear system, such that the first gear system and the second gear system are connected in series, such that the first gear system receives mechanical work having a first force and a first speed and outputs mechanical work having a different second force and a different second speed, while the second gear system receives mechanical work output from the first gear system as input and outputs mechanical work having a third force and a different third speed.

[0130] In any of the embodiments herein, the first and second gear systems may be coaxially positioned along an axis of rotation of the first and second gear systems.

[0131] The second gear of at least one of the first and second gear systems may have a smaller diameter than the rotatable structure of any embodiment herein and be at least partially disposed in the same axial plane, such that the rotatable structure at least partially axially overlaps the second gear of at least one of the first and second gear systems, thereby causing at least one of the first and second gear systems to be at least partially disposed within the electric motor.

[0132] In one embodiment, the first gear and the second gear of the second gear system may have a larger diameter than the rotatable structure and be at least partially disposed in the same axial plane, such that the first gear and the second gear of the second gear system at least partially axially overlap the rotatable structure, thereby causing the electric motor to be at least partially disposed within the second gear system.

[0133] The operable implant may further comprise a radially extending connection structure connecting the first gear of the first gear system directly or indirectly to the operable element of the second gear system, thereby transmitting force from the first gear system to the second gear system.

[0134] The first gear system may include a third gear having an inner side including the same number of teeth as an outer side of the first gear, the teeth of the third gear being adapted to interengage with the teeth of the third gear, thereby causing the third gear to rotate relative to the second gear with the angularly separated position.

[0135] According to one embodiment, the first gear of the first gear system is indirectly connected to the operable element of the second gear system via the third gear of the embodiment.

[0136] In any embodiment, the rotatable structure may be positioned radially on the inside of the circularly distributed coils.

[0137] The rotatable structure may be disposed radially on an outer side of the circularly distributed coils.

[0138] In any embodiment, the coil may remain encapsulated during operation of the operating device.

[0139] The first gear of at least one of the first and second gear systems may be directly or indirectly connected to a threaded member adapted to convert a radially rotating force into an axially reciprocating force. The threaded member may be directly or indirectly connected to a movable wall portion of the reservoir.

[0140] In any of the embodiments herein, the operable implant may include at least one fixation portion for fixing at least a portion of the operable implant to at least one of a fibrous, fascial, and muscle layer facing the inside of the patient's subcutaneous space.

[0141] The operable implant may further comprise a separate unit comprising a receiving unit adapted to receive wireless energy transmitted from outside the body.

[0142] The operable implant may further comprise a first reservoir in fluid connection with the hydraulically operable body engaging portion.The operation device may be adapted to effectuate the transfer of fluid from the first reservoir to the hydraulically operable body engaging portion.

[0143] A portion of the wall of the reservoir may comprise at least one of: a bellows structure, a shape adapted to allow movement even when covered with fibrous material, and a plate-shaped surface, in all cases enabling movement of the at least one movable wall portion, enabling compression and / or expansion of the reservoir.

[0144] According to one embodiment, the manipulation device comprises a hydraulic pump for delivering fluid from the first reservoir to the hydraulically operable body engaging portion. The hydraulic pump may be a hydraulic pump selected from the group consisting of: at least one reservoir having walls that move by mechanical work to function as a pump; at least one reservoir that changes volume to move fluid to function as a pump; at least one non-valve pump; at least one valve pump; at least one peristaltic pump; at least one diaphragm pump; at least one gear pump; and at least one bellows pump.

[0145] The electric motor may be an electric motor selected from the following: an alternating current (AC) electric motor; a direct current electric motor; a linear electric motor; an axial electric motor; a piezoelectric motor; a three-phase motor; a motor with more than one phase; a bimetallic motor; and a memory metal motor.

[0146] The operating device may further include: a first unit, which includes: a receiving unit for receiving wireless energy; and a first gear system, suitable for receiving mechanical work with a first force and a first speed and outputting mechanical work with a different second force and a different second speed; a second unit, which includes an electric motor suitable for converting electrical energy into mechanical work; and a spacing element, which includes: a wire for transmitting electrical energy from the first unit to the second unit; and a mechanical transmission member, which is suitable for transmitting mechanical work from the electric motor in the second unit to the gear system in the first unit; wherein, the spacing element is suitable for separating the first unit and the second unit so that the receiving unit is basically not affected by the second unit when receiving wireless energy.

[0147] According to one embodiment, the second unit comprises: a second gear system adapted to receive as input the mechanical work having a second different force and a second different speed output from the first gear system, and to output mechanical work having a third different force and a third different speed, wherein the gear system of the second unit is connected in series with the gear system of the first unit via the mechanical transmission member of the spacing element.

[0148] The first unit may include a second gear system adapted to receive mechanical work of a first force and speed as input and output mechanical work of a different force and speed. The second gear system may be connected in series with the first gear system.

[0149] The first unit of the operable implant may be adapted to be positioned in at least one of the following locations: subcutaneously, subcutaneously in the abdominal wall, and intra-abdominally.

[0150] The motor may comprise a magnetic material, wherein the first unit may be adapted to be substantially unaffected by the magnetic material in the second unit, or not significantly affected by the magnetic material in the second unit, during wireless energy transfer.

[0151] The first unit may comprise a reservoir for supplying fluid to the hydraulically operable body engaging portion.

[0152] The first unit may comprise a hydraulic pump adapted to convert mechanical work into hydraulic power for powering the hydraulically operable body engaging part, wherein the hydraulic pump is connected to a force output of the first gear system or the second gear system.

[0153] The operable implant may further include a gear system, the gear system comprising: an operable element; a first gear having the shape of a hollow cylinder and including a first number of teeth on the outer side of its periphery; and a second gear having the shape of a hollow cylinder and including more teeth than the first gear on its inner surface, wherein the operable element is suitable for engaging the inner side of the first gear so that the outer side of the first gear is pressed against the inner side of the second gear, so that the teeth of the first gear and the teeth of the second gear are engaged with each other in at least one position, and the at least one position is separated from the position where the teeth are not engaged with each other, wherein operation of the operable element causes the position to advance, thereby causing relative rotation between the first gear and the second gear, wherein the gear system and the axial electric motor are coaxially positioned along the rotation axis of the electric motor.

[0154] According to one embodiment, the operable element comprises at least one of: a planetary gear, a structure or a wheel that at least partially uses friction to interconnect with the first gear.

[0155] The first set of coils distributed in a circle around the rotation axis of the electric motor may be located on a magnetizable core structure, and the radially extending rotatable structure may include a rotatable disk, wherein a surface portion of the magnetizable core structure and the rotatable disk are coaxially positioned, and the rotatable disk is connected to a drive shaft connected to the operable element.

[0156] In one embodiment, the operating device may include: an electric motor having a force output end; a gear system connected to the force output end of the electric motor, the gear system including: an operable element; a first gear having a hollow cylindrical shape and including a first number of teeth on an outer side of its periphery; and a second gear having a hollow cylindrical shape and including a greater number of teeth on an inner surface than the first gear, wherein the operable element is adapted to engage an inner side of the first gear so that the outer side of the first gear is pressed against the inner side of the second gear, thereby causing the teeth of the first gear to engage with the teeth of the second gear in at least one position, the at least one position being separate from a position in which the teeth do not engage with each other; operation of the operable element causes the position to advance, thereby causing relative rotation between the first gear and the second gear; a gear system force output end connected to the first gear of the gear system and adapted to supply force directly or indirectly to the body engaging part, the gear system force output end including: a magnetic coupler for directly or indirectly connecting to the body engaging part magnetically to supply force; and an enclosure for sealingly enclosing the operating device.

[0157] According to one embodiment, the magnetic coupling comprises an inner rotating structure disposed within the enclosure, the inner rotating structure comprising at least one magnet or portion comprising a magnetic or magnetizable material. The magnet or portion comprising a magnetic or magnetizable material may be adapted to rotate to transmit a force to a corresponding rotating structure on the outside of the sealed enclosure, for supplying the force directly or indirectly to the body engaging portion via the sealed enclosure.

[0158] According to one embodiment, the operable implant may further comprise a corresponding rotational structure on the outside of the sealed enclosure for supplying force directly or indirectly to the body engaging portion.

[0159] According to one embodiment, the operable implant further comprises a reservoir for holding hydraulic fluid, wherein the reservoir comprises a movable wall portion adapted to change the volume of the reservoir, the movable wall portion being directly or indirectly connected to the gear system force output such that operation of the electric motor changes the volume of the reservoir via the gear system.

[0160] According to one embodiment, the operable implant further comprises: a corresponding rotation structure on the outside of the sealed package, the corresponding rotation structure being directly or indirectly connected to a threaded member, the threaded member being adapted to convert radial rotational force into axial reciprocating force.

[0161] In any embodiment herein, the threaded member is directly or indirectly connected to a movable wall of the reservoir to change the volume of the reservoir.

[0162] The operable implant may further include a peristaltic pump, the peristaltic pump including a hollow member for fluid delivery and an operable compression member adapted to engage and compress the hollow member. The force output end of the gear system is connected to the compression member via the magnetic coupler, such that operation of the electric motor operates the compression member via the gear system, thereby delivering fluid into the hollow member.

[0163] According to one embodiment, the operating device further comprises: a control unit for controlling at least one of the operating device and the body engaging portion, wherein the packaging body is adapted to package the operating device including the control unit.

[0164] The operating device of the operable implant further includes: at least one receiving unit, which is suitable for receiving wireless energy supplied from outside the patient's body, wherein the receiving unit is placed separately from the operating device, and wherein the package is suitable for including: the operating device, a spacing element connecting the operating device and the receiving unit, and the receiving unit.

[0165] The spacing element of the operable implant is adapted to form a spacing between the wireless energy receiver and at least one of the electric motor and the magnetic coupler such that the wireless energy receiver remains substantially unaffected or not significantly affected by metallic and / or magnetic components of the electric motor and the magnetic coupler.

[0166] The receiving unit further comprises at least one coil adapted to convert the received wireless energy in the form of a magnetic field, an electric field or an electromagnetic field into electrical energy.

[0167] The electric motor of the operable implant can be an axial electric motor, comprising: a plurality of coils, which are distributed in a circular manner around the rotation axis of the electric motor, so that the central axis of the spiral of the coil extends in the axial direction of the electric motor, parallel to the rotation axis of the electric motor; and magnets, which are distributed in a circular manner on a radially extending rotatable structure, the magnets are distributed in a circular manner around the rotation axis on the radially extending rotatable structure, and the magnets face the coils in the axial direction, so that the magnets at least partially overlap with the coils in the radial direction, so that the sequential energization of the coils magnetically pushes the magnets axially and causes the rotatable structure to rotate around the rotation axis of the electric motor.

[0168] In one embodiment, the electric motor is a radial electric motor, comprising: a plurality of coils distributed in a circle around the rotation axis of the implantable electric motor, such that the central axes of the coils' spirals extend in the radial direction of the implantable electric motor, substantially perpendicular to the rotation axis of the motor; and a plurality of magnets distributed in a circle on an axially extending rotatable structure, the magnets being distributed in a circle around the rotation axis on the axially extending rotatable structure, the magnets facing the coils in a radial direction, such that the magnets at least partially overlap with the coils in the axial direction, so that sequential energization of the coils magnetically pushes the magnets and rotates the rotatable structure around the rotation axis of the electric motor.

[0169] In any embodiment, the electric motor may be a linear electric motor, wherein: the coils are linearly distributed along the movement direction of a movable part of the linear electric motor; and the movable part includes: magnets linearly distributed along the movement direction of the movable part, so that sequential energization of the coils magnetically pushes the magnets and causes the movable part to move linearly.

[0170] The electric motor of the operating device may be an alternating current (AC) electric motor, wherein the control unit may include a frequency converter for changing an AC frequency to control the AC electric motor.

[0171] According to one embodiment, the package may comprise a material selected from the group consisting of: a carbon material, a boron material, a material mixture, Materials, material alloys, metal materials, titanium, aluminum, ceramic materials, polymer materials, polyurethane, polyetheretherketone, silicon, and Silicon coating.

[0172] The operating means may comprise a hydraulic pump for delivering hydraulic fluid from a reservoir to the hydraulically operable body engaging portion.

[0173] According to one embodiment, the electric motor includes an electric motor selected from the following: an alternating current (AC) electric motor; a direct current electric motor; a linear electric motor; an axial electric motor; a piezoelectric motor; a three-phase motor; a motor with more than one phase; a bimetallic motor; and a memory metal motor.

[0174] The electric motor can be adapted to drive a hydraulic pump selected from: at least one reservoir having walls that move by mechanical work and act as a pump; at least one reservoir that changes volume to move fluid and act as a pump; at least one non-valve pump; at least one valve pump; at least one peristaltic pump; at least one diaphragm pump; at least one gear pump; and at least one bellows pump.

[0175] According to one embodiment, the electric motor includes: a set of coils distributed in a circular pattern around an axis of rotation of the electric motor; and a set of magnets connected to a rotatable structure, the rotatable structure at least partially axially overlapping the coils, such that sequential energizing of the coils magnetically urges the magnets and rotates the rotatable structure about the axis of rotation. The second gear has a smaller diameter than the rotatable structure and is at least partially disposed in the same axial plane, such that the rotatable structure at least partially axially overlaps the second gear, such that the gear system is at least partially disposed within the electric motor.

[0176] According to one embodiment, the operable element is adapted to offset the first gear and to maintain the offset first gear so that the teeth of the first gear engage with the teeth of the second gear in at least one of one position, two positions, three positions, four or more positions, wherein the two, three, and four positions are angularly separated positions that are separate from positions where the teeth do not engage with each other.

[0177] The operable element may be adapted to offset the first gear and to maintain the offset first gear so that the teeth of the first gear engage with the teeth of the second gear at at least two angularly separated positions that are separate from positions where the teeth do not engage with each other.

[0178] The operating device may further include a second gear system, the second gear system comprising: an operable element; a first gear having a hollow cylindrical shape and including a first number of teeth on an outer periphery thereof; and a second gear having a hollow cylindrical shape and including a greater number of teeth on an inner surface thereof than the first gear, wherein the operable element is adapted to engage an inner side of the first gear so that the outer side of the first gear is pressed against the inner side of the second gear, thereby causing the teeth of the first gear and the teeth of the second gear to engage with each other in at least one position, the at least one position being separate from a position in which the teeth do not engage with each other, wherein operation of the operable element advances the position, thereby causing relative rotation between the first gear and the second gear. The first gear of the first gear system is directly or indirectly connected to the operable element of the second gear system, such that the first gear system is connected in series with the second gear system, such that the first gear system receives mechanical work having a first force and a first speed and outputs mechanical work having a different second force and a different second speed, while the second gear system receives the mechanical work output from the first gear system as input and outputs mechanical work having a third force and a different third speed.

[0179] The first and second gear systems may be coaxially positioned along an axis of rotation of the first and second gear systems.

[0180] According to one embodiment, the second gear of at least one of the first and second gear systems has a smaller diameter than the rotatable structure and is at least partially disposed in the same axial plane, such that the rotatable structure at least partially axially overlaps the second gear of at least one of the first and second gear systems, thereby causing at least one of the first and second gear systems to be at least partially disposed within the electric motor.

[0181] The first gear and the second gear of the second gear system may have a larger diameter than the rotatable structure and be at least partially disposed in the same axial plane, such that the first gear and the second gear of the second gear system at least partially axially overlap the rotatable structure, thereby causing the electric motor to be at least partially disposed within the second gear system.

[0182] The operable implant may further comprise a radially extending connecting structure connecting the first gear of the first gear system directly or indirectly to the operable element of the second gear system, thereby transmitting force from the first gear system to the second gear system.

[0183] The first gear system may include a third gear, wherein an inner side of the third gear includes the same number of teeth as an outer side of the first gear. The teeth of the third gear may be adapted to interengage with the teeth of the first gear, thereby causing the third gear to rotate relative to the second gear with the angularly separated position.

[0184] The first gear of the first gear system may be adapted to be indirectly connected to the operable element of the second gear system via the third gear.

[0185] The rotatable structure of any embodiment may be positioned radially inside or outside the circularly arranged coils.

[0186] The coil of the operable implant may be adapted to remain encapsulated during operation of the operation device.

[0187] According to one embodiment, the first gear of at least one of the first and second gear systems is directly or indirectly connected to a threaded member adapted to convert a radially rotating force into an axially reciprocating force. The threaded member may be directly or indirectly connected to a movable wall portion of the reservoir.

[0188] The operable implant may further include at least one fixation portion for fixing at least a portion of the operable implant to at least one of a fibrous, fascial, and muscle layer toward the inside of the patient's subcutaneous space.

[0189] According to one embodiment, the first reservoir is in fluid connection with the hydraulically operable body engaging part, wherein the operation device is adapted to cause fluid to be transferred from the first reservoir to the hydraulically operable body engaging part.

[0190] A portion of the wall of the reservoir may comprise at least one of: a bellows structure, a shape adapted to allow movement even when covered with fibrous material, and a plate-shaped surface, in all cases enabling movement of the at least one movable wall portion, enabling compression and / or expansion of the reservoir.

[0191] Further provided is an operable implant, which may include an operating device and a body-engaging portion. The operating device includes an electric motor having a force output end; and a starting resistance delay member located between the force output end of the electric motor and the body-engaging portion, wherein the starting resistance delay member is adapted to enable the electric motor to operate for a period of time with at least one of reduced force or reduced friction due to direct or indirect connection with the body-engaging portion, thereby enabling the electric motor to start with reduced resistance.

[0192] According to one embodiment, the force output end of the electric motor can be directly or indirectly connected to the force input end of the gear system. The gear system may include: an operable element; a first gear having a hollow cylindrical shape and including a first number of teeth on the outer side of its periphery; and a second gear having a hollow cylindrical shape and including a greater number of teeth on its inner surface than the first gear, wherein the operable element is adapted to engage the inner side of the first gear so that the outer side of the first gear presses against the inner side of the second gear, thereby causing the teeth of the first gear and the teeth of the second gear to engage with each other in at least one position, the at least one position being separate from a position in which the teeth do not engage with each other, wherein operation of the operable element causes the position to advance, thereby causing relative rotation between the first gear and the second gear; wherein the gear system includes a force output end connected to the first gear.

[0193] In any embodiment, the operable implant may further include: a second gear system located between the first gear system and the starting resistance delay. The second gear system may include: a force input end connected to the operable element and directly or indirectly connected to the force output end of the first gear system; a first gear having a hollow cylindrical shape and including a first number of teeth on the outer side of its periphery; and a second gear having a hollow cylindrical shape and including more teeth on its inner surface than the number of the first gear, wherein the operable element is adapted to engage the inner side of the first gear so that the outer side of the first gear presses against the inner side of the second gear, thereby causing the teeth of the first gear and the teeth of the second gear to engage with each other in at least one position, the at least one position being separated from a position in which the teeth do not engage with each other, wherein operation of the operable element causes the position to advance, thereby causing relative rotation between the first gear and the second gear; wherein the second gear system includes a force output end connected to the first gear of the second gear system.

[0194] The starting resistance delay member may be located between a force output of the electric motor and a force input of the gear system, or between the force output of the gear system and the body engaging portion.

[0195] In an alternative embodiment, the starting resistance delay member is located at one of the following positions: between the force output end of the first gear system and the force input end of the second gear system; between the force output end of the second gear system and the body engaging portion.

[0196] According to one embodiment, the starting resistance delay member comprises a spring, which may be a coil spring or a leaf spring.

[0197] In an alternative embodiment, the starting resistance delay member includes mechanical play, which may be one of a radial mechanical play and a linear mechanical play.

[0198] The starting resistance delay member may include radial mechanical clearance enabling the force output end of the electric motor to perform at least one of: 1 / 10 turn, 1 / 8 turn, 1 / 6 turn, 1 / 4 turn, 1 / 2 turn, 1 turn before the force output end directly or indirectly engages the drive member.

[0199] According to one embodiment, the starting resistance delay member is located at one of the following locations: between the first gear system force output end and the second gear system force input end; and between the second gear system force output end and the body engaging portion. The starting resistance delay member may include a radial mechanical clearance that enables the force output end of the gear system to perform at least one of 1 / 10 rotation, 1 / 8 rotation, 1 / 6 rotation, 1 / 4 rotation, 1 / 2 rotation, and 1 rotation before the force output end engages the drive member, so that the force output end of the electric motor can perform at least one of the following: 1 / 10 rotation*transmission of the gear system, 1 / 8 rotation*transmission of the gear system, 1 / 6 rotation*transmission of the gear system, 1 / 4 rotation*transmission of the gear system, 1 / 2 rotation*transmission of the gear system, and 1 rotation*transmission of the gear system.

[0200] In an alternative embodiment, the starting resistance retarder device may include a friction clutch.

[0201] In yet other alternative embodiments, the starting resistance delay device may include at least one element adapted to be operated by centrifugal force. The at least one element may be connected to the electric motor and adapted to directly or indirectly engage the body engaging portion when the centrifugal force acting on the element exceeds the centrifugal delay force.

[0202] According to one embodiment, the operable element of the first gear system and / or the second gear system may comprise an element adapted to be operated by centrifugal force such that the operable element of the gear system engages the first gear when the centrifugal force acting on the element exceeds the centrifugal retardation force.

[0203] The electric motor may be an electric motor selected from the following: an alternating current (AC) electric motor; a direct current electric motor; a linear electric motor; an axial electric motor; a piezoelectric motor; a three-phase motor; a motor with more than one phase; a bimetallic motor; and a memory metal motor.

[0204] According to one embodiment, the body engaging portion is a hydraulically operable body engaging portion connected to a hydraulic pump for delivering hydraulic fluid to operate the hydraulically operable body engaging portion. The hydraulic pump may comprise a reservoir comprising at least one movable wall portion, wherein the at least one movable wall portion is directly or indirectly connectable to the electric motor such that the electric motor is arranged to operate the movable wall portion to vary the volume of the reservoir.

[0205] According to one embodiment, the force output end of the electric motor is directly or indirectly connected to a threaded member, the threaded member being adapted to convert the radially rotating force of the electric motor into an axially reciprocating force. The threaded member can be directly or indirectly connected to a movable wall portion of the reservoir to change the volume of the reservoir.

[0206] According to an embodiment of the operable implant, the threaded member is directly or indirectly connected to a movable wall portion of the second reservoir to vary the volume of the second reservoir.

[0207] The movable wall portion of the first reservoir is moved in a first direction by the threaded member so as to expand the first fluid reservoir and increase the volume of the first reservoir. The movable wall portion of the second reservoir is moved in a first direction by the threaded member so as to contract the second reservoir and reduce the volume of the second reservoir.

[0208] According to one embodiment, the first reservoir is fluidly connected to a first hydraulically operable body engaging portion, and the second reservoir is fluidly connected to a second hydraulically operable body engaging portion. Operation of the electric motor in a first direction, through connection with the threaded member, causes: fluid to be transferred from the first reservoir to the first hydraulically operable implant; and fluid to be transferred from the second hydraulically operable body engaging portion to the second reservoir.

[0209] The reservoir may be, for example, circular or torus-shaped. According to one embodiment of the operable implant, the operable implant comprises a circular reservoir surrounding the operating device. The circular reservoir comprises a movable wall portion adapted to compress and expand the circular reservoir to thereby change the volume of the reservoir, the movable wall portion being connected to the electric motor such that operation of the electric motor changes the volume of the circular reservoir.

[0210] A portion of the wall of the reservoir may comprise at least one of: a bellows structure, a shape adapted to allow movement even when covered with fibrous material, and a plate-shaped surface, in all cases enabling movement of the at least one movable wall portion, enabling compression and / or expansion of the reservoir.

[0211] In one embodiment, the operable implant includes a hydraulic pump, which may be a peristaltic pump, comprising: a hollow member for fluid delivery, and an operable compression member suitable for engaging and compressing the hollow member, wherein the electric motor is directly or indirectly connected to the compression member so that operation of the motor operates the compression member to deliver fluid into the hollow member.

[0212] Further provided is an operable implant suitable for implantation into a patient's body. The operable implant includes an operating device and a body-engaging portion. The operating device includes a first gear system comprising an operable element; a first gear having a hollow cylindrical shape and including a first number of teeth on an outer periphery thereof; and a second gear having a hollow cylindrical shape and including a greater number of teeth on an inner surface thereof than the first gear. The operable element is adapted to engage the inner side of the first gear, causing the outer side of the first gear to press against the inner side of the second gear, thereby causing the teeth of the first gear and the teeth of the second gear to engage with each other in at least one position, the at least one position being separate from a position in which the teeth do not engage with each other. Operation of the operable element advances the mutually engaged position, thereby causing relative rotation between the first and second gears. The operating device further includes a second gear system comprising an operable element; a first gear having a hollow cylindrical shape and including a first number of teeth on an outer periphery thereof; and a second gear having a hollow cylindrical shape and including a greater number of teeth on an inner surface thereof than the first gear. The operable element is adapted to engage an inner side of the first gear, causing the outer side of the first gear to press against the inner side of the second gear, thereby causing the teeth of the first gear and the teeth of the second gear to engage with each other in at least one position, the at least one position being separate from a position in which the teeth do not engage with each other. Operation of the operable element causes the at least one position to advance, thereby causing relative rotation between the first gear and the second gear.

[0213] The first gear of the first gear system is directly or indirectly connected to an operable element of the second gear system such that the first gear system and the second gear system function as a single gear system.

[0214] According to one embodiment, the first gears of the first and second gear systems include deflectable walls. The operable element is adapted to deflect the first gear and maintain the deflected first gear such that teeth of the first gear engage with teeth of the second gear in at least one angularly spaced apart position, the angularly spaced apart position being separate from a position in which the teeth do not engage with each other. Operation of the urging element rotationally advances the angularly spaced apart position, thereby causing relative rotation between the first and second gears.

[0215] According to one embodiment, the operable element is suitable for offsetting the first gear and maintaining the offset first gear so that the teeth of the first gear engage with the teeth of the second gear in at least two angularly separated positions and at least one of at least three angularly separated positions, and the angularly separated positions are separate from the positions in which the teeth do not engage with each other.

[0216] In one embodiment of the operable implant, at least one of the first gear system and the second gear system comprises a third gear having a hollow cylindrical shape, wherein an inner side of the third gear comprises the same number of teeth as an outer side of the first gear, wherein the teeth of the third gear are adapted to interengage with the teeth of the first gear, thereby causing the third gear to rotate relative to the second gear along the at least one interengaging position.

[0217] According to one embodiment, the first gear system comprises a third gear having a hollow cylindrical shape, the inner side of the third gear comprising the same number of teeth as the outer side of the first gear of the first gear system, wherein the teeth of the third gear are adapted to interengage with the teeth of the first gear, thereby causing the third gear to rotate relative to the second gear along the at least one interengaging position; wherein the operable element of the second gear system is directly or indirectly connected to the third gear of the first gear system.

[0218] The first gear is at least partially located radially inwardly of the second gear system, such that the second gear system at least partially overlaps the first gear system axially. In an alternative embodiment, the first and second gear systems may be coaxially positioned along the rotational axes of the first and second gear systems.

[0219] According to one embodiment, the operable implant further comprises a radially extending connection structure connecting the first gear of the first gear system directly or indirectly to the operable element of the second gear system to transmit force from the first gear system to the second gear system.

[0220] The operable implant according to any of the preceding embodiments may further comprise an enclosure adapted to sealingly enclose the first and second gear systems such that the first and second gear systems are sealed against body fluids when implanted.

[0221] The operable element of the first and second gear systems of any of the embodiments herein may further comprise at least one of: a planetary gear, a structure comprising a friction surface connection, or a wheel.

[0222] In one embodiment, the operable implant further comprises an electric motor. The electric motor may be an electric motor selected from the group consisting of an alternating current (AC) electric motor, a direct current (DC) electric motor, a linear electric motor, an axial electric motor, a piezoelectric motor, a three-phase motor, a motor with more than one phase, a bimetallic motor, and a memory metal motor.

[0223] In any embodiment, the operable implant may further comprise: an enclosure adapted to hermetically enclose the first gear system and the electric motor. The enclosure may comprise: a sealed outlet for a rotational force, such that the force can be transmitted from the hermetically enclosed first gear system to the second gear system.

[0224] In any embodiment, the operable implant may further comprise: a system package adapted to sealingly enclose the first gear system, the second gear system, and the electric motor.

[0225] The operable implant may further comprise a sealed outlet for a rotational force, such that the force can be transferred from the sealed and enclosed second gear system to the operable implant.

[0226] The operable implant may further comprise an enclosure adapted to sealingly enclose the electric motor; the enclosure may comprise a sealed outlet for rotational force such that the force can be transferred from the sealed enclosed motor to the first gear system.

[0227] The operable implant may further comprise: an enclosure adapted to sealingly enclose a stationary part of the electric motor, the stationary part comprising at least one of: at least two coils, at least one core.

[0228] According to one embodiment, the enclosure of the stationary part of the motor may include: a wall, the operable implant may be adapted to form a rotational force from the sealed stationary part that passes wirelessly through the sealed wall, thereby forming a rotational force for rotating the rotor part of the motor, the rotor part including at least one of the following: at least one magnet, a magnetizable material, and at least one coil, the rotor being adapted to be further connected directly or indirectly to the first gear system.

[0229] According to one embodiment, the operable implant further comprises an enclosure adapted to sealingly enclose a rotor part of the electric motor and to sealingly enclose at least one of: the first gear system, the first and second gear systems.

[0230] Further provided is an operable implant suitable for implantation into a patient's body. The operable implant includes an operating device and a body-engaging portion. The operating device includes: at least one of at least one magnet, at least one magnetic material, and at least one magnetizable material, adapted to be influenced by a moving magnetic field generated by an external unit when implanted, causing the magnet, magnetic material, or magnetizable material to move in accordance with the moving magnetic field of the external unit. The operating device further includes: a gear system comprising: an operable element directly or indirectly connected to the at least one magnet, magnetic material, or magnetizable material, such that the operable element is moved by the magnet or magnetic material moving in accordance with the moving magnetic field of the external unit; a first gear having a hollow cylindrical shape and including a first number of teeth on an outer periphery thereof; and a second gear having a hollow cylindrical shape and including a greater number of teeth on an inner surface thereof than the first gear. The operable element is adapted to engage an inner side of the first gear, causing the outer side of the first gear to press against the inner side of the second gear, thereby causing the teeth of the first gear to engage with the teeth of the second gear in at least one position, the at least one position being separate from a position where the teeth do not engage with each other. Operation of the operable element causes the position to advance, thereby causing relative rotation between the first gear and the second gear.

[0231] The operation device of any embodiment herein may be adapted to be implanted subcutaneously and may be implanted subcutaneously in the abdominal region.

[0232] In any embodiment, the operating device may comprise a first unit and a second unit, wherein the at least one magnet, magnetic material or magnetizable material is arranged in the first unit and the gear system is arranged in the second unit.

[0233] The operable implant may further comprise: a spacing element adapted to create a spacing between the first unit and the second unit. The spacing element is adapted to perform at least one of the following operations: placement through the muscle layer of the abdominal wall, fixation to the muscle fascia at the inner side of the subcutaneous space. The spacing element may be flexible so that the first unit and the second unit can move relative to each other. The spacing element may be adapted to be fixed to at least one of the fascia and the muscle layer of the abdominal wall so that the spacing between the first part of the operating device and the patient's skin can be controlled. The spacing element may comprise: a mechanical transmission member adapted to transmit force from the first unit to the second unit so that force can be transmitted from the at least one magnet, magnetic material, or magnetizable material to the operable element of the gear system.

[0234] In one embodiment, the operable implant further comprises an enclosure adapted to sealingly encapsulate at least one of the operable implant, the operating device, the body engaging portion, the first unit, the second unit, or the distance element to achieve a seal against the patient's body fluids.

[0235] In one embodiment, the enclosure constitutes a reservoir for supplying fluid to the hydraulically operable body engaging portion such that the at least one magnet, magnetic material, or magnetizable material and the gear system are positioned within the reservoir.

[0236] The operable implant may further comprise a reservoir comprising a movable wall portion adapted to vary the volume of the reservoir, wherein the movable wall portion is directly or indirectly connected to the first gear of the gear system such that operation of the gear system varies the volume of the reservoir.

[0237] The first gear of the gear system may be directly or indirectly connected to a threaded member adapted to convert a rotational force into a reciprocating force.

[0238] The threaded member may be directly or indirectly connected to a movable wall portion of the reservoir to vary the volume of the reservoir.

[0239] The operable implant according to any of the preceding embodiments may further comprise a peristaltic pump comprising a hollow member for fluid delivery and an operable compression member adapted to engage and compress the hollow member, wherein the first gear of the gear system is directly or indirectly connected to the compression member such that operation of the gear system operates the compression member to deliver fluid into the hollow member.

[0240] In any of the foregoing embodiments, the operable implant may further include: a second gear system, the second gear system comprising: an operable element; a first gear having a hollow cylindrical shape and including a first number of teeth on an outer side of its periphery; and a second gear having a hollow cylindrical shape and including a greater number of teeth on its inner surface than the first gear. The operable element is adapted to engage an inner side of the first gear such that the outer side of the first gear presses against the inner side of the second gear, thereby causing the teeth of the first gear to engage with the teeth of the second gear in at least one position, the at least one position being separate from a position in which the teeth do not engage with each other, wherein operation of the operable element advances the at least one position, thereby causing relative rotation between the first gear and the second gear; wherein the first gear of the first gear system is directly or indirectly connected to the operable element of the second gear system such that the first gear system and the second gear system function as a single gear system.

[0241] The operable element of one of the first gear system and the second gear system includes at least one of a planetary gear, a structure or a wheel that enables transmission of rotational force using at least in part friction.

[0242] In any of the foregoing embodiments, the operable implant may further comprise: a wireless communication unit adapted to perform at least one of: receive wireless communication signals from an external unit; and transmit wireless communication signals to an external unit.

[0243] An external unit for supplying force to an implanted operating device is further provided. The external unit comprises an external drive unit adapted to generate a moving magnetic field on the outside of the patient's skin, the moving magnetic field adapted to influence at least one magnet, or magnetic material, or magnetizable material of the implanted operating device, causing the magnet or magnetic material to move in accordance with the moving magnetic field of the external drive unit.

[0244] The external drive unit may further include: a group of coils distributed in a circle around the rotation axis of the external unit, so that the coils are energized in sequence to form a rotating magnetic field, and the rotating magnetic field is suitable for affecting the magnet, magnetic material or magnetizable material of the implanted operating device, so that the magnet or magnetic material moves with the moving magnetic field of the external drive unit.

[0245] The external drive unit may further include a rotatable structure, which includes at least one magnet or magnetic material, and the rotatable structure can influence the magnet, magnetic material, or magnetizable material of the implanted operating device to rotate, so that the magnet, magnetic material, or magnetizable material rotates with the rotatable structure of the external unit.

[0246] According to one embodiment, the external unit further comprises: a wireless communication unit adapted to perform at least one of: receiving wireless communication signals from the implantable unit; and sending wireless communication signals to the implantable unit.

[0247] A medical system is further provided, comprising: an operable implant according to any one of the embodiments herein; and an external unit according to any one of the embodiments herein.

[0248] In one embodiment, the operating device includes a rotatable structure, which is suitable for holding at least one of at least one magnet, at least one magnetic material and at least one magnetizable material, and is further suitable for being affected by an externally formed moving magnetic field so that the rotatable structure rotates.

[0249] The operable implant may further comprise: an enclosure adapted to sealingly enclose at least one of the rotating structure according to any embodiment, the reservoir according to any embodiment, and the treading member according to any embodiment, thereby being sealed against bodily fluids of the patient.

[0250] In any of the foregoing embodiments, the operating device may include: a reservoir adapted to contain hydraulic fluid and at least one movable wall portion for changing the volume of the reservoir. The operating device is adapted to operate the movable wall of the reservoir, wherein the operating device includes a gear system disposed within the reservoir, the gear system including: an operable element; a first gear having a hollow cylindrical shape and including a first number of teeth on an outer side of its periphery; and a second gear having a hollow cylindrical shape and including a greater number of teeth on an inner surface than the first gear, wherein the operable element is adapted to engage an inner side of the first gear so that the outer side of the first gear presses against the inner side of the second gear, thereby causing the teeth of the first gear to engage with the teeth of the second gear in at least one position separate from a position in which the teeth do not engage with each other, wherein operation of the operable element causes the position to advance, thereby causing relative rotation between the first gear and the second gear.

[0251] Further provided is an operable implant suitable for implantation in a patient's body. The operable implant includes a hydraulic operating device for supplying hydraulic pressure, and a body-engaging portion adapted to receive the hydraulic pressure. The hydraulic operating device includes a reservoir adapted to contain hydraulic fluid, the reservoir including at least one movable wall portion for varying the volume of the reservoir; and an operating device adapted to operate the movable wall portion. The operating device includes a gear system disposed within the reservoir, the gear system comprising an operable element; a first gear having a hollow cylindrical shape and including a first number of teeth on an outer periphery thereof; and a second gear having a hollow cylindrical shape and including a greater number of teeth on an inner surface thereof than the first gear, wherein the operable element is adapted to engage an inner side of the first gear such that the outer side of the first gear presses against the inner side of the second gear, thereby causing the teeth of the first gear to engage with the teeth of the second gear in at least one position, the at least one position being separate from a position in which the teeth do not engage with each other, wherein operation of the operable element advances the position, thereby causing relative rotation between the first and second gears.

[0252] The first gear of the operable implant is directly or indirectly connected to a threaded member adapted to convert a rotational force into a reciprocating force.

[0253] The threaded member may be directly or indirectly connected to a movable wall portion of the reservoir such that operation of the operating device changes the volume of the reservoir.

[0254] The operable implant according to any one of the embodiments may further include: a rotatable structure located on the inner side of the reservoir and connected to the operable element of the gear system, the rotatable structure including at least one magnet, at least one magnetic material, or at least one magnetizable material, suitable for magnetic connection with the rotating magnetic field outside the reservoir, so that the rotating magnetic field on the outside of the reservoir pushes the rotatable structure inside the reservoir.

[0255] The rotatable structure of the operable implant may comprise a radially extending disc comprising a plurality of magnets, wherein the plurality of magnets may be adapted to magnetically couple axially with the rotating magnetic field.

[0256] According to one embodiment, the operable implant further includes: a driving unit, which includes a plurality of axially positioned coils, and the coils are distributed in a circle around the rotation axis of the rotatable structure located on the inner side of the reservoir, so that the central axis of the coil spiral extends in the axial direction, roughly parallel to the rotation axis of the rotatable structure or roughly aligned with the center of the rotation axis, wherein the coils are energized in sequence to form a rotating magnetic field to push the rotatable structure axially.

[0257] The operable implant may further comprise a magnetic coupler comprising a driven rotatable structure comprising a plurality of magnets distributed in a circular pattern around an axis of rotation of the rotatable structure. The driven rotatable structure may be adapted to magnetically couple with a rotatable structure located on the inside of the reservoir, the driven rotatable structure being connected to an electric motor adapted to propel the driven rotatable structure, thereby causing the rotatable structure located on the inside of the reservoir to rotate with the driven rotatable structure.

[0258] The rotatable structure may include an axially extending cylinder including a plurality of magnets on a circumferential surface of the cylinder, wherein the plurality of magnets are adapted to be radially magnetically coupled with the rotating magnetic field.

[0259] The operable implant may further include: a driving unit comprising a plurality of radially positioned coils, wherein the coils are distributed in a circle around the rotation axis of the rotatable structure located on the inner side of the reservoir, so that the central axis of the coil spiral extends in a radial direction, roughly perpendicular to the rotation axis of the rotatable structure, wherein the coils are energized in sequence to form a rotating magnetic field to drive the rotatable structure.

[0260] The operable implant may further comprise a drive unit comprising a drive rotatable structure, the drive rotatable structure comprising a plurality of magnets, the plurality of magnets being distributed in a circular pattern around the rotation axis of the rotatable structure. The drive rotatable structure may be adapted to be magnetically coupled radially to the rotatable structure located on the inner side of the reservoir, the drive rotatable structure being connectable to an electric motor adapted to propel the drive rotatable structure, thereby causing the rotatable structure located on the inner side of the reservoir to rotate along with the drive rotatable structure adapted to rotate radially on the outer side thereof.

[0261] According to one embodiment, the drive unit is an external drive unit adapted to be located on the outside of the patient's skin and to push a rotatable structure in the hydraulically operated device.

[0262] According to one embodiment, the hydraulic operating device includes an electric motor adapted to move the operable element of the gear system. The electric motor may be selected from the group consisting of an alternating current (AC) electric motor, a direct current (DC) electric motor, a linear electric motor, an axial electric motor, a radial motor, a three-phase motor, a motor with more than one phase, a piezoelectric motor, a bimetallic motor, and a memory metal motor.

[0263] The electric motor may be adapted to be located on the inside of the reservoir.

[0264] The operable implant according to any of the aforementioned embodiments may further include: a force transfer member suitable for performing at least one of the following actions: penetrating the wall of the fluid reservoir, not penetrating the wall of the reservoir, transferring force from outside the reservoir to inside the reservoir, and transferring force between the motor and the gear system within the reservoir.

[0265] The force transmitting member is connectable to an implantable electric motor and to the operable element of the gear system and is adapted to transmit a rotational force from the electric motor to the operable element.

[0266] The operable implant may further include: a second gear system, the second gear system including: an operable element; a first gear having a hollow cylindrical shape and including a first number of teeth on an outer side of its periphery; and a second gear having a hollow cylindrical shape and including a greater number of teeth on its inner surface than the first gear, wherein the operable element is adapted to engage an inner side of the first gear so that the outer side of the first gear is pressed against the inner side of the second gear, thereby causing the teeth of the first gear and the teeth of the second gear to engage with each other in at least one position, the at least one position being separate from a position in which the teeth do not engage with each other, wherein operation of the operable element advances the at least one position, thereby causing relative rotation between the first gear and the second gear. The first gear of the first gear system may be connected to the operable element of the second gear system so that the first gear system and the second gear system function as a single gear system.

[0267] According to one embodiment, the operable element of at least one of the first and second gear systems comprises at least one of a planetary gear, a wheel or a structure adapted to use a direct or indirect friction connection between the operable element and the first gear.

[0268] The hydraulic operating device further includes at least one receiving unit adapted to receive wireless energy supplied from outside the patient's body.

[0269] The receiving unit of the operable implant comprises at least one coil adapted to convert received wireless energy in the form of a magnetic field or an electromagnetic field into electrical energy.

[0270] The operable implant may further include a spacing element adapted to provide a spacing between the receiving unit and at least one of the reservoir and the electric motor such that the receiving unit remains substantially free from metallic components and / or magnetic parts of the reservoir and / or the electric motor. The spacing element is adapted to at least one of: be positioned through the muscle layer of the abdominal wall, and be secured to the fascia of the muscle facing the inner side of the subcutaneous space.

[0271] According to one embodiment, the distance element is flexible so that the wireless energy receiver can move relative to the reservoir and / or electric motor. The distance element can be adapted to be fixed to at least one muscle layer of the abdominal wall to achieve at least one of the following results: the distance between the first portion of the implantable unit and the patient's skin can be controlled; and movement of the distance element, including rotation, is minimized.

[0272] The operable implant may further comprise an injection port for supplying fluid directly or indirectly to the reservoir or the hydraulically operable implant.

[0273] An implantable generator for converting mechanical work into electrical energy is further provided. The implantable generator includes a movable structure comprising at least one magnet, at least one magnetic material, or at least one magnetizable material. The movable structure is adapted to be magnetically coupled to an external drive unit that generates a moving magnetic field, such that the movable structure moves with the moving magnetic field. The implantable generator further includes a generator unit coupled to the movable structure and adapted to convert the movement of the movable structure into electrical energy.

[0274] The generator unit comprises a movable generator part comprising at least one magnet, the movable generator part being connected to the movable structure; and at least one coil magnetically connected to the at least one magnet, a current being induced in the coil by movement of the movable generator part relative to the coil.

[0275] According to one embodiment, the movable structure comprises a rotatable disk, wherein the at least one magnet or magnetic material is located on the rotatable disk and is adapted to be magnetically coupled to an external unit that generates a rotating magnetic field. The generator unit is a rotating generator unit coupled to the rotatable disk such that the rotating generator unit rotates with the rotatable disk or becomes part of the rotatable disk for inducing current.

[0276] The movable structure is adapted to perform a reciprocating motion, wherein the movable structure is adapted to be magnetically connected to an external unit that forms a reciprocating magnetic field, so that the movable structure performs a reciprocating motion with the reciprocating magnetic field.

[0277] According to one embodiment, the movable structure is connected to an elastic element or spring such that the movable structure can be operated in a first direction by a magnetic force supplied by the external unit and in a second direction by the elastic element or spring.

[0278] The elastic element may include at least one of the following: an elastic material, a flexible material, a structure suitable for generating elastic movement, and a spring.

[0279] In one embodiment, the generator unit may be a linear generator unit comprising: a movable generator portion comprising at least one magnet, wherein the movable generator portion is connected to the movable structure adapted to perform a reciprocating motion; and at least one coil magnetically connected to the at least one magnet such that the reciprocating motion of the movable structure is propagated to the movable generator portion and induces a current in the at least one coil.

[0280] According to one embodiment, the implantable generator further comprises a battery connected to the generator unit, wherein the battery is adapted to store the electrical energy generated in the generator unit.

[0281] The implantable generator may further comprise an enclosure adapted to sealingly enclose the implantable generator such that the implantable generator is sealed from bodily fluids of the patient.

[0282] The implantable generator may further include a wireless communication unit adapted to perform at least one of: receiving a wireless communication signal from an external unit; and transmitting a wireless communication signal to an external unit.

[0283] The implantable generator may be adapted to be implanted subcutaneously. The implantable generator may be adapted to be implanted subcutaneously in the abdomen.

[0284] An external unit for supplying force to an implantable generator is further provided. The external unit includes an external drive unit adapted to generate a moving magnetic field on the outside of the patient's skin, the moving magnetic field adapted to influence at least one magnet, or at least one magnetic material, or at least one magnetizable material of the implantable generator, causing the magnet or magnetic material to move in accordance with the moving magnetic field of the external drive unit.

[0285] According to one embodiment, the external drive unit comprises at least one electromagnet adapted to be alternately energized and de-energized, thereby forming an alternating magnetic field to influence at least one magnet or magnetic material of the implantable generator.

[0286] The external drive unit may include at least one permanent magnet, wherein the positive pole of the permanent magnet is adapted to influence the permanent magnet of the implantable generator, and the negative pole of the permanent magnet is adapted to influence the permanent magnet of the implantable generator. The at least one permanent magnet may be adapted to move such that the positive and negative poles alternately influence the permanent magnet of the implantable generator.

[0287] According to one embodiment, the external drive unit comprises: a group of coils distributed in a circular pattern, such that sequential energization of the coils forms a rotating magnetic field suitable for influencing the magnets, magnetic materials or magnetizable materials of the implantable generator, so that the magnets, magnetic materials or magnetizable materials rotate with the rotating magnetic field of the external drive unit.

[0288] In one embodiment, the external unit comprises: a set of coils distributed in a linear shape, such that sequential energization of the coils forms a linear motion magnetic field suitable for influencing the magnet, magnetic material, or magnetizable material of the implantable generator, so that the magnet, magnetic material, or magnetizable material moves along the linear magnetic field of the external unit.

[0289] The external unit may include a rotatable structure including at least one magnet or magnetic material, and rotation of the rotatable structure may affect the magnet or magnetic material of the implantable generator to rotate, so that the magnet or magnetic material rotates with the rotatable structure of the external unit.

[0290] The external unit may include a reciprocating structure comprising at least one of a magnetic material, a permanent magnet, and an electromagnet. The reciprocating structure may be adapted to move the magnetic material, permanent magnet, or electromagnet between a first position proximate to the patient's skin and a second position further from the patient's skin, thereby forming a reciprocating magnetic field adapted to influence the magnet or magnetic material of the implantable generator; or adapted to intermittently receive electrical pulses to the at least one electromagnet to induce movement of the magnetic field while the reciprocating structure is substantially stationary.

[0291] According to one embodiment, the external unit further comprises: a wireless communication unit adapted to perform at least one of: receiving wireless communication signals from the implantable generator; and sending wireless communication signals to the implantable generator.

[0292] A system for generating an electric current in a patient's body is further provided. The system comprises: an implantable generator according to any embodiment herein; and an external unit according to any embodiment herein.

[0293] Further provided is an operable hydraulic implant comprising a hydraulically operated device. The hydraulically operated device comprises an enclosure adapted to sealingly enclose a reservoir adapted to contain hydraulic fluid for operating the operable hydraulic implant; and a gear system adapted to receive mechanical work at a first force and velocity as input and output mechanical work at a different force and velocity. The reservoir and gear system are sealed from bodily fluids when implanted.

[0294] The reservoir may comprise at least one movable wall portion for varying the volume of the reservoir.

[0295] In one embodiment, the gear system is connected to the movable wall for varying the volume of the reservoir. In one embodiment, the operable hydraulic implant further comprises an electric motor connected to the gear system and enclosed by the enclosure.

[0296] In one embodiment herein, the gear system includes: an operable element; a first gear having a hollow cylindrical shape and including a first number of teeth on an outer side of its periphery; and a second gear having a hollow cylindrical shape and including a greater number of teeth on an inner surface thereof than the first gear, wherein the operable element is adapted to engage an inner side of the first gear so that the outer side of the first gear is pressed against the inner side of the second gear, thereby causing the teeth of the first gear to engage with the teeth of the second gear in at least one position, the at least one position being separate from a position in which the teeth are not engaged with each other, wherein operation of the operable element causes the position to advance, thereby causing relative rotation between the first gear and the second gear.

[0297] In one embodiment of the operable hydraulic implant, the operable element of the gear system is adapted to receive mechanical work at a first force and speed from the electric motor. A first gear of the gear system is directly or indirectly connected to the at least one movable wall portion to supply mechanical work at a second, different force and speed to the at least one wall portion, whereby operation of the electric motor causes the movable wall portion to move and change the volume of the reservoir.

[0298] In one embodiment, the first gear of the gear system is directly or indirectly connected to a threaded member, the threaded member being adapted to convert a radially rotating force into an axially reciprocating force; wherein the threaded member is directly or indirectly connected to the movable wall portion for changing the volume of the reservoir. The threaded member can be directly or indirectly connected to a movable wall portion of a second fluid reservoir for changing the volume of the second reservoir.

[0299] The movable wall portion of the first reservoir moves in a first direction through the threaded member, causing the first reservoir to expand and increase the volume in the first reservoir; the movable wall portion of the second reservoir moves in the first direction through the threaded member, causing the second reservoir to contract and reduce the volume in the second reservoir.

[0300] The first reservoir can be fluidically connected to a first hydraulically operable body engaging part, and the second reservoir can be fluidically connected to a second hydraulically operable body engaging part, and the operation of the electric motor along the first direction is connected to the threaded member so that: the fluid is delivered from the first reservoir to the first hydraulically operable body engaging part; and the fluid is delivered from the second hydraulically operable body engaging part to the second reservoir.

[0301] According to one embodiment of the operable hydraulic implant, the wall of the encapsulation body constitutes at least a part of the wall of the reservoir, and at least one movable wall portion can be located between the reservoir and the gear system, so that the portion of the at least one movable wall portion separates the reservoir from the part of the encapsulation body enclosing the gear system, thereby sealing the gear system with respect to the reservoir.

[0302] The operable hydraulic implant further comprises a second gear system enclosed by the enclosure, the second gear system being adapted to receive mechanical work of the second different force and speed from an output of the first gear system and output mechanical work of a third different force and speed.

[0303] The second gear system includes: an operable element; a first gear having a hollow cylindrical shape and including a first number of teeth on the outer side of its periphery; and a second gear having a hollow cylindrical shape and including a number of teeth on its inner surface that is greater than the number of the first gear, wherein the operable element is adapted to engage the inner side of the first gear so that the outer side of the first gear is pressed against the inner side of the second gear, thereby causing the teeth of the first gear to engage with the teeth of the second gear in at least one position, the at least one position being separated from a position in which the teeth are not engaged with each other, wherein operation of the operable element causes the position to advance, thereby causing relative rotation between the first gear and the second gear; wherein the first gear of the first gear system is directly or indirectly connected to the operable element of the second gear system, so that the first gear system and the second gear system function as a single gear system.

[0304] According to one embodiment, the operable element of at least one of the first and second gear systems may comprise at least one of: a planetary gear, a wheel or a structure using a friction connection.

[0305] The operable hydraulic implant may further comprise at least one battery enclosed by the enclosure and adapted to energize the electric motor.

[0306] According to one embodiment, the operable hydraulic implant further comprises a receiving unit adapted to receive wireless energy transmitted from outside the patient's body.

[0307] The receiving unit is adapted to be encapsulated by the encapsulation body such that the receiving unit is sealed against body fluids.

[0308] The operable hydraulic implant may further comprise a spacing element adapted to create a spacing between the receiving unit and at least one of the gear system and the electric motor such that the receiving unit is removed from metallic and / or magnetic components of the gear system and / or the electric motor.

[0309] The receiving unit is adapted to charge the battery according to any one of the embodiments herein.

[0310] In one embodiment, the operable hydraulic implant further includes: a magnetic coupler comprising a first part and a second part, the first part being connected to the operable element of the gear system and encapsulated by the enclosure, and the second part: being located on the outside of the enclosure; being connected to an electric motor, the electric motor being positioned so that operation of the electric motor operates the second part of the magnetic coupler; and being magnetically connected to the first part of the magnetic coupler so that the first part of the magnetic coupler rotates with the second part of the magnetic coupler so that the electric motor pushes the gear system through the wall of the enclosure.

[0311] According to one embodiment, the operable hydraulic implant may further comprise an implanted electric motor, wherein the second part is connected to the implantable electric motor. The second part of the magnetic coupler may be connected to an external drive unit adapted to propel the first unit from outside the patient's body.

[0312] The electric motor may be an electric motor selected from the following: an alternating current (AC) electric motor; a direct current electric motor; a linear electric motor; an axial electric motor; a radial motor; a three-phase motor; a motor with more than one phase; a piezoelectric motor; a bimetallic motor; and a memory metal motor.

[0313] The packaging of the implantable hydraulic unit may comprise a material selected from the group consisting of: carbon material, boron material, a material mixture, Materials, material alloys, metal materials, titanium, aluminum, ceramic materials, polymer materials, polyurethane, polyetheretherketone, silicon, Silicon coating.

[0314] An operable implant for implantation into a patient's body is provided. The operable implant comprises: at least one fixation member adapted to directly or indirectly fix the operable implant toward at least one of: at least one muscle fascia, at least one bone fascia, at least one cortical bone layer, at least one muscle layer, fibrotic tissue, any portion of the abdominal wall, any portion of the subcutaneous space in the body, and its surrounding portion; and at least one adjustable spacing element adapted to: be directly or indirectly connected to at least a portion of the operable implant at one end thereof, be directly or indirectly connected to the fixation member at another end thereof, and adjust the spacing between the portion of the operable implant connected to the adjustable spacing element and the fixation member.

[0315] The operable implant may include: at least one part selected from the following list: an operating device; a control unit; a receiving unit for receiving wireless energy; a coil for receiving wireless energy; a receiving unit for receiving a magnetic field or an electromagnetic field; a magnetic force transmission coupler; an electric circuit; a button for controlling any function of the operable implant; an energy storage device; a structure capable of being pushed for adjusting the adjustable spacing element; an integrated operating device and receiving unit for receiving wireless energy, or a magnetic field, or an electromagnetic field suitable for generating kinetic energy; a housing for enclosing at least one of the different parts of the operable implant; two or more housings for enclosing at least one of the different parts of the operable implant in each housing. The at least one adjustable spacing element may be suitable for adjusting the spacing between the fixing member and at least one of the above-mentioned parts.

[0316] According to one embodiment of the operable implant, the at least one fixing member is integrated with at least one of: an operating device; a control unit; a receiving unit for receiving wireless energy; a coil for receiving wireless energy; a receiving unit for receiving a magnetic field or an electromagnetic field; a magnetic force transfer coupler; an electrical circuit; a button for controlling any function of the operable implant; an energy storage device; a pushable structure for adjusting the adjustable spacing element; an integrated operating device and receiving unit for receiving wireless energy, or a magnetic field, or an electromagnetic field suitable for generating kinetic energy; a housing for enclosing at least one of the different parts of the operable implant; two or more housings for enclosing at least one of the different parts of the operable implant in each housing; and an integrated unit comprising two or more of the parts. The at least one adjustable spacing element is suitable for adjusting the spacing between the following items: the fixing member integrated with one or more of the parts of the operable implant.

[0317] According to one embodiment, the at least one adjustable distance element is adjustable from outside the patient's body.

[0318] According to one embodiment, the at least one adjustable distance element is electrically or manually adjustable from outside the patient's body.The at least one adjustable distance element may comprise: two, three, four or more adjustable distance elements.

[0319] According to one embodiment, the at least one adjustable distance element comprises a threaded member for transferring a rotational motion into a linear motion for adjusting the distance.

[0320] The at least one adjustable spacing element or operable implant may include: an element capable of being detected by X-rays, so that the spacing adjusted by the at least one adjustable spacing element can be measured on an X-ray image; and / or, an element capable of being detected using ultrasound, so that the spacing adjusted by the at least one adjustable spacing element can be measured using ultrasound.

[0321] At least a portion of the operable implant may be adapted to be positioned subcutaneously; and / or the operation device may be adapted to be positioned subcutaneously.

[0322] The operation device of the operable implant may be adapted to be secured to at least one of: at least one fascia layer, and at least one muscle layer of the abdominal wall.

[0323] The at least one adjustable distance element may be adapted for placement through at least one of: at least one fascia layer, and at least one muscle layer of the abdominal wall.

[0324] In any of the embodiments herein, the adjustable spacing element may be flexible, such that different parts of the operable implant can bend relative to each other.

[0325] In one embodiment, the receiving unit includes at least one coil adapted to convert received wireless energy in the form of an electric, magnetic, or electromagnetic field into electrical energy. Alternatively, the receiving unit includes at least one first coil having a first number of windings and at least one second coil having a second, different number of windings.

[0326] The operable implant may further comprise at least one packaging body adapted to sealingly enclose at least one component of the operable implant and / or the adjustable distance element.

[0327] In any embodiment, the at least one adjustable distance element may include a wire for transferring electric current from the receiving unit to the operating device.

[0328] The operable implant may further comprise a control unit for controlling at least one parameter of the operable implant. The control unit may be adapted to communicate wirelessly with an external unit, such that the control unit can be wirelessly controlled from outside the body.

[0329] According to one embodiment, at least one of the at least one adjustable distance element and the receiving unit may be free from magnetic components.

[0330] In any embodiment, the at least one enclosure may include two or more enclosures, and the at least one adjustable distance element may be adapted to adjust the distance between the enclosures.

[0331] A surgical kit is further provided for an operable implant capable of adjusting a spacing between at least one fixation member of the operable implant and at least one component of the operable implant. The surgical kit includes: at least one first spacing element having: a first connecting portion adapted to be directly or indirectly connected to the at least one component of the operable implant; a second connecting portion adapted to be directly or indirectly connected to the at least one fixation member of the operable implant for forming a first spacing between the at least one component of the operable implant and the at least one fixation member of the operable implant; and at least one second spacing element having: a first connecting portion adapted to be directly or indirectly connected to the at least one component of the operable implant; and a second connecting portion adapted to be directly or indirectly connected to the at least one fixation member of the operable implant for forming a second, longer spacing between the at least one component of the operable implant and the at least one fixation member of the operable implant.

[0332] According to one embodiment of the surgical accessory tool, at least one of the at least one first distance element and the at least one second distance element comprises: an element that can be detected by X-rays, so that the distance between the at least one part of the operable implant and the at least one fixation member of the operable implant can be measured on an X-ray image.

[0333] In one embodiment of the surgical kit, at least one of the at least one first distance element and the at least one second distance element comprises an element detectable using ultrasound, such that the distance between the at least one part of the operable implant and the at least one fixation member of the operable implant can be measured using ultrasound.

[0334] According to one embodiment, at least one of the at least one first distance element and the at least one second distance element may be adapted to be positioned subcutaneously.

[0335] At least one of the at least one first spacing element and the at least one second spacing element may be adapted to be fixed to at least one of the following locations: at least one muscle fascia, at least one bone fascia, at least one cortical bone layer, at least one muscle layer, fibrotic tissue, any portion of the abdominal wall, any portion of the subcutaneous space in the body, and surrounding portions thereof.

[0336] In any embodiment of the surgical kit, at least one of the first and second distance elements can be adapted to create a distance between a muscle layer of the abdominal wall and an operation device of the operable implant.

[0337] At least one of the first and second distance elements of the surgical kit may be adapted for placement through at least one of: at least one fascia layer, and at least one muscle layer of an abdominal wall.

[0338] At least one of the first and second distance elements may be flexible, such that different parts of the operable implant can move relative to each other.

[0339] In any of the embodiments herein, at least one of the first distance element and the second distance element may be free from magnetic components.

[0340] At least one of the first and second distance elements may be adapted to guide a wire for transferring electric current from the wireless energy receiving unit to an operating device of the operable implant.

[0341] At least one of the first and second distance elements may be adapted to secure the wireless energy receiving unit to a preferred location in the patient's body and to prevent the body from rejecting the wireless energy receiving unit.

[0342] A system for adjusting the spacing in an operable implant is further provided. The system includes a surgical kit according to any embodiment of the present invention and an operable implant, the operable implant including: at least one fixed member, and at least one component selected from the following list: an operating device; a control unit; a receiving unit for receiving wireless energy; a coil for receiving wireless energy; a receiving unit for receiving a magnetic field or an electromagnetic field; a magnetic force transmission coupler; a circuit; a button for controlling any function of the operable implant; an energy storage device; a structure capable of being pushed for adjusting the adjustable spacing element; an integrated operating device and receiving unit for receiving wireless energy, a magnetic field, or an electromagnetic field suitable for generating kinetic energy; a housing for enclosing at least one of the different components of the operable implant; two or more housings for enclosing at least one of the different components of the operable implant in each housing. At least one of the first and second spacing elements can be adapted to form a spacing between the fixed member and at least one of the aforementioned components.

[0343] The at least one fixing member may be integrated with at least one of the following: an operating device; a control unit; a receiving unit for receiving wireless energy; a coil for receiving wireless energy; a receiving unit for receiving a magnetic field or an electromagnetic field; a magnetic force transfer coupler; an electrical circuit; a button for controlling any function of the operable implant; an energy storage device; a pushable structure for adjusting the adjustable spacing element; an integrated operating device and receiving unit for receiving wireless energy, or a magnetic field, or an electromagnetic field suitable for generating kinetic energy; a housing for enclosing at least one of the different parts of the operable implant; two or more housings for enclosing at least one of the different parts of the operable implant in each housing. At least one of the first and second spacing elements may be adapted to form a spacing between: a fixing member integrated with one or more of the above-mentioned parts; and the one or more other parts of any embodiment.

[0344] According to one embodiment, at least one of the first and second distance elements comprises a conductive line for transferring current from the wireless energy receiving unit to the operating device.

[0345] At least one part of the operable implant may be adapted to be positioned subcutaneously, or the operation device may be adapted to be positioned subcutaneously.

[0346] According to one embodiment, the manipulation device is adapted to be fixed to at least one of: at least one fascia layer, and at least one muscle layer of the abdominal wall.

[0347] The receiving unit may further include: at least one coil adapted to convert the received wireless energy in the form of electric, magnetic, or electromagnetic fields into electrical energy. The receiving unit may include: at least one first coil having a first number of windings; and at least one second coil having a second, different number of windings.

[0348] The system may further comprise: at least one packaging body adapted to hermetically enclose: at least any one of the components according to any of the embodiments; and the adjustable distance element.

[0349] According to one embodiment, the system further comprises: at least one packaging body adapted to hermetically enclose at least one of the components of any embodiment herein.

[0350] The control unit of the system may be adapted to control at least one parameter of the operable implant, and the control unit may be adapted to communicate wirelessly with an external unit such that the control unit can be wirelessly controlled from outside the body.

[0351] According to one embodiment, the at least one package comprises two or more packages, and one of the first distance element and the second distance element is adapted to adjust a distance between the two packages.

[0352] An operable implant for implantation in a patient is provided. The operable implant includes a body-engaging portion and an operating device for applying a force to the body-engaging portion. The operating device includes an implantable gear system adapted to receive mechanical work at a first force and velocity at a force input end and to supply mechanical work at a second force and velocity at a force output end to operate the body-engaging portion. The gear system includes an operable element connected to the force input end; a first gear connected to the force output end, the first gear having a hollow cylindrical shape and including a first number of teeth on an outer periphery thereof; and a second gear having a hollow cylindrical shape and including a greater number of teeth on an inner surface thereof than the first gear. The operable element may be adapted to engage an inner side of the first gear, causing the outer side of the first gear to press against the inner side of the second gear, thereby causing the teeth of the first gear to engage with the teeth of the second gear in at least one position separate from a position in which the teeth do not engage with each other, wherein operation of the operable element causes the position to advance, thereby causing relative rotation between the first and second gears.

[0353] According to one embodiment, the operable element is adapted to offset the first gear and maintain the offset first gear so that the teeth of the first gear engage with the teeth of the second gear at one or more angularly separated positions, and the angularly separated positions are separated from the positions where the teeth do not engage with each other.

[0354] The operable element may be adapted to offset the first gear and maintain the offset first gear so that the teeth of the first gear engage with the teeth of the second gear at at least two or more angularly separated positions, and the at least two or more angularly separated positions are separated from the position where the teeth do not engage with each other.

[0355] According to one embodiment, the operating device comprises an implantable electric motor for converting electrical energy into mechanical work. The electric motor is connectable to the force input.

[0356] The electric motor may be an electric motor selected from the following: an alternating current (AC) electric motor; a direct current electric motor; a linear electric motor; an axial electric motor; a piezoelectric motor; a three-phase motor; a motor with more than one phase; a bimetallic motor; and a memory metal motor.

[0357] The operable implant according to any embodiment herein may further comprise: a magnetic coupler connected to the force input end, such that the mechanical work of the first force and velocity is supplied to the gear system by the magnetic coupler. A magnetic coupler may be connected to the force output end, such that the mechanical work of the second force and velocity is supplied to the body engaging portion by the magnetic coupler.

[0358] According to one embodiment, the magnetic coupling is adapted to transmit at least one of a rotational force and a reciprocating force.

[0359] The magnetic coupler may include a rotating element disposed within a sealed enclosure that encloses at least the gear system of the operable implant, the rotating element including at least one magnet or portion comprising a magnetic or magnetizable material. The magnet or portion comprising a magnetic or magnetizable material may be adapted to rotate to transmit a force to a corresponding rotating element on an outer side of the sealed enclosure, for supplying the force directly or indirectly to the body engaging portion via the sealed enclosure.

[0360] The magnetic coupler may include a rotating element placed in a sealed enclosure, the rotating element including: at least one magnet or portion containing magnetic material or magnetizable material, suitable for rotating when receiving a transmitted force from a corresponding external rotating element placed on the outside of the sealed enclosure and on the outside of the body, for supplying force directly to the rotating element placed in the sealed enclosure.

[0361] The operable implant may further comprise an enclosure adapted to sealingly enclose the operable implant.

[0362] In any embodiment, the gear system may further include a third gear having a hollow cylindrical shape. The inner side of the third gear may include the same number of teeth as the outer side of the first gear, and the teeth of the third gear may be adapted to interengage with the teeth of the first gear, so that the third gear rotates relative to the second gear along the at least one interengaging position.

[0363] According to one embodiment, the third gear is connected to a second gear system, allowing the first and second gear systems to function as a single gear system. The second gear system includes a force input adapted to receive mechanical work at the second force and second speed from a force output of the first gear system; and a force output adapted to supply mechanical work at a third force and third speed to the body engaging portion. The second gear system may include an operable element connected to the force input of the second gear system; a first gear connected to the force output of the second gear system, having a hollow cylindrical shape and including a first number of teeth on its outer periphery; and a second gear having a hollow cylindrical shape and including a greater number of teeth on its inner surface than the first gear. The operable element may be adapted to engage the inner side of the first gear, causing the outer side of the first gear to press against the inner side of the second gear, thereby causing the teeth of the first gear to engage with the teeth of the second gear in at least one position separate from a position in which the teeth do not engage with each other, wherein operation of the operable element advances the at least one position, thereby causing relative rotation between the first and second gears.

[0364] According to one embodiment, the operable element of at least one of the first and second gear systems comprises at least one of: a planetary gear, a structure or a wheel that achieves rotational force transmission at least partially using friction.

[0365] In any of the embodiments herein, the force output end of the first gear system or the second gear system may be directly or indirectly connected to a threaded member, the threaded member being adapted to convert a rotational force into a linear force.

[0366] According to another embodiment, the operable implant further comprises a reservoir comprising a movable wall portion adapted to change the volume of the reservoir.The threaded member may be directly or indirectly connected to the movable wall portion such that operation of the threaded member changes the volume of the reservoir.

[0367] In some embodiments, the operable implant may further include: a second reservoir including a movable wall portion, the threaded member being directly or indirectly connected to the movable wall portion of the second reservoir to change the volume of the second reservoir. Movement of the movable wall portion of the first reservoir in a first direction by the threaded member may cause the first reservoir to expand and increase the volume in the first fluid reservoir; movement of the movable wall portion of the second reservoir in the first direction by the threaded member may cause the second reservoir to contract and decrease the volume in the second reservoir.

[0368] The first reservoir can be fluidically connected to the first body-joining part, and the second reservoir can be fluidically connected to the second body-joining part. The operation of the operating device along the first direction can enable: fluid to be transported from the first reservoir to the first body-joining part; fluid to be transported from the second body-joining part to the second reservoir through the connection with the threaded member.

[0369] In any embodiment, the reservoir may be at least one of circular and torus-shaped.

[0370] In any embodiment, the operable implant may further comprise a peristaltic pump comprising a hollow member for fluid delivery and an operable compression member adapted to engage and compress the hollow member. The force output end may be directly or indirectly connected to the compression member such that operation of the operation device operates the compression member to deliver fluid into the hollow member.

[0371] The operable implant may further comprise a friction coupling adapted to limit the torque that can be supplied by the operating device. The friction coupling may be located between the operating device and the body engaging portion such that the torque required to activate the operating device is reduced.

[0372] The operable implant may further comprise a reservoir for holding hydraulic fluid. The reservoir may comprise a movable wall portion adapted to change the volume of the reservoir. The movable wall portion may be directly or indirectly connected to a gear system outlet such that operation of the gear system changes the volume of the reservoir.

[0373] In any of the aforementioned embodiments, the electric motor may be a one-phase, two-phase, three-phase or more-phase motor, including at least one of an axial electric motor, a radial electric motor, and a linear electric motor.

[0374] The operable implant may further comprise: a separate receiving unit adapted to receive wireless energy; the receiving unit may comprise at least one coil adapted to convert the received wireless energy in the form of a magnetic field, an electric field or an electromagnetic field into electrical energy.

[0375] The operable implant may further comprise at least one spacing element adapted to create a spacing between the receiving unit and at least one of the patient's skin and any metallic, magnetic or magnetizable parts of the operable implant, such that the receiving unit remains substantially unaffected by the metallic parts and / or magnetic parts of the operable implant.

[0376] The at least one distance element may be adjustable.

[0377] The operable implant may further comprise at least one fixation member for securing at least one part of the operable implant to at least one of: muscle fascia, bone fascia, cortical bone, muscle layer, fibrotic tissue, and at least one layer toward the inside of the patient's subcutaneous space.

[0378] A medical system is further provided for transferring energy from outside a patient's body to an operable implant placed in the patient's body. The medical system comprises: an external drive unit; and an operable implant. The external drive unit comprises an external rotating structure, the external rotating structure comprising at least one magnet for forming a rotating magnetic field, the rotating magnetic field being adapted to be magnetically coupled to at least one of: a magnet, a magnetizable material, or a magnetic material of the operable implant for transferring force from the external drive unit to the magnet or magnetic material of the implant in the patient's body; and at least one coil of the operable implant for inducing an electric current in the patient's body. The provided medical system can transfer a rotational dynamic force to directly or indirectly power the medical implant.

[0379] The magnet or magnetic material of the operable implant may be fixed to an internal rotating structure adapted to rotate with a rotating magnetic field of the external drive unit used to operate the operable implant.

[0380] According to one embodiment, the magnet or magnetic material of the operable implant may be fixed to an internal reciprocating structure adapted to reciprocate with a rotating magnetic field of the external drive unit for operating the operable implant.

[0381] The inner reciprocating structure may be adapted to reciprocate due to magnetic coupling with a polarity-switching magnetic field such that magnets of the inner reciprocating structure are alternately attracted and repelled by a rotating magnetic field generated by the outer drive unit.

[0382] The external rotating structure may have a larger diameter than the internal rotating structure, and the magnets may be arranged so that the radial force that enables the magnets of the internal rotating structure to rotate with the magnets of the external rotating structure is greater than the axial force applied by the magnets that presses the internal structure against the external structure, thereby reducing the risk of magnetic force damaging the patient's skin.

[0383] According to one embodiment, at least one of the internal rotating structure and the external rotating structure may include: a repelling magnet, adapted to reduce the axial force generated by the magnetic connection between the internal and external magnets and / or magnetic materials, thereby reducing the squeezing effect on the patient's skin.

[0384] The force with which the magnets are repelled or attracted may be adjustable, thereby enabling adjustment of the compression effect on the patient's skin.

[0385] The repelling magnet of any embodiment may be a repelling electromagnet, the force of which may be adjusted by varying the current to the electromagnet.

[0386] According to one embodiment, the repelling magnets are permanent magnets, and the force of the repelling permanent magnets can be adjusted by changing the position of or the spacing between the permanent magnets relative to the patient's skin.

[0387] The inner rotating structure may include an inner spherical cap, the magnet or magnetic material of the inner rotating structure may be located on the outer side of the inner spherical cap. The outer rotating structure may include an outer spherical cap, the magnet or magnetic material of the outer rotating structure is located on the inner side of the outer spherical cap, so that the rotational force can be transmitted radially using the magnetic connection between the inner and outer spherical caps.

[0388] According to one embodiment, the inner spherical cap includes a centrally positioned magnet and the outer spherical cap includes a centrally positioned magnet, wherein the magnets of the inner spherical cap and the outer spherical cap are adapted to apply a repulsive force to each other, thereby reducing the axial force generated by the magnetic connection between the inner and outer magnets and / or magnetic materials, thereby reducing the squeezing effect on the patient's skin.

[0389] The medical system may further comprise: a gear system connected to the internal rotating structure. The gear system may be adapted to receive mechanical work at a first force and speed and to supply mechanical work at a different force and speed.

[0390] The gear system may include: an operable element; a first gear including a first number of teeth on an outer side thereof; and a second gear including a greater number of teeth than the first gear on an inner side thereof. The operable element may be adapted to press the outer side of the first gear toward the inner side of the second gear such that the teeth of the first gear and the teeth of the second gear engage with each other in at least one position separate from a position in which the teeth do not engage with each other, wherein operation of the operable element advances the position, thereby causing relative rotation between the first gear and the second gear.

[0391] According to one embodiment, the operable implant comprises an operating device and a body engaging portion. The operating device may comprise a hydraulic operating device. The body engaging portion may be a hydraulically operable body engaging portion. The operable implant may further comprise a hydraulic pump and a reservoir adapted to hold hydraulic fluid, the reservoir being connected to the hydraulic pump. The hydraulic pump may be adapted to deliver hydraulic fluid from the reservoir to the body engaging portion.

[0392] The hydraulic pump may comprise a movable wall portion of the reservoir and may be adapted to deliver hydraulic fluid from the reservoir to the hydraulically operable body engaging portion by moving the movable wall portion and thereby changing the volume of the reservoir.

[0393] According to one embodiment, the operating device includes an electric motor comprising a stationary component containing a plurality of coils and a movable component containing a plurality of magnets, such that sequential energization of the coils magnetically propels the magnets, thereby propulsing the movable component. The operating device may further include an enclosure adapted to hermetically enclose the coils of the stationary component, thereby forming a seal between the stationary component and the movable component, which is propelled by the magnets. This seal seals the coils of the stationary component against bodily fluids when implanted.

[0394] The medical system may further include: an implantable generator comprising: a movable generator portion including at least one generator magnet connected to the magnet or magnetic material of the operable implant, such that movement of the magnet or magnetic material causes the movable generator portion to move; and at least one coil magnetically connected to the at least one generator magnet such that current is induced in the coil by movement of the movable generator portion relative to the coil.

[0395] According to one embodiment, the movable generator part is adapted to perform a rotational movement.

[0396] The implantable generator may be an implantable rotary generator, the movable generator portion may be adapted to perform a rotational movement, and the at least one coil may be magnetically coupled to the at least one magnet such that rotational movement of the movable generator portion induces a current in the at least one coil.

[0397] The movable generator portion may be adapted to perform a reciprocating motion.

[0398] The implantable generator may be an implantable linear generator, the movable generator portion may be adapted to perform a reciprocating motion, and the at least one coil may be magnetically coupled to the at least one magnet such that reciprocating motion of the movable generator portion induces current in the at least one coil.

[0399] According to one embodiment, the operable implant comprises a plurality of coils arranged in a circular configuration such that a rotating magnetic field passed through the external drive unit sequentially induces currents in the plurality of coils.

[0400] The medical system may further include at least one battery or energy storage device connected to the at least one coil such that the current induced in the at least one coil can be stored as electrical energy in the battery.

[0401] The medical system may further comprise an enclosure adapted to sealingly enclose the operable implant such that the operable implant is sealed from bodily fluids of the patient.

[0402] In any embodiment, the operable implant may be adapted for subcutaneous implantation.

[0403] According to one embodiment, the operable implant comprises an operating device and a body-engaging portion. The operating device comprises a movable part, directly or indirectly connected to the body-engaging portion, the movable part being connected to at least one magnet, magnetizable material, or magnetic material. The movable part can be adapted to magnetically couple to a moving magnetic field on the outside of the patient's body, such that the movable part moves with the moving magnetic field. The operating device further comprises an implantable generator, connected to the movable part, and adapted to convert motion into electrical current, such that the motion of the movable part operates the body-engaging portion and generates electrical current.

[0404] At least one magnet, magnetizable material or magnetic material may be connected to the rotating structure and adapted to magnetically connect to a rotating magnetic field on the outside of the patient's skin such that the rotating structure rotates with the rotating magnetic field.

[0405] At least one magnet, magnetizable material or magnetic material may be connected to the structure adapted for reciprocation and adapted to magnetically couple to a reciprocating magnetic field on the outside of the patient's skin such that the structure adapted for reciprocation moves with the reciprocating magnetic field.

[0406] The implantable generator may further include at least one magnet and at least one coil, wherein movement of the at least one magnet relative to the at least one coil can induce a current in the at least one coil. The at least one magnet of the movable part may be adapted to magnetically couple to a moving magnetic field on the outside of the patient's body and also function as the at least one magnet in the implantable generator.

[0407] According to one embodiment, the operable implant further comprises a battery or energy storage device adapted to be charged by the implantable generator. The battery or energy storage device may be adapted to power the body engaging portion.

[0408] The operable implant may further comprise a control unit for controlling at least one parameter of the operable implant.

[0409] The control unit may be connected to the battery or energy storage device such that the battery provides power for the control unit.

[0410] The operating device may include a hydraulic operating device.

[0411] According to one embodiment, the body engaging portion may be a hydraulically operable body engaging portion, and the operable implant may further comprise a hydraulic pump and a reservoir adapted to hold hydraulic fluid, the reservoir being connected to the hydraulic pump. The hydraulic pump may be adapted to deliver hydraulic fluid from the reservoir to the body engaging portion.

[0412] The hydraulic pump may comprise a movable wall portion of the reservoir and may be adapted to deliver hydraulic fluid from the reservoir to the hydraulically operable body engaging portion by moving the movable wall portion and thereby changing the volume of the reservoir.

[0413] According to one embodiment, the hydraulic pump may be a hydraulic pump selected from: a peristaltic pump; a diaphragm pump; a gear pump; and a bellows pump.

[0414] In any of the embodiments herein, the operating device may include a gear system adapted to receive mechanical work at a first force and speed as input and output mechanical work at a different force and speed.

[0415] The gear system of the operating device may include: an operable element; a first gear having a hollow cylindrical shape and including a first number of teeth on an outer peripheral surface thereof; and a second gear having a hollow cylindrical shape and including a greater number of teeth on an inner surface thereof than the first gear. The operable element may be adapted to engage an inner side of the first gear so that the outer side of the first gear presses against the inner side of the second gear, thereby causing the teeth of the first gear and the teeth of the second gear to engage with each other in at least one position, the at least one position being separate from a position in which the teeth do not engage with each other. Operation of the operable element causes the position to advance, thereby causing relative rotation between the first gear and the second gear.

[0416] According to one embodiment, the operable element is connected to the movable part such that movement of the movable part operates the gear system.

[0417] According to one embodiment, the operable implant further comprises: an enclosure adapted to encapsulate the operable implant.

[0418] In any of the embodiments herein, the movable part of the gear system may be positioned subcutaneously.

[0419] The manipulation device may be adapted to be fixed to at least one fascia, fibrotic tissue, skin, muscle layer, or any subcutaneous tissue in the abdominal wall or in the abdomen.

[0420] The operating device may further include: a spacing element adapted to form a spacing between the operating device and the movable part.

[0421] The distance element may be adapted to control the position of the movable part to prevent the body from rejecting the movable part.

[0422] According to an embodiment of the operable implant, the operable implant further comprises a wireless communication unit adapted for wireless communication with an external unit.

[0423] According to one embodiment, the system further comprises an external unit comprising an external driving unit for supplying a driving force to the operable implant.

[0424] The external driving unit may include: a moving magnet adapted to generate a moving magnetic field; or may include: coils, wherein sequential energization of the coils generates the moving magnetic field.

[0425] According to one embodiment, the external driving unit further comprises: a wireless communication unit adapted for wireless communication with the operable implant.

[0426] An operable hydraulic implant is further provided. The operable hydraulic implant comprises: a body engaging portion; a power operating device fluidically connected to the body engaging portion. The operating device comprises: a reservoir for storing hydraulic fluid, wherein the reservoir comprises a movable wall portion, the movable wall portion being adapted to move to change the volume of the reservoir and thereby transport the hydraulic fluid from the reservoir to the body engaging portion; and an operating member connected to the movable wall portion such that operation of the operating member changes the volume of the reservoir; and a flexible encapsulating body adapted to have its volume changed by changing the outer dimensions and shape of the encapsulating body, and encapsulating the movable wall portion and the operating member. The movable wall portion may be adapted to move within the encapsulating body such that the volume of the reservoir can be changed by affecting the outer dimensions of the operable hydraulic implant through the movement of the movable wall portion within the encapsulating body.

[0427] The reservoir further includes a manual portion adapted to be compressed by manual force from outside the patient's body, thereby enabling the manual force to transfer fluid from the reservoir to the body-engaging portion of the operable hydraulic implant to temporarily increase the hydraulic pressure at the body-engaging portion. The manual portion enables manual override and / or increase of the reservoir pressure and / or emergency operation.

[0428] In any of the embodiments herein, the reservoir may be generally circular or oval in shape.

[0429] According to one embodiment, the average thickness of the movable wall portion is smaller than the average thickness of the manual portion of the reservoir.

[0430] According to one embodiment of the operable hydraulic implant, the reservoir comprises Silicon coating.

[0431] In one embodiment, the operating device is connected to a threaded member adapted to convert a radially rotating force into an axially reciprocating force, wherein the threaded member is connectable to the operating member.

[0432] The operable hydraulic implant may further comprise an electrical circuit, and a control unit for controlling the operable hydraulic implant.

[0433] The operable hydraulic implant may further comprise an injection port for injecting hydraulic fluid into the reservoir from outside the patient's body.

[0434] At least a portion of the operable hydraulic implant may be adapted for subcutaneous implantation.

[0435] The operable hydraulic implant may further comprise at least one fixation member adapted to directly or indirectly fix at least a portion of the operable hydraulic implant toward at least one of: at least one muscle fascia, at least one bone fascia, at least one cortical bone layer, at least one muscle layer, fibrotic tissue, any portion of the abdominal wall, any portion of the subcutaneous space in the body, and surrounding portions thereof.

[0436] The hydraulically operable object may further comprise a second body engaging portion and a second reservoir in fluid communication with the second body engaging portion. The second reservoir may comprise a movable wall portion adapted to move to change the volume of the second reservoir and thereby deliver hydraulic fluid from the second reservoir to the second body engaging portion.

[0437] The movable walls of the first and second reservoirs may be connected to the same operating member, adapted to increase or decrease the size of the reservoirs, and the volume of the first reservoir may be adapted to change in an opposite direction to the second reservoir.

[0438] According to one embodiment, the operating device includes an electric motor connected to the operating member. The electric motor may be selected from the group consisting of an alternating current (AC) electric motor, a direct current (DC) electric motor, a linear electric motor, an axial electric motor, a piezoelectric motor, a two-phase or more-phase motor, a three-phase motor, a bimetallic motor, and a memory metal motor.

[0439] According to one embodiment, operation of said electric motor affects both said movable walls of said first and second reservoirs.

[0440] The operating device may include a gear system adapted to receive mechanical work at a first force and speed and to supply mechanical work at a second force and a second speed having different forces. The gear system may include a force input end connected to an electric motor and a force output end directly or indirectly connected to the operating member.

[0441] The gear system may include: an operable element; a first gear having a shape of a hollow cylinder and including a first number of teeth on an outer side of its periphery; and a second gear having a shape of a hollow cylinder and including a number of teeth greater than that of the first gear on an inner surface thereof, wherein the operable element is adapted to engage an inner side of the first gear so that the outer side of the first gear is pressed against the inner side of the second gear, thereby causing the teeth of the first gear to engage with the teeth of the second gear in at least one position, the at least one position being separate from a position in which the teeth are not engaged with each other, wherein operation of the operable element causes the position to advance, thereby causing relative rotation between the first gear and the second gear.

[0442] The gear system may be connected to a threaded member adapted to convert a radially rotating force into an axially reciprocating force, wherein the threaded member is connected to the operating member.

[0443] According to one embodiment, the operating device comprises a magnetic coupler adapted to magnetically connect with an outer part of a magnetic coupler adapted to be located on the outside of the patient's body, thereby causing the inner part of the magnetic coupler to move with the outer part of the magnetic coupler to operate the movable wall part.

[0444] The operable hydraulic implant may further comprise a wireless communication unit for wirelessly communicating with an external unit located on the outside of the patient's body.

[0445] The operable hydraulic implant may further comprise at least one battery adapted to store electrical energy in the patient's body.

[0446] A medical system is further provided, comprising an operable implant adapted to be placed in a patient's body. The operable implant comprises a movable structure adapted for reciprocating motion, the movable structure comprising at least one magnet or magnetic material, and the movable structure adapted to be magnetically coupled to an external unit generating a reciprocating magnetic field or electromagnetic field, such that the movable structure reciprocates with the reciprocating magnetic field or electromagnetic field.

[0447] According to one embodiment, the operable implant further comprises a generator connected to the movable structure and adapted to convert the reciprocating motion of the movable structure into electrical energy.

[0448] The generator may include: a movable generator portion including at least one magnet, wherein the movable generator portion is connected to the movable structure; and at least one coil magnetically coupled to the at least one magnet, wherein a current is induced in the coil by movement of the movable generator portion relative to the coil.

[0449] According to one embodiment, the at least one magnet of the movable generator part is a magnet of the movable structure.

[0450] The operable implant may further comprise a force conversion member adapted to convert the reciprocating force into a rotational force. The generator may be a rotational generator connected to the force conversion member.

[0451] The generator may be a linear generator comprising: a reciprocating generator portion comprising at least one magnet, wherein the reciprocating generator portion is coupled to the movable structure adapted to perform a reciprocating motion; and at least one coil magnetically coupled to the at least one magnet such that reciprocating motion of the reciprocating generator portion induces a current in the at least one coil.

[0452] According to one embodiment, the movable structure is spring-loaded in one direction, so that the reciprocating motion is caused by a magnetic force due to a magnetic connection with the external unit in one direction and by the movable part being spring-loaded in an opposite direction.

[0453] The operable implant may further comprise a battery or energy storage device connected to the generator unit, the battery being adapted to store electrical energy generated in the generator unit.

[0454] According to one embodiment, the operable implant may further comprise a body engaging portion coupled to the movable structure such that movement of the movable structure operates the body engaging portion.

[0455] In any embodiment, the medical system may further comprise: an enclosure adapted to sealingly enclose the operable implant such that the implantable generator is sealed from the patient's bodily fluids.

[0456] The medical system according to any of the aforementioned embodiments may further comprise: a wireless communication unit adapted to perform at least one of: receiving a wireless communication signal from the external unit; and sending a wireless communication signal to the external unit.

[0457] In any of the embodiments herein, the operable implant may be adapted for subcutaneous implantation, wherein the operable implant may be implanted subcutaneously into the abdomen.

[0458] According to one embodiment, the operable implant further includes: an external unit, which includes an external driving unit, suitable for forming a reciprocating magnetic field on the outside of the patient's skin, and the reciprocating magnetic field is suitable for affecting at least one magnet or magnetic material of the operable implant so that the magnet or magnetic material reciprocates with the reciprocating magnetic field of the external unit.

[0459] The external drive unit may further include a reciprocating structure including at least one magnet, electromagnet, or magnetic material, and the reciprocating motion of the reciprocating structure may affect the magnet or magnetic material of the movable structure of the implantable generator to cause it to reciprocate.

[0460] According to one embodiment, the external drive unit may include a rotatable structure including at least one magnet, electromagnet, or magnetic material. Rotation of the rotatable structure affects the magnet or magnetic material of the movable structure of the implantable generator to cause it to reciprocate.

[0461] The rotatable structure of the external drive unit may include: a first magnet or electromagnet, which generates a positive magnetic field; and a second magnet or electromagnet, which generates a negative magnetic field, whereby rotation of the rotatable structure causes the first and second magnets or electromagnets to alternately affect the magnet or magnetic material of the operable implant to cause it to reciprocate.

[0462] According to one embodiment, the external drive unit comprises an electromagnet for alternately generating a magnetic field with positive and negative polarity, which causes the magnet or magnetic material of the implantable generator to move back and forth.

[0463] According to one embodiment, the operable implant further includes: a gear system suitable for receiving mechanical work of a first force and speed as input and outputting mechanical work with a different force and speed, the gear system including: an operable element; a first gear having the shape of a hollow cylinder and including a first number of teeth on the outer side of its periphery; and a second gear having the shape of a hollow cylinder and including more teeth than the first gear on its inner surface, wherein the operable element is suitable for engaging the inner side of the first gear so that the outer side of the first gear is pressed against the inner side of the second gear, thereby causing the teeth of the first gear to engage with the teeth of the second gear in at least one position, and the at least one position is separated from the position where the teeth are not engaged with each other, wherein operation of the operable element causes the position to advance, thereby causing relative rotation between the first gear and the second gear.

[0464] According to one embodiment, the operable implant comprises an operating device and a body-engaging portion, the operating device comprising an electric motor, the electric motor comprising a stationary part containing a plurality of coils and a movable part containing a plurality of magnets, such that sequential energization of the coils magnetically propels the magnets and, thereby, the movable part. The operating device further comprises an enclosure adapted to hermetically enclose the coils of the stationary part, forming a seal between the stationary part and the movable part, which is propelled by the magnets, thereby sealing the coils of the stationary part from bodily fluids when implanted.

[0465] According to one embodiment, the external unit further comprises: a wireless communication unit adapted to perform at least one of: receiving wireless communication signals from the operable implant; and sending wireless communication signals to the operable implant.

[0466] A medical system is provided for forming a magnetic connection between an external unit and an operable implant. The medical system comprises: an operable implant comprising at least one of a magnet, a magnetic material, and a magnetizable material; and an external unit comprising at least one of an external permanent magnet and an external electromagnet, adapted to magnetically connect to the at least one of the magnet, the magnetic material, and the magnetizable material of the operable implant. The magnetic force of the external magnet can be arranged or adjusted such that the compressive force on the patient's skin can be arranged or adjusted. The medical system thus reduces the risk of injury to the patient's skin.

[0467] According to one embodiment, the external magnet comprises at least one permanent magnet, and the external unit further comprises: a skin contact portion; and an adjustment device for adjusting the position of or the spacing between the permanent magnets relative to the skin contact portion.

[0468] According to one embodiment, the operable implant includes at least one of a first magnet, a first magnetic material portion, and a first magnetizable material portion; and at least one of a second magnet, a second magnetic material portion, and a second magnetizable material portion. The external unit includes at least one first magnet or a first electromagnet; and at least one second magnet or a second electromagnet. At least one of the first magnet, the magnetic material portion, and the magnetizable material portion of the operable implant is adapted to be attracted by the first magnet or the first electromagnet of the external unit, and at least one of the second magnet, the magnetic material portion, and the magnetizable material portion of the operable implant is adapted to be repelled by the second magnet or the second electromagnet of the external unit to balance the compressive force on the patient's skin.

[0469] According to one embodiment, the external unit is adapted to generate the first magnetic field and the second magnetic field with different polarities at different locations, or at the same location at different times. The operable implant may be adapted to generate the first magnetic field and the second magnetic field with different polarities at different locations, wherein the first magnetic field is adapted to reduce the attractive force between the operable implant and the external unit caused by the second magnetic field, thereby reducing the compression effect on the patient's skin.

[0470] According to one embodiment, the external unit comprises at least one electromagnet, wherein the external unit comprises a control unit for controlling the magnetic force of the electromagnet.

[0471] According to one embodiment, the medical system is adapted to transfer kinetic force from the external unit to the operable implant using a magnetic connection, the external unit comprising an external drive unit adapted to generate a kinetic magnetic field, the kinetic magnetic field adapted to be magnetically connected to the operable implant to transfer force from the external drive unit to at least one of a magnet, a magnetic material, and a magnetizable material of the operable implant.

[0472] According to one embodiment, the medical system is adapted to transmit a rotational force through a patient's skin, wherein the external drive unit includes an external rotating structure including at least one of at least one permanent magnet and at least one electromagnet for generating a rotating magnetic field adapted to magnetically couple to an internal rotating structure, causing the internal rotating structure to rotate with the external rotating structure. The compressive force applied to the patient's skin by the magnets of the internal rotating structure and the external rotating structure is adjusted to enable the rotational force to be transmitted without excessive force on the patient's skin.

[0473] According to one embodiment, the outer rotating structure has a larger diameter than the inner rotating structure, and the magnets are arranged so that the radial force that enables the magnets of the inner rotating structure to rotate with the magnets of the outer rotating structure is greater than the axial force that presses the inner structure against the outer structure.

[0474] According to one embodiment, the external unit is adapted to generate a rotating magnetic field, the rotating magnetic field comprising the first magnetic field and the second magnetic field according to any embodiment herein, and is implemented by at least one of the following alternatives:

[0475] 1. The first magnetic field is generated at least when the external rotating structure rotates, comprising at least one of an angularly intermittent first magnetic field, a central first magnetic field, and a circumferentially substantially continuous first magnetic field, wherein the first magnetic field further generates at least a portion of a magnetic coupling force to allow rotation of the internal rotating structure to join in at least one of the rotational motion of the external rotating structure and the rotational motion of the magnetic field generated by the rotating structure, wherein the first magnetic field reduces a force compressing the patient's skin;

[0476] 2. The first magnetic field is generated by one or more negative permanent magnets disposed on the inner rotating structure and the outer rotating structure, comprising at least one of an angularly discontinuous first magnetic field, a central first magnetic field, and a circumferentially substantially continuous first magnetic field, wherein the first magnetic field additionally generates at least a portion of a magnetic coupling force to allow rotation of the inner rotating structure to join at least one of a rotational motion of the outer rotating structure and a rotational motion of a magnetic field generated by the rotating structure when standing still, wherein a force compressing the patient's skin is reduced by the first magnetic field; and

[0477] 3. The first magnetic field is generated by one or more negative permanent magnets disposed on the inner rotating structure and the outer rotating structure, forming a repulsive magnetic force between the inner rotating structure and the outer rotating structure, wherein the permanent magnets are adapted to form at least one of an angularly discontinuous first magnetic field, a central first magnetic field, and a substantially continuous first magnetic field;

[0478] 4. The first magnetic field is formed by one or more negative permanent magnets disposed on the internal rotating structure, wherein the permanent magnets are adapted to generate at least one of an angularly discontinuous second magnetic field, a central second magnetic field, and a circumferentially substantially continuous second magnetic field, and the magnetic field formed by the internal rotating structure is adapted to form a magnetic coupling force toward the external unit;

[0479] 5. The second magnetic field is suitable for being generated by the external structure, and the external structure includes at least one of two or more coils and two or more positive permanent magnets, and is suitable for forming at least one of an angularly discontinuous second magnetic field, a central second magnetic field, and a circumferentially substantially continuous second magnetic field, and includes at least one of the following features: when there are two or more permanent magnets, the rotation of the external rotating structure causes the rotation of the internal rotating structure due to the magnetic coupling force formed by the rotating magnetic field according to Example 7; when there are two or more coils, the external rotating structure will stop, and the magnetic field of the external rotating structure will rotate by sequentially energizing the coils, causing the internal rotating structure to rotate due to the rotating magnetic field, and forming at least a portion of the magnetic coupling force that can rotate the internal rotating structure;

[0480] 6. The second magnetic field and the first magnetic field are both suitable for being generated at least in part by the external structure, the external structure comprising at least one of one or more coils, one or more positive permanent magnets, and one or more negative permanent magnets, suitable for forming: at least one of an angularly discontinuous second magnetic field and a first magnetic field, a central second magnetic field or a first magnetic field, and a circumferentially substantially continuous second magnetic field or a first magnetic field, wherein the second magnetic field and the first magnetic field are both generated by one or more negative permanent magnets disposed on the internal rotating structure, the permanent magnets being suitable for generating at least one of an angularly discontinuous second magnetic field, a central second magnetic field, and a circumferentially substantially continuous second magnetic field, and the magnetic field generated by the internal rotating structure being suitable for generating a magnetic coupling force toward the external unit, which is achieved by at least one of the following alternatives: when there are two or more positive permanent magnets and the internal rotating structure, When the two or more negative permanent magnets of the internal structure are magnetically coupled, the external rotating structure will rotate, and the rotation of the internal rotating structure will be caused by at least a portion of the magnetic coupling force formed by the rotating magnetic field; when the two or more negative permanent magnets are magnetically coupled with the two or more negative permanent magnets of the internal structure, the external rotating structure will rotate, and the rotation of the internal rotating structure will be caused by at least a portion of the magnetic coupling force formed by the rotating magnetic field; when the two or more coils are magnetically coupled with the two or more negative permanent magnets of the internal structure, the external rotating structure will stop and the magnetic field of the external rotating structure will rotate by successive energization of the coils, thereby causing the rotation of the internal rotating structure due to the rotating magnetic field, and forming at least a portion of the magnetic coupling force capable of rotating the internal rotating structure; and

[0481] 7. Both the second magnetic field and the first magnetic field are suitable for being at least partially rotated by the internal structure, and the internal structure includes at least one of one or more coils, one or more positive permanent magnets, and one or more negative permanent magnets, and is suitable for forming: at least one of an angularly discontinuous second magnetic field and a first magnetic field, a central second magnetic field or a first magnetic field, and a peripherally approximately continuous second magnetic field or a first magnetic field.

[0482] According to one embodiment, the inner rotating structure comprises an inner spherical cap, the magnets or magnetic material of the inner rotating structure being located on the outer side of the inner spherical cap. The outer rotating structure comprises an outer spherical cap, the magnets of the outer rotating structure being located on the inner side of the outer spherical cap, so that the rotational force can be transmitted radially by means of the magnetic connection between the inner and outer spherical caps.

[0483] According to one embodiment, the medical system according to any embodiment further comprises: an implantable generator comprising: at least one movable generator portion comprising at least one generator magnet adapted to be magnetically coupled to at least one of a magnet, a magnetic material, or a magnetizable material of the operable implant such that movement of the at least one of the magnet, the magnetic material, or the magnetizable material moves the movable generator portion or is the generator portion; and at least one coil magnetically coupled to the at least one generator magnet such that current is induced in the coil by movement of the movable generator portion relative to the coil.

[0484] According to one embodiment, the movable generator part is adapted to perform a rotational movement.

[0485] According to one embodiment, the implantable generator is an implantable rotary generator, wherein the movable generator part is adapted to perform a rotational movement, is positioned on the internal rotating structure, and the at least one coil is magnetically connected to the at least one magnet such that the rotational movement of the movable generator part induces a current in the at least one coil.

[0486] According to one embodiment, the movable generator part is adapted to perform a reciprocating motion.

[0487] According to one embodiment, the implantable generator is an implantable linear generator, the movable generator portion is adapted to perform a reciprocating motion, and the at least one coil is adapted to be magnetically coupled to the at least one magnet such that the reciprocating motion of the movable generator portion induces a current in the at least one coil.

[0488] According to one embodiment, the external unit is adapted to generate a rotating magnetic field; the operable implant comprises: a plurality of coils arranged in a circular configuration, the coils being adapted to be magnetically connected to the rotating magnetic field such that the rotating magnetic field sequentially induces currents in the plurality of coils.

[0489] In one embodiment, the external unit includes a wireless energy transmitter; the operable implant further includes a wireless energy receiver, enabling wireless energy to be transmitted from the external unit to the internal unit. The wireless energy transmitter may include a wireless energy transmitting coil; and the wireless energy receiver may include a wireless energy receiving coil.

[0490] The medical system may further comprise: at least one battery adapted to store electrical energy.

[0491] According to one embodiment, the external unit comprises a wireless communication unit; and the medical system comprises a wireless communication unit, such that the external unit and the operable implant can communicate wirelessly.

[0492] The medical system may further comprise an enclosure adapted to sealingly enclose the operable implant such that the operable implant is sealed from bodily fluids of the patient.

[0493] According to one embodiment, the operable implant may be adapted for subcutaneous implantation.

[0494] An operable implant is further provided. The operable implant includes an electric motor adapted to convert electrical energy into mechanical work, the electric motor adapted to output mechanical work at a first force and velocity; and a gear system adapted to receive mechanical work at the first force and velocity as input from the electric motor and output mechanical work at a second, different force and velocity. The medical system further includes a first force output adapted to output mechanical work at the first force and velocity from the electric motor; and a second force output adapted to output mechanical work at the second force and velocity from the gear system.

[0495] According to one embodiment, the operable implant further comprises an implantable generator, the first force output being connected to the implantable generator for generating an electric current within the patient's body.

[0496] According to one embodiment, the operable implant further comprises an operable body engaging portion connected to the second force output end of the operating device and operated by the second force output end.

[0497] The operable body engaging portion may be a hydraulically operable body engaging portion, wherein the operation means may further comprise a hydraulic pump for delivering hydraulic fluid to the hydraulically operable body engaging portion.

[0498] The hydraulic pump of the operable implant comprises a reservoir adapted to contain hydraulic fluid, the reservoir may comprise a movable wall portion for varying the volume of the reservoir, the movable wall portion being connectable to the operating device such that the operating device operates the movable wall portion.

[0499] The hydraulic pump may be a hydraulic pump selected from: at least one non-valve type pump; at least one valve type pump; at least one peristaltic pump; at least one diaphragm pump; at least one gear pump; and at least one bellows pump.

[0500] According to one embodiment, at least one of the first force output end and the second force output end is connected to a threaded member, the threaded member being adapted to convert a radially rotating force into an axially reciprocating force. The threaded member may be directly or indirectly connected to a movable wall portion of the reservoir to change the volume of the reservoir.

[0501] The threaded member may be directly or indirectly mechanically connected to the body engaging portion such that the body engaging portion is operated by the threaded member.

[0502] According to one embodiment, the gear system of the operable implant includes: an operable element connected to the first force output end; a first gear having the shape of a hollow cylinder and including a first number of teeth on the outer side of its periphery; and a second gear having the shape of a hollow cylinder and including more teeth than the first gear on its inner surface, wherein the operable element is suitable for engaging the inner side of the first gear so that the outer side of the first gear is pressed against the inner side of the second gear, so that the teeth of the first gear and the teeth of the second gear are engaged with each other in at least one position, and the at least one position is separated from the position where the teeth are not engaged with each other, wherein operation of the operable element causes the position to advance, thereby causing relative rotation between the first gear and the second gear, wherein the first gear is connected to the second force output end to output mechanical work with a second force and speed.

[0503] According to one embodiment, the operating device further comprises: a second gear system adapted to receive mechanical work of a second force and speed as input from the first gear system, and output mechanical work of a third different force and speed.

[0504] According to one embodiment, the operating device further comprises: a third force output end adapted to output mechanical work having a third force and speed from the second gear system.

[0505] The second gear system may include: an operable element connected to the second output end; a first gear having a shape of a hollow cylinder and including a first number of teeth on the outer side of its periphery; and a second gear having a shape of a hollow cylinder and including a number of teeth on its inner surface that is greater than the number of the first gear, wherein the operable element is adapted to engage the inner side of the first gear so that the outer side of the first gear is pressed against the inner side of the second gear, thereby causing the teeth of the first gear to engage with the teeth of the second gear in at least one position, the at least one position being separated from a position in which the teeth are not engaged with each other, wherein operation of the operable element causes the position to advance, thereby causing relative rotation between the first gear and the second gear, wherein the first gear is connected to the third force output end to output mechanical work having a third force and speed.

[0506] According to one embodiment, the operable implant further comprises: an enclosure adapted to encapsulate the operation device.

[0507] The package body may include a first penetration portion and a second penetration portion, wherein the first penetration portion may be applicable to the first force output end, and the second penetration portion may be applicable to the second force output end.

[0508] According to one embodiment, the package body includes: first, second, and third penetrating force output parts.

[0509] According to one embodiment, the package body includes first, second, and third penetrating portions. The first penetrating portion is adapted for the first force output end, the second penetrating portion is adapted for the second force output end, and the third penetrating portion is adapted for the third force output end. The first force output end is connectable to a first hydraulic pump for operating the first body-engaging portion, and the second force output end is connectable to a second hydraulic pump for operating the second body-engaging portion.

[0510] According to one embodiment, the first force output end comprises a first rotatable shaft; and the second force output end comprises a second rotatable shaft.

[0511] The enclosure may include at least one of a first sealing member adapted to seal between the enclosure and the first rotatable shaft and a second sealing member adapted to seal between the enclosure and the second rotatable shaft. The first and second sealing members may allow the rotatable shaft to rotate.

[0512] The first rotatable shaft may be adapted to be located within the second rotatable shaft; or the second rotatable shaft may be adapted to be located within the first rotatable shaft.

[0513] According to one embodiment, the first force output end includes a first rotatable shaft; the second force output end includes a second rotatable shaft; and the third force output end includes a third rotatable shaft.

[0514] According to one embodiment, the enclosure comprises at least one of: a first sealing member adapted to seal between the enclosure and the first rotatable shaft; a second sealing member adapted to seal between the enclosure and the second rotatable shaft; and a third sealing member adapted to seal between the enclosure and the third rotatable shaft. The first and second sealing members allow the rotatable shaft to rotate.

[0515] The first and second rotatable shafts may be adapted to be located within the third rotatable shaft; alternatively, the second and third rotatable shafts may be adapted to be located within the first rotatable shaft; alternatively, the first and third rotatable shafts may be adapted to be located within the second rotatable shaft.

[0516] The operable implant may comprise at least one implantable battery adapted to power the electric motor.

[0517] The operable implant may further comprise a receiving unit adapted to receive wireless energy transmitted from outside the patient's body. The receiving unit may be adapted to charge the battery.

[0518] According to one embodiment, the electric motor is an electric motor selected from the following: alternating current (AC) electric motor; direct current electric motor; linear electric motor; axial electric motor; radial motor; three-phase motor; motor with more than one phase; piezoelectric motor; bimetallic motor; and memory metal motor.

[0519] The package may include a material selected from the group consisting of: a carbon material, a boron material, a material mixture, Materials, material alloys, metal materials, titanium, aluminum, ceramic materials, polymer materials, polyurethane, Silicon coating.

[0520] Different schemes or any parts of a scheme, or different embodiments or any parts of an embodiment, may be combined in any feasible way. Any method or any step in a method may also be considered as an apparatus description, and any apparatus embodiment, scheme, or part of a scheme or part of an embodiment may be considered as a method description, and may be combined in any feasible way, even to the smallest detail. Any detailed description should be understood in its broadest sense as a general summary description, and please note that any embodiment or part of an embodiment and any method or part of a method may be combined in any way. BRIEF DESCRIPTION OF THE DRAWINGS

[0521] The present invention will now be described by way of example with reference to the accompanying drawings, in which:

[0522] Figure 1a An overall schematic diagram showing an embodiment of an operable implant and an external unit;

[0523] Figure 1b An overall schematic diagram showing an embodiment of an operable implant and an external unit;

[0524] Figure 2a showing a cutaway top view of an embodiment of a gear system;

[0525] Figure 2b a cutaway side view showing an embodiment of a gear system;

[0526] Figure 2c A schematic top view showing an embodiment of a gear system;

[0527] Figure 3a showing a cutaway top view of an embodiment of a gear system;

[0528] Figure 3ba cutaway side view showing an embodiment of a gear system;

[0529] Figure 3c A schematic top view showing an embodiment of a gear system;

[0530] Figure 3d A schematic top view showing an embodiment of a gear system;

[0531] Figure 4 showing a cut-away side view of an embodiment of an implantable hydraulically operated device;

[0532] Figure 5 A front perspective view showing an embodiment of an implantable hydraulically operated device in cross-section;

[0533] Figure 6 Showing a cross-sectional side view and a cross-sectional top view of an embodiment of an implantable hydraulically operated device;

[0534] Figure 7 Showing a cross-sectional side view and a cross-sectional top view of an embodiment of an implantable hydraulically operated device;

[0535] Figure 8 Showing a cross-sectional side view and a cross-sectional top view of an embodiment of an implantable hydraulically operated device;

[0536] Figure 9 Showing a cross-sectional side view and a cross-sectional top view of an embodiment of an implantable hydraulically operated device;

[0537] Figure 10a Showing a cross-sectional side view and a cross-sectional top view of an embodiment of an implantable hydraulically operated device;

[0538] Figure 10b An exploded front perspective view showing an embodiment of an implantable electric motor;

[0539] Figure 11a Showing a cross-sectional side view and a cross-sectional top view of an embodiment of an implantable hydraulically operated device;

[0540] Figure 11b An exploded front perspective view showing an embodiment of an implantable electric motor;

[0541] Figure 12 showing a cross-sectional side view and a cross-sectional top view of an embodiment of an implantable operation device;

[0542] Figure 13a - 14b schematically shows an embodiment in which the gear system includes a plurality of gear systems;

[0543] Figure 15showing a cutaway side view of an embodiment of a hydraulically operated device including two gear systems;

[0544] Figure 16 showing a cutaway side view of a left portion of an embodiment of a gear system including two gear systems;

[0545] Figure 17 A front perspective view, in section, showing an embodiment of an implantable operating device including two gear systems;

[0546] Figure 18a Showing a cross-sectional side view and a cross-sectional top view of an embodiment of an implantable hydraulically operated device;

[0547] Figure 18b An exploded perspective side view showing an embodiment of an implantable operating device in cross-section;

[0548] Figure 19 A front perspective view showing an embodiment of an implantable operating device and a front perspective view of the implantable operating device in cross-section;

[0549] Figure 20 showing cut-away side and top views of an embodiment of an implantable surgical device;

[0550] Figure 21 A cross-sectional side view showing an embodiment of an implantable hydraulically operated device including a magnetic coupling;

[0551] Figure 22 showing a cut-away side view of an embodiment of an implantable surgical device including a magnetic coupler;

[0552] Figure 23 showing a cutaway top view of a peristaltic pump;

[0553] Figure 24a showing a front perspective view of an implantable procedure device including a peristaltic pump;

[0554] Figure 24b showing a cut-away side view of an implantable procedure device including a peristaltic pump;

[0555] Figure 25a showing a cut-away side view of an implantable procedure device including a peristaltic pump;

[0556] Figure 25b showing a cutaway top view of an implantable procedure device including a peristaltic pump;

[0557] Figure 26 A front perspective view showing an embodiment of an implantable hydraulically operated device in cross-section;

[0558] Figure 27a showing a cross-sectional side view of the implantable hydraulically operated device in a first state;

[0559] Figure 27b Show Figure 27a A cross-sectional side view of the implantable hydraulically operated device in a second state;

[0560] Figure 28a a cutaway side view showing an implantable hydraulically operated device;

[0561] Figure 28b a cutaway top view showing an implantable hydraulically operated device;

[0562] Figure 28c Show Figure 28a and 28b Schematic diagram of a reservoir of an implantable hydraulically operated device;

[0563] Figure 29 a front perspective view showing an implantable operating device in cross-section;

[0564] Figure 30a showing a front perspective view of the implantable operating device in a first state;

[0565] Figure 30b Show Figure 30a A front perspective view of an implantable operating device in a first state;

[0566] Figure 31a An exploded perspective view showing an implantable procedure device including a start resistance delay;

[0567] Figure 31b showing an exploded perspective view of an implantable surgical device including a start resistance delay;

[0568] Figure 31c showing an exploded perspective view of an implantable surgical device including a start resistance delay;

[0569] Figure 31d showing an exploded perspective view of an implantable surgical device including a start resistance delay;

[0570] Figure 31e An exploded perspective view showing an implantable operating device including a coupling;

[0571] Figure 32 a cut-away side view showing an implantable operating device positioned on the inside of a patient's skin and an external unit for powering the implantable operating device;

[0572] Figure 33 showing a side view of a wireless energy transmitter and an implantable wireless energy receiver;

[0573] Figure 34 a side view showing an operable implant and wireless energy transmitter;

[0574] Figure 35a showing a cross-sectional side view of a wireless energy transmitter and a cross-sectional side view of a wireless energy receiver positioned on the inside of a patient's skin;

[0575] Figure 35b showing a cross-sectional side view of a wireless energy transmitter and a cross-sectional side view of a wireless energy receiver positioned on the inside of a patient's skin;

[0576] Figure 35c Showing alternatives for wireless energy transmission;

[0577] Figure 36 a side view showing an operable implant and wireless energy transmitter;

[0578] Figure 37 a side view showing an operable implant and wireless energy transmitter;

[0579] Figure 38a - 38c shows a schematic side view illustrating the principle of wireless energy transfer through the patient's skin;

[0580] Figure 39 a side view showing an operable implant and wireless energy transmitter;

[0581] Figure 40 a side view showing an operable implant and wireless energy transmitter;

[0582] Figure 41 a schematic side view showing an operable implant;

[0583] Figure 42 a schematic side view showing an operable implant;

[0584] Figure 43a showing a side view of an operable implant including fixation and spacing forming elements;

[0585] Figure 43b showing a side view of an operable implant including fixation and spacing forming elements;

[0586] Figure 43c and 43d Two spacing elements constituting a spacing element kit are shown;

[0587] Figure 43e An adjustable spacing element is shown;

[0588] Figure 44 An embodiment of an operable implant is shown wherein the body engaging portion is an injection device;

[0589] Figure 45a An embodiment of an operable implant is shown wherein the body engaging portion is a constriction device;

[0590] Figure 45b An embodiment of an operable implant is shown wherein the body engaging portion is two constricting devices;

[0591] Figure 45c An embodiment of an operable implant is shown wherein the body engaging portion is a mechanical body engaging portion. DETAILED DESCRIPTION

[0592] Hereinafter, a detailed description of embodiments of the present invention will be given with reference to the accompanying drawings. It should be understood that the drawings are for illustration purposes only and are not intended to limit the scope of the present invention in any way. Thus, any directional references, such as "up" or "down," refer only to the directions shown in the drawings. It should be noted that features with the same reference numerals have the same function, and features in one embodiment can therefore be interchanged with features with the same reference numerals in another embodiment unless clearly contradictory. The descriptions of features with the same reference numerals should therefore be considered to be complementary in describing the basic concept of the features, thereby demonstrating the versatility of the features.

[0593] An operable implant is understood to be any implant that can be operated to perform a function associated with a patient's body. "Operated" includes changing the size and / or shape of a portion of the implant, delivering an active or inactive substance to the patient's body, electrically stimulating a portion of the patient's body, sensing a physical or functional parameter of the operable implant and / or a physiological or physical parameter of the patient, communicating with an external unit on the outside of the patient's skin, and receiving or transmitting energy to or from the operable implant to the external unit. The operable implant may be, for example, a pacemaker unit; an external cardiac compression device; a device that assists the heart's pumping function, such as a left ventricular assist device (LVAD); an operable artificial heart valve; an implantable drug delivery device, such as an implantable device for delivering insulin or chemotherapeutic agents; a hydraulic, mechanical, and / or electrical constriction implant, for example, to constrict the intestine (for treating anal incontinence), the intestine (for managing anastomoses), the urethra (for treating urinary incontinence), the bile duct (for treating gallbladder dysfunction), the fallopian tube (for fertility control purposes), the vas deferens (for sexual performance control purposes), or a blood vessel (for the purpose of increasing blood volume in erectile tissue or for the purpose of constricting or inhibiting an aneurysm). The operable implant may further be an operable implant for treating obesity, such as an operable volume filling device for reducing gastric volume, an operable gastric band for restricting food passage, or an operable implant for stretching the stomach wall to produce a feeling of fullness. The operable implant may be an operable device for treating gastroesophageal reflux disease (GERD), an operable cosmetic implant (such as an operable breast implant), or an implant for regulating or replacing any bony part of the body. In addition, the implant may replace an organ or part of an organ, or may regulate or replace organ function. Other examples of implants are implants for treating impotence by implanted drug delivery, implants for affecting blood flow, which may include vascular treatment devices for clot removal, implants for affecting fertility and / or infertility, or implants suitable for moving fluids in the body. The examples of operable implants listed above are to be regarded as examples and do not in any way limit the possible fields of application of the operable implants described.

[0594] A body engaging portion is understood to be any part or portion of an operable implant that is directly or indirectly connected to the patient's body to perform a function associated with the patient's body. Such functions may include, for example, pressing and / or pulling against a portion of the patient's body, transferring a substance to the patient's body, collecting a sample from the patient's body, electrically stimulating a portion of the patient's body, and / or filling or emptying an implantable volume filling device with a hydraulic fluid.

[0595] The physical or functional parameters of the operable implant may be, for example, electrical parameters (e.g., voltage, current, or impedance), fluid-related parameters (e.g., pressure, flow rate, temperature, volume, weight, or viscosity), and may be related to energy received at the operable implant, energy delivered to the patient's body, fluid received at the operable implant, fluid delivered to the patient's body, forces acting on the patient's body, or time elapsed since performing an action with respect to the patient's body.

[0596] Physiological or physical parameters of the patient may be, for example, patient blood pressure, blood flow, parameters related to blood saturation, parameters related to ischemic markers, patient body temperature, parameters related to muscle activity, or parameters related to gastrointestinal system activity.

[0597] The encapsulation referred to herein is in most cases suitable for separating the components of the operable implant from the body fluids during implantation. However, the encapsulation can also be used to contain a fluid or to separate the fluid used by the operable implant from other components of the operable implant. The encapsulation can be made of one of the following materials or a combination thereof: a carbon material (e.g., graphite, silicon carbide, or carbon fiber material), a boron material, a polymer material (e.g., silicon, Polyurethane, ultra-high molecular weight polyethylene (UHWPE), or polytetrafluoroethylene (PTFE)), metal materials (such as titanium, stainless steel, tantalum, platinum, niobium or aluminum), ceramic materials (such as zirconium dioxide, aluminum oxide, tungsten carbide), or glass. In any case, the package should be made of a material with low permeability to prevent the fluid from moving through the wall of the package.

[0598] The operating device in the operable implant may include an electric motor for converting electrical energy into mechanical work. The electric motor may be, for example, an alternating current (AC) electric motor, such as a three-phase electric motor (which may be controlled using a variable frequency drive); a direct current (DC) electric motor; a linear electric motor; an AC or DC axial electric motor; a piezoelectric motor; a bimetallic motor; or a memory metal motor.

[0599] In general, a medical system is described herein that includes an operable implant comprising an implantable body-engaging portion and an implantable operating device and components thereof. The implantable operating device may be adapted to electrically, mechanically, or hydraulically operate the body-engaging portion and may be powered by wireless energy transmitted from outside the patient's body or by an implantable battery adapted to store electrical energy within the patient's body. The operating device may include an electric motor for converting electrical energy into mechanical work (force x distance), which may be coupled to one or more gear systems to vary the speed and / or force / torque and / or direction of the supplied force. The operable implant may further include a communication unit for communicating with various components of the operable implant, other operable implants, and / or external units. Communication with the external unit may include control signals from the external unit for controlling the operable implant, or feedback signals from the operable implant, such as sensor parameters (e.g., physiological or physical sensor parameters related to the patient's body state) or physical or functional parameters related to the state of the operable implant.

[0600] Figure 1a and 1b An overall view of a medical system is shown, the medical system comprising: an operable implant 100 adapted to be implanted in a patient's body; and an external unit 200 for powering and / or communicating with the operable implant 100 . Figure 1a and 1b The overall view in FIG. 1 shows examples of components that may be included in the operable implant 100 and the external unit 200, respectively, and the embodiment is to be considered incomplete in that the components shown in the figure are not considered essential to the practice of the invention.

[0601] Figure 1a An operable implant 100 is shown implanted subcutaneously beneath the patient's skin S. The operable implant 100 comprises an operating device 110 comprising: a receiving unit 120 adapted to receive wireless energy or information from an external unit 200. The wireless energy may take the form of an electromagnetic field transmitted between a coil of the external unit 200 and a coil of the operable implant 100, with the coil of the operable implant 100 and the coil of the external unit 200 being mutually inductively coupled electrical conductors, forming a transformer-like loop for the purpose of transmitting an AC power signal. In an alternative embodiment, the wireless energy may take the form of a moving magnetic field that is magnetically coupled to a movable structure of the implantable operating device 110 comprising a magnet or magnetic material, causing the movable structure of the operable implant to move with the moving magnetic field formed in the external unit (e.g., with reference to FIG. 1 ). Figure 32-39). The receiving unit 120 may further be a combined unit adapted to receive wireless energy in the form of a moving magnetic field that affects a movable structure of the operating device, and also adapted to receive wireless energy that generates an electric current on / in the implantable operating device 110 to operate power-consuming components or to charge batteries (e.g., 190a, 190b) to indirectly power power-consuming components of the operable implant 100.

[0602] exist Figure 1a In the embodiment shown in FIG, the external unit 200 includes an external drive unit 210 for forming the rotating magnetic field using an external electric motor 230. The electric motor 230 rotates an external part of a magnetic coupling 220 (including a rotatable structure having a magnet or an electromagnet), so that the rotatable structure is rotated by the operation of the external electric motor 230 to form a movable magnetic field (for example, referring to FIG). Figures 35a-35c as well as Figure 36 further disclosure).

[0603] The operation device 110 of the operable implant 100 further includes a spacing element 110c adapted to form a spacing between a first unit 110a of the operation device 110 (including most of the components of the operation device 110) and a second unit 110b of the operation device 110 (including the receiving unit 120). The spacing enables the receiving unit 120 to be substantially unaffected by components in the first unit 110a, which may include magnetic or magnetizable materials and which may disrupt the magnetic and / or electromagnetic fields used to transfer wireless energy between the transmitting unit 220 and the receiving unit 120.

[0604] The distance element 110c connecting the first unit 110a and the second unit 110b may include: an electrical conductor for transmitting energy and / or information from the second unit 110b to the first unit 110a; and / or a mechanical force transmission member adapted to transmit mechanical force from the second unit 110b to the first unit 110a. The mechanical force transmission member may be, for example, at least one of the following: a rotating shaft for transmitting rotational force, a flexible member for transmitting rotational force (e.g., a Bowden cable, a wire, a ribbon), a rod, a worm gear, or a gear (e.g., a bevel gear) adapted to change the direction of the rotational force received at the receiving unit by approximately 90 degrees.

[0605] Figure 1aThe operating device may further include an electric motor 130 adapted to convert electrical energy into mechanical work. The electric motor 130 may receive electrical energy directly transmitted from the external unit 200 from the receiving unit, or may receive electrical energy stored in the implantable battery 190. The electric motor 130 may be omitted in an embodiment in which a motive force, such as a rotational motive force, directly transmitted from the external drive unit 210 is received at the receiving unit 120. The electric motor 130 may be, for example, an electric motor 130 selected from the following motors: an alternating current (AC) electric motor, a direct current (DC) electric motor, a linear electric motor, an axial electric motor, a piezoelectric motor, a multi-phase motor (e.g., a three-phase motor), a bimetallic motor, and a memory metal motor.

[0606] according to Figure 1a , the force output of the electric motor 130 is associated with the force input of the gear system 140. The gear system 140 is adapted to receive mechanical work having a first force and a first speed, and to output mechanical work having a second, different force and a second, different speed, such that a high-speed motion supplied by the electric motor 130 and / or a direct connection to the receiving unit 120 is converted into a low-speed motion having an increased force.

[0607] Gear system 140 may, for example, include a gear system having a configuration such as any of the gear systems described herein, such as with reference to Figure 2a - Figure 16 In alternative embodiments, it is contemplated that the gear system 140 comprises some other configuration of transmission system, such as a conventional gear system, a worm gear system, or a belt drive system. Figure 1a In the embodiment shown in FIG, the gear system 140 is connected to the connecting member 182, so that the gear system 140 of the operating device 110 is connected to the body engaging portion 180 for operating the body engaging portion. Figure 1a In the embodiment shown in FIG, the connection between the gear system 140 and the body engaging portion 180 comprises a mechanical connection portion 181 (eg, a rotating shaft for transmitting rotational force), a rod, or a flexible member for transmitting rotational force (eg, a Bowden cable).

[0608] The operating device may further comprise a generator 170 for generating electric current (cf. Figure 36 -40). The operable implant 100 can be configured such that the generator 170 is positioned between the receiving unit 120 and the gear unit 140, thereby enabling the generator 170 to receive high-speed forces. In an alternative embodiment, there is no direct mechanical connection between the receiving unit 120 and the body-engaging portion 180, and the gear system 140 can be omitted entirely.

[0609] The operable implant may include at least one implantable battery 190a, 190b that can be used to operate and control the operable implant. The batteries 190a, 190b can be used in combination with a direct drive from an external drive unit 210. As an example, the patient can use the direct drive to operate the operable implant when at home and use battery power when away from home or in an emergency. The batteries 190a, 190b can be adapted to power the operation of the operable implant 100 and / or can be adapted to power a control and / or communication unit. The batteries 190a, 190b can be adapted to be charged by a receiving unit that receives wireless energy, or by the implantable generator 170. The batteries can be replaced by any form of energy storage device, such as a capacitor.

[0610] See again Figure 1a The operable implant 100 further includes at least one implantable battery 190a, 190b, which may be housed in a separate unit (e.g., battery 190a) or in the operating device 110 (e.g., battery 190b). The operable implant 100 may include a lead 122 connecting the batteries 190a, 190b to the receiving unit 120 so that wireless energy received at the receiving unit 120 can be stored in the batteries 190a, 190b, or a lead 172 connecting the batteries 190a, 190b to the generator 170 so that current generated in the generator 170 can be stored in the batteries 190a, 190b. The at least one battery 190a, 190b may be adapted to power at least one of a control system 195 for controlling the operable implant 100 and an electric motor 130. A first wire 192 connects the batteries 190a, 190b to a control system 195, and a second wire 132 connects the electric motor 130 to the batteries 190a, 190b.

[0611] The control unit 195 may include components for controlling the operable implant 100, which may include controlling the electric motor 130, for example, by adjusting the frequency of the alternating current supplied to the electric motor 130, or by adjusting the voltage supplied to the electric motor 130. The control unit 195 may be adapted to receive sensor input from one or more sensors of the operable implant 100, which may be sensors adapted to monitor physical parameters of the operable implant 100 or physiological parameters of the patient. In some embodiments, the control unit 195 may be adapted to control a hydraulically operated device, for example, by controlling the actuation of a valve or movable wall portion of a reservoir. The control unit 195 may include a communication unit for communicating with the external unit 200, in which case the receiving unit 120 may further include a unit for transmitting information, such that information related to physical parameters or the operable implant and / or physiological parameters related to the patient's body can be communicated between the operable implant 100 and the external unit 200. If necessary, the control unit 195 may include a rectifier circuit for converting the AC received at the receiving unit into a DC suitable for powering components of the operable implant 100 or for charging at least one battery 190a, 190b of the operable implant 100. For the purpose of processing communications, information, and / or data, the control unit 195 may further include a demodulator and a microprocessor. The demodulator demodulates signals transmitted from the external unit 200, and the microprocessor can decode and / or decipher received signals. The receiving unit 120 of the operable implant and the transmitting unit 220 of the external unit 200 can be adapted to communicate using, for example, radio, infrared (IR), ultrasonic, magnetic, inductive, or capacitive signals.

[0612] The operable implant 100 or parts of the operable implant may be encapsulated by an encapsulation body to separate the components of the operable implant 100 from body fluids when implanted. However, the encapsulation body may also be used to contain fluids (e.g., fluids in a reservoir), or to separate fluids used by the operable implant 100 (e.g., lubricating fluids in a gear system) from other components of the operable implant 100. The encapsulation body may be made of non-metallic and non-magnetic materials that do not affect the electromagnetic energy transfer between the external unit 200 and the operable implant 100. The encapsulation body may be made of one of the following materials or a combination thereof: a carbon material (e.g., graphite, silicon carbide, or carbon fiber material), a boron material, a polymer material (e.g., silicon, Polyurethane, UHWPE, or PTFE), metallic materials (such as titanium, stainless steel, tantalum, platinum, niobium, or aluminum), ceramic materials (such as zirconium dioxide, aluminum oxide, and tungsten carbide), or glass. In any case, the package should be made of a material with low permeability to prevent the fluid from moving through the wall of the package.

[0613] Turning now to the external unit 200, the external unit 200 is adapted to power, control and / or communicate with the operable implant 100. The external unit 200 may comprise: an external drive unit 210, which may be adapted to form a moving magnetic field adapted to achieve a magnetic connection with a magnet or magnetic material of a receiving unit 120 of the operable implant 100, such that the formation of a moving magnetic field on the outside of the patient's body operates the operable implant 100 by a magnetic connection between the external drive unit 210 and a movable structure of the operable implant 100. The moving magnetic field may be formed by an electric motor 230 in combination with a moving structure comprising at least one magnet, which may be an electromagnet or a permanent magnet. In an alternative embodiment, the moving magnetic field is formed by varying the magnetic field, for example by alternating the current to the electromagnet such that the force supplied by the electromagnet alternates and thereby enables the formation of a reciprocating motion of the magnet or magnetic or magnetizable material. Formation of the moving magnetic field with reference to Figure 32 -39 Further description.

[0614] The external unit 200 can be powered directly via a connection to a power outlet of the electrical grid, or can include at least one rechargeable or disposable battery 290 that can be connected to the drive unit 210 using circuitry 292 to power the electric motor 230 and / or the electromagnet. The external unit 200 can also include an external control / communication unit for communicating with the control / communication unit 195 of the operable implant 100. The external control / communication unit can be adapted to receive control signals from the operable implant and adjust control of the external unit 200 in response to the received control signals.

[0615] Figure 1b An embodiment of an operable implant 100 is shown, which is viewed as Figure 1a An alternative to the embodiment shown in . The differences are: Figure 1b The embodiment is a specific hydraulic embodiment, which is suitable for operating a hydraulically operable body engaging portion 180', which is connected to the operating device 110 using a connecting portion 182, and the connecting portion 182 includes: at least one conduit for transferring hydraulic fluid from the operating device 110 to the hydraulically operable body engaging portion 180'.

[0616] Figure 1b The operating device 110 of the embodiment shown in FIG. 1 includes a hydraulic pump 150 connected to a reservoir 160 for storing hydraulic fluid. The reservoir 160 may include at least one movable wall portion 163 constituting the hydraulic pump 150 (which may be realized by operating the movable wall, for example, referring to FIG. 1 ). Figure 4(or 5 disclosed). In alternative embodiments, hydraulic pump 150 may be, for example, a non-valve-type pump, a pump including at least one valve, a peristaltic pump, a diaphragm pump, a gear pump, or a bellows pump. Hydraulic pump 150 is operated by connection to an implantable electric motor 130 or a movable structure operable from outside the patient's body. The connection between hydraulic pump 150 and electric motor 130 or the movable structure is achieved via gear system 140, which is adapted to convert high-speed, low-force motion into low-speed, high-force motion.

[0617] The hydraulic body engaging portion 180' may, for example, comprise a hydraulic constriction or restraint device, or a volume filling device.

[0618] Figure 2a An embodiment of an implantable gear system 140 for operation in an operating device 110 is shown. The gear system 140 is adapted to receive mechanical work having a first force and a first speed and output mechanical work having a second, different force and a second, different speed. The gear system 140 includes a force input end 142 connected to an operable element 143' adapted to engage a first gear 144 and a second gear 145. The first gear 144 has a hollow cylindrical shape and has a first number (e.g., 160) of teeth 144t on its outer periphery. The second gear 145 has a hollow cylindrical shape and has a greater number (e.g., 162) of teeth 145t on its inner surface than the first gear. The operable element 143' is adapted to engage the inner side 144a of the first gear 144, causing the outer side 144b of the first gear 144 to press against the inner side 145a of the second gear 145, so that the teeth 144t of the first gear 144 and the teeth 145t of the second gear 145 engage with each other at position P1, which is spaced apart from a position (e.g., position P2) where the teeth do not engage with each other. Operation of the operable element 143' causes position P1 to advance, thereby causing relative rotation between the first gear 144 and the second gear 145. Figure 2a In the embodiment shown in FIG, the second gear 145 comprises two more teeth 145t than the first gear 144, so that for each rotation performed by the operable element 143 ′, the first gear 144 rotates 2 / 160 or 1 / 80 of a revolution, which results in an 80-fold transmission, i.e., the force output ( Figure 2b The force provided by the 149) has a speed of 1 / 80 and a force of 80 times, thereby increasing the force that can be applied to the body engaging portion 180 of the operable implant 100, for example, by an electric motor, by a factor of 80. Figure 2aIn the embodiment shown in FIG, the operable element slides radially against the inner surface of the first gear 144. To reduce friction, a lubricating fluid may be provided in the gear system, and it is further contemplated that the operable element 143' or the surface against which the operable implant 143' slides may comprise a self-lubricating material, such as graphite, Nyliol, or PTFE, which saturates molten metal under high pressure.

[0619] Figure 2b The gear system 140 is shown in a cross-sectional side view. In this embodiment, the gear system 140 includes a third gear 146, the inner side 146a of the third gear 146 including the same number of teeth 146t as the outer side 144b of the first gear 144. The teeth 146t of the third gear 146 are adapted to interengage with the teeth of the first gear 144, such that the third gear 146 is in an interengaged position ( Figure 2a The third gear 146 is connected to the force output end 149 of the gear system 140 by a radially extending connecting structure 147 to transmit the force from the third gear 146 to the force output end 149.

[0620] Figure 2c An alternative embodiment of the medical device is shown in which an operable element 143" is adapted to engage the inner side 144a of the first gear 144 at two diametrically disposed positions. The operable element 143" offsets the first gear 144 so that the first gear 144 assumes an elliptical shape in axial cross-section. The operable element 143" is adapted to maintain the offset of the first gear 144' so that the teeth of the first gear 144 engage with the teeth of the second gear 145 at two angularly separated and diametrically separated positions P1' and P1". The two positions P1' and P1" are separated from positions such that the teeth do not engage with each other, such as positions P2' and P2". In Figure 2cIn the illustrated embodiment, when the teeth of the first and second gears 144, 145 engage with each other in two positions, for the first gear 144 to be uniformly offset and thus formed into an elliptical shape, the difference in the number of teeth between the first and second gears 144, 145 must be divisible by 2. This allows the different numbers of teeth to be evenly distributed across two regions between the first and second gears 144, 145, with positions where the teeth of the first and second gears 144, 145 do not engage with each other. Mathematically, this can be expressed as follows: if the first gear has x teeth, then the second gear must have (x + n * 2) teeth. The transmission provided by the gear system 140 is then calculated as: Transmission = x / (x + n * 2). In alternative embodiments (not shown), the operable element may be adapted to offset the first gear so that the first and second gears 144, 145 engage with each other in three, four, or more positions. To achieve uniform offset of the first gear 144, the difference in the number of teeth between the first and second gears 144, 145 must correspond to the number of contact portions. In more general mathematical expression, the relationship can be expressed such that the second gear must have x+n*m number of teeth, where n is a constant chosen based on the desired transmission and m is the number of positions where the teeth of the first and second gears engage with each other.

[0621] Figure 3a In the embodiment shown, the operable element comprises a planetary gear in which the force input end 142 comprises a central gear connected to the first planetary gear 143"'a and the second planetary gear 143"'b and in turn offsetting the first gear 144 so that the teeth of the first gear 144 and the teeth of the second gear 145 engage with each other in the first and second positions P1', P1'. Figure 2c Similarly, for the first gear 144' to be similarly offset and thereby formed into an elliptical shape, the difference in the number of teeth between the first gear 144 and the second gear 145 must be divisible by 2 so that the different numbers of gears can be evenly distributed in two areas between the first and second gears 144, 145, with positions where the teeth of the first and second gears 144, 145 do not engage with each other.

[0622] Figure 3a The planetary gears further increase the transmission of the gear system, wherein the transmission resulting from the difference in the number of teeth between the sun gear 142 and the planetary gears 143'"a, 143'"b, i.e. the total transmission of the gear system 140, is equal to the transmission provided by the planetary gears plus the transmission provided by the difference in the number of teeth between the first gear 144 and the second gear 145.

[0623] Figure 3b The gear system 140 is shown in a cutaway side view. Figure 3b In the embodiment shown in FIG, the gear system 140 further includes: Figure 2b The third gear 146 of the third gear rotates with the first gear and the mutual engagement positions P1', P1". The third gear 146 is connected to the force output end 149 of the gear system 140 by a radially extending connecting structure 147 for transmitting force from the third gear 146 to the force output end 149.

[0624] Figure 3c An alternative embodiment of the planetary gear is shown, wherein the planetary gear comprises only one planet gear 143'"a connected to the central gear 142. This embodiment is similar to that of reference Figure 2a The described embodiment functions, except that the additional transmission is provided by planetary gears.

[0625] Figure 3d An embodiment is shown in which the planetary gear comprises three planetary gears 143"'a, 143"'b, 143"'c, each of which is offset from the first gear 144' so that the first gear 144 is pressed against the second gear 145 in three angularly separated contact positions P1', P1", P1'" (approximately 120° between each position). Similar to the other described embodiments, the difference in the number of teeth between the first gear 144 and the second gear 145 must correspond to the number of contact positions, i.e. Figure 3d In the embodiment shown in FIG, for the first gear 144 to be evenly offset, the difference must be divisible by 3.

[0626] In an alternative embodiment, reference Figure 3a The planetary gears of any embodiment described in -3d are toothless gears and thus engage with each other using only friction. The sun gear is thus connected to and drives the planetary gears using a friction-based connection.

[0627] Figure 2a- The gear system 140 of any embodiment in any of 3d can be made of, for example, a metal material, a plastic material, or a ceramic material. In one embodiment, the gear system is made of a non-metallic and / or non-magnetic material so that the gear system does not affect the energy transmission to the implantable energy receiver. The gear system can be lubricated by a biocompatible lubricant (such as hyaluronic acid) and for this purpose can be placed in a reservoir suitable for storing hydraulic fluid, which can also be used as a lubricant. The gear system can be enclosed by an enclosure to prevent body fluids from affecting the gear system, and / or human tissue from growing into the gear system, and / or hydraulic and / or lubricating fluid from leaking. The enclosure can be a non-metallic and / or non-magnetic enclosure so that the material of the enclosure does not affect the ability to transmit wireless energy to the wireless energy receiver of the operable implant. The gear system can be enclosed independently, or can be enclosed together with the electric motor of the operating device, or other components of the operating device.

[0628] Figure 4 An embodiment of an implantable manipulation device 110 is shown with reference to an operable implant 100 comprising Figure 3a The gear system 140 is further described. The gear system 140 includes a force input 142, which can be connected to an electric motor (such as any of the electric motors described herein) suitable for converting electrical energy into mechanical work. The force input 142 is connected to planetary gears 143"'a, 143"'b, which in turn operate a first gear 144 of the gear system 140 (see Figure 4 Further described). The force output end 149 is connected to the gear system 140 via the third gear 146 of the gear system 140 and the radially extending connecting structure 147. Figure 4 In the embodiment described in the drawings, the force output end 149 is a hollow shaft equipped with an internal thread (not shown) adapted to engage the external thread of the threaded member 441, so that the interaction between the hollow shaft 149 and the threaded member 441 converts the radial rotational force generated by the operation of the gear system 140 into a linear axial reciprocating force. Figure 4 In the embodiment shown in FIG, the threaded member 441 is connected to a radially extending engagement member 444 adapted to engage a reservoir 160 adapted to contain hydraulic fluid. Figure 4 In the embodiment shown in , the reservoir 160 is a torus-shaped reservoir 160 that is adapted to be compressed so that the volume in the reservoir is reduced, forcing the hydraulic fluid from the reservoir 160 to the fluid conduit 162 and further to the hydraulically operable body engaging portion 180 of the operable implant 100.

[0629] The operating device 110 further includes a seat portion 445 that acts as an anvil associated with the compression of the reservoir 160 and also serves as an enclosure to at least partially enclose the gear system 140. The seat portion 445 is connected to a portion of the enclosure 442 that is adapted to enclose the force output end 149 and the threaded member 441, such that the threaded member 441 and the force output end 149 are sealed from bodily fluids. The connection of the seat portion 445 to the portion of the enclosure 442 that encloses the force output end 149 and the threaded member 441 eliminates the need for a seal between the seat portion 445 and the force output end 149, which facilitates operation of the gear system 140 and allows the gear system 140 to be sealed. The portion of the enclosure 442 that encloses the force output end 149 and the threaded member 441 includes a corrugated section 443 that acts as a bellows. The corrugated section 443 is adapted to allow fibrotic tissue to grow inward without affecting the mobility of the corrugated section 443. The reservoir 160 is preferably made of a resilient and / or elastic material (such as silicon) and may be made of The coating is provided to better resist stress and wear due to compression of the reservoir 160. The force input 142 may be sealed against the bottom portion of the enclosure, or, alternatively, the operating device (e.g., an electric motor) may be housed in the same sealed environment, making a seal between the force input 142 and the enclosure unnecessary.

[0630] Figure 5 An embodiment of the operating device 110 is shown in which the gear system is arranged within a reservoir 160 ′ such that the reservoir 160 ′ at least partially surrounds the gear system 140 . Figure 5 The embodiment shown in further includes: an electric motor 130, which is connected to the force input end 142 of the gear system 140. The force transmission between the electric motor 130 and the gear system 140 may include: a shaft, which extends out of the first packaging body enclosing the electric motor 130 and enters the second packaging body of the gear system 140 within the packaging reservoir 160', in which case both packaging bodies need to be rotatably penetrated by the shaft, which generates friction at the seal. In an alternative embodiment, the packaging body enclosing the electric motor 130 and the packaging body enclosing the gear system 140 are connected to form a single packaging space that encloses both the gear system 140 and the electric motor 130, in which case the force transmission shaft does not need to be sealed. The packaging body 445' is thus sealedly connected to the packaging body enclosing the electric motor 130. The force output end 149 connected to the threaded member 441 is connected to the reference Figure 4The same approach functions as described above, except that the threaded member 441 is directly connected to the movable wall portion of the reservoir 160, thereby changing the volume of the reservoir 160' by moving the movable wall portion through the threaded member 441. The reservoir 160' is connected to a fluid conduit 162', such that fluid in the reservoir 160' is transferred from the reservoir 160' through the fluid conduit 162' to the hydraulically operable body engaging portion of the operable implant, such that compression of the reservoir 160' indirectly applies a force to a portion of the patient's body.

[0631] exist Figure 5 In the embodiment shown in , the operable elements 143'"a, 143'"b are connected to the force input end and the first gear using friction, ie the operable elements 143'"a, 143'"b do not include any teeth.

[0632] In some embodiments, positioning the gear system within the reservoir enables the gear system 140 to be lubricated by a hydraulic fluid contained in the reservoir 160. The fluid may be a biocompatible lubricating fluid such as hyaluronic acid, an isotonic solution, or a glycerin-based fluid, among others.

[0633] The basic principles of the gear system 140 described above can be implemented in conjunction with any operable implant herein. Advantages of the gear system 140 include low friction, high transmission in a compact form, good precision, low noise, and the gear system 140 can function without lubrication.

[0634] Figure 6An embodiment of an implantable operating device 110 is shown for operating an operable implant. The operating device 110 includes an implantable electric motor including a coil 132 and a magnet 133. The coil 132 is energized, generating a magnetic field through current in the coil winding 132' and the coil core 132" which are magnetically connected to the magnet 133. The magnet 133 is fixed to a rotatable structure 135 so that the sequential energizing of the coil 132 pushes the magnet 133 and rotates the rotatable structure 135. The magnetic connection between the coil 132 and the magnet 133 is located in the periphery of the operating device 110 so that the torque generated should be as large as possible. The rotatable structure 135 includes a radially extending portion 147 which transmits the force generated by the coil 132 and the magnet 133 in the periphery of the operating device 110 to the force input end 142 of the gear system connected to the operable elements 143'"a, 143'"b. The operable elements engage and offset the gear system First gear 144 of system 140 is pressed against the inner side of second gear 145 by the outer side of first gear 144, thereby causing the teeth of first gear 144 and second gear 145 to engage with each other at two positions, which are separate from the position where the teeth do not engage with each other. Second gear 145 has a greater number of teeth on its inner surface than first gear 144, and operation of operable elements 143'"a, 143'"b causes the mutually engaged position to advance, thereby causing relative rotation between first gear 144 and second gear 145.

[0635] The gear system further includes a third gear 146 having a hollow cylindrical shape. The inner side of third gear 146 includes the same number of teeth as the outer side of first gear 144. The teeth of third gear 146 are adapted to interengage with the teeth of first gear 144, allowing third gear 146 to rotate relative to second gear 145 with at least one interengaging position. Third gear 146 is connected to a radially extending portion 147, which connects third gear 146 to a centrally located force output end 149 of the gear system.

[0636] The first, second, and third gears 144, 145, and 146 are smaller in diameter than the portion of the rotatable structure 135 to which the magnet 133 is affixed, and are also smaller in diameter than the enclosure portion 111c to which the coil 133 is affixed. The gear system can thus be positioned within the electric motor such that the coil 132 and magnet 133 axially overlap the gear system. Positioning the electric motor and gear system in the same axial plane enables the operating device 110 to be enclosed in a thin enclosure 111, making the operating device 110 suitable for subcutaneous implantation, for example.

[0637] Reference Figure 6The embodiment of the described operating device includes a threaded member in the form of a worm shaft 441' having a first helical groove extending in a first direction and a second helical groove extending in a second direction. The worm shaft 441' is engaged by an operable portion 446 connected to a radially extending engagement member 444, thereby being adapted to compress the reservoir 160. Rotation of the worm shaft 441' causes the operable portion 446 to switch from engaging the first helical groove to engaging the second helical groove at an end portion of the worm shaft 441', with the operable portion 446 reciprocating within each helical groove. Operation of the worm shaft 441' thereby causes the reservoir 160 to perform a pumping action, delivering fluid in the first and second directions into the fluid conduit 162.

[0638] exist Figure 6 In the operating device 110, the coil 132 is housed in a sealed space that further includes: a battery 190 adapted to power the electric motor; and a control unit 195 adapted to control the electric motor and / or other operable elements of the operable implant. The battery 190 and / or the control unit 195 are connected to wires 192, which connect the battery 190 and / or the control unit 195 to a wireless energy receiver, and / or a wireless communication unit, and / or another battery 190 for powering the operating device with additional energy. In an alternative embodiment, when the electric motor is powered directly from the wireless energy receiver, the battery 190 is adapted only to power the control unit 195.

[0639] Figure 7 Show and reference Figure 6 The operating device 110 shown is similar to the operating device 110, except that: Figure 7 In the operating device of FIG, a magnet 133 is fixed to a rotatable structure 135, and the rotatable structure 135 includes a radially extending portion 147 adapted to transmit force from the periphery of the rotatable structure 135 to the center of the rotatable structure 135 below the electric motor and gear system. The radially extending portion 147 transmits the force to the force input end 142 of the gear system, which in turn engages the operable elements 143'"a, 143'"b.

[0640] exist Figure 7 In an embodiment, the coil 132 is positioned and sealed in a separate coil enclosure 131, so that the coil 132 is further isolated from the patient's body fluids, and / or from the lubricating fluid used in the gear system, and / or from the hydraulic fluid suitable for transmitting force from the reservoir 160 through the fluid conduit 162 to the hydraulically operable body engaging portion.

[0641] Figure 8 Show and reference Figure 6 and 7Another alternative embodiment of the operating device 110 is similar to the operating device 110 shown. Figure 8 In the embodiment shown, a rotatable structure 135 including a magnet 133 is adapted to be propelled by a coil 132 mounted to a portion 111c of the enclosure 111 having a peripheral diameter that is larger than the diameter of the rotatable structure 135 where the magnet 133 is mounted. The coil 132 is thus positioned radially outwardly of the magnet 133 and is sealed from the remainder of the operating device 110 and from the patient's bodily fluids by the coil enclosure 131. The rotatable structure 135 is connected to a force input 142 at the center of the rotatable structure, which in turn is adapted to engage an operable element 143'"a, 143'"b of a gear system (as described in further detail in other embodiments herein). Figure 8 The embodiment shown in FIG places all rotating parts of the operating device 110 centrally in the operating device 110 , which further isolates the rotating parts of the operating device 110 , thereby reducing the possibility of noise generated by the moving parts being transmitted through the enclosure 111 of the operating device 110 and the patient's body.

[0642] Figure 9 Yet another alternative embodiment of the operating device is shown, in which the magnet 133 is integrated into the operable elements 143'"a, 143'"b of the operating device 110. The operable elements 143'"a, 143'"b are rotatably connected to the connecting structure 143c and engage and offset the first gear 144 of the gear system when the magnetic attraction force generated by the coil sequentially attracts the magnet 133 to push the operable elements 143'"a, 143'"b. The portion of the operable elements 143'"a, 143'"b connected to the magnet 133 has a larger diameter than the portion of the operable elements 143'"a, 143'"b that engages the first gear 144 of the gear system, so that the magnet 133 can be positioned to be tightly connected to the coil 132. The distance between the coil 132 and the magnet 133 may be as small as one of 50 μm, 100 μm, 200 μm, 400 μm, 600 μm, 800 μm, 1 mm, 2 mm, 3 mm, or 5 mm, for example, depending on the overall dimensions of the operating device 110 and the magnetic force generated by the coil 132 .

[0643] Figure 10a and 10b Show and reference Figure 6 -An embodiment of an operating device similar to the embodiment shown in Figure 9. Figure 6 and 10a The differences between the embodiments are: Figure 10aAn embodiment includes: an axial electric motor 130', which is suitable for pushing the force input end 142 of the gear system. The axial electric motor 130' includes: a group of coils 132 distributed in a circular manner around the rotation axis of the electric motor 130'; and a group of magnets 133 connected to a rotatable structure 135 extending in the radial direction, the rotatable structure 135 overlaps the magnets 133 in the axial direction, so that the sequential energization of the coils 132 pushes the magnets 133 in the axial direction by magnetic means and rotates the rotatable structure 135 connected to the force input end 142 of the gear system (which is connected to the operable elements 143'"a, 143'"b), and the operable elements 143'"a, 143'"b are in Figure 10a In the embodiment shown in FIG, these are planetary gears 143'"a, 143'"b. The gear system and the axial electric motor 130' are coaxially positioned along the axis of rotation of the electric motor 130'.

[0644] The operable elements 143'"a, 143'"b engage and offset the first gear 144 of the gear system, causing the outer side of the first gear 144 to press against the inner side of the second gear 145, thereby causing the teeth of the first gear 144 and the teeth of the second gear 145 to engage with each other in two positions, which are separated from the position where the teeth do not engage with each other. The second gear 145 has a greater number of teeth on its inner side surface than the first gear 144, and operation of the operable elements 143'"a, 143'"b thus advances the mutually engaged position, thereby causing relative rotation between the first gear 144 and the second gear 145.

[0645] The force output end 149 of the gear system generates a reciprocating force to compress the reservoir 160 in the same manner as in the reference Figure 4 and 5 The same is described in further detail. Figure 10a The embodiment further includes a sealed space located below the axial electric motor 130' and housing: a battery 190 adapted to power the axial electric motor 130'; and a control unit 195 adapted to control the axial electric motor 130' and / or other operable elements of the operable implant. The battery 190 and / or the control unit 195 are connected to wires 192, wherein the wires 192 connect the battery 190 and / or the control unit 195 to the coil 132, thereby energizing the coil 132 and thereby operating the axial electric motor 130'.

[0646] Figure 10b A rotatable structure 135 is shown with the magnets 133 and the force input end 142 of the gear system fixed to the rotatable structure, the rotatable structure 135 being a non-metallic disk so that the individual magnets 133 are not affected by their fixing to the rotatable structure 135. Figure 10bAlso shown is a coil 132 comprising a coil winding 132′ and a coil core 132″ connected to a core structure 132s, wherein the core structure 132s is adapted to position the magnets 133 and serve as a magnetic connection between the cores 132″ of the individual coils 132. The coils 132 are arranged in a circle around the axis of rotation of the operating device 110 and are connected to the core structure 132s such that the core 132″ of the individual coils 132 and the spiral of the winding 132′ extend axially, parallel to the axis of rotation of the gear system and the electric motor.

[0647] Figure 11a Shows the Figure 10a , except that the axial electric motor 130′ includes two sets of coils 132 arranged in a circular pattern, each set being arranged to a magnetizable core structure 132s magnetically connected to a core 132″. A rotatable structure 135 including magnets 133 and the two sets of coils 132a, 132b is coaxially positioned such that the first and second sets of coils 132a, 132b both overlap the magnets of the rotatable structure 135, such that the first set of coils 132a pushes on the magnets 133 on a first side thereof and the second set of coils 132b pushes on the magnets 133 on a second side thereof. 133. In an alternative embodiment, it is contemplated that the rotatable structure / disc 135 between each set of coils 132a, 132b includes two sets of magnets, one on each side. It is contemplated that the first and second sets of magnets are radially offset, allowing the lag of the electric motor to be made smaller. The battery 190 and / or control unit 195 are connected to wires 192, which connect the battery 190 and / or control unit 195 to the first and second sets of coils, thereby energizing the coils sequentially and thereby operating the axial electric motor 130'.

[0648] Figure 12 An embodiment of an operating device 110 is shown, in which coils 132 are located within an enclosure 111 made of a cast material, enclosing the coils 132 and a sealed space containing a battery 190 and a control unit 195. The coils 132 are connected to the battery 190 and the control unit 195 using wires 192, allowing them to be energized sequentially to push the magnets 133. The magnets 133 are integrated into an operable element 143", which is secured to a guide shaft 450 adapted to be guided through a guide recess 451. The coils 132 are arranged in a circular pattern around the axis of rotation of the operating device 110, such that the core 132" and the spiral of the winding 132' of each coil 132 extend axially, parallel to the axis of rotation of the operating device 110.

[0649] The operable element 143"" is adapted to be pushed by a magnetic connection between the coil 132 and the magnet 133 in the package 111. The operable element 143"" engages the first gear 144 and the second gear 145, wherein the first gear 144 has a hollow cylindrical shape and includes a first number (e.g., 160) of teeth 144t on the outer side of its periphery, and the second gear 145 has a hollow cylindrical shape and includes a larger number (e.g., 162) of teeth 145t on its inner surface than the first gear 144. The outer side of the first gear 144 presses against the inner side of the second gear 145, causing the teeth 144t of the first gear 144 and the teeth 145t of the second gear 145 to engage with each other at a position P1, which is separated from a position (e.g., position P2) where the teeth 144t, 144t are not engaged with each other. Operation of the operable element 143' causes the position P1 to advance, thereby causing relative rotation between the first gear 144 and the second gear 145. Figure 12 The gear system of the operating device further includes a third gear 146, the inner side of which includes the same number of teeth 146t as the outer side of the first gear 144. The teeth 146t of the third gear 146 are adapted to interengage with the teeth 144t of the first gear 144, causing the third gear 146 to rotate relative to the second gear 145 at the interengagement position P1. The third gear 146 is connected to a force output end 149 of the gear system 140 via a radially extending connection structure 147, thereby transmitting force from the third gear 146 to the force output end 149.

[0650] Reference Figure 12 The implantable operating device 110 described allows all electrical components (in particular the coil 132, the battery 190 and the control unit 195) to be completely sealed from the surrounding environment, i.e. both from body fluids when implanted and from other components of the operating device. In addition, there are almost no moving parts and the magnet 133 can be completely encapsulated by the operating element 143", which protects the magnet 133 from corrosion and wear. The surface of the encapsulation 111 that engages the operating element 143" is preferably made of a wear-resistant material (e.g. a ceramic material) and is preferably also the operating element 143" that encapsulates the magnet 133 made of a wear-resistant material such as a ceramic material. The material of the encapsulation arranged between the coil 132 and the magnet 133 is preferably non-metallic and non-magnetic, so that the magnetic connection between the coil 132 and the magnet 133 is minimally affected.

[0651] Figure 13a Schematically shows how two gear systems 140a, 140b can be connected in series so that they act as a single gear system with a transmission equal to the transmission of the first gear system 140a times the transmission of the second gear system 140b. The gear systems 140a, 140b can be of the same type, for example, Figure 2aAlternatively, one of the gear systems 140a, 140b may be, for example, a gear system of the type disclosed in Figure 2a In addition to the gear system of the type described in FIG. 5 , the other gear system 140 a , 140 b may be a different type of gear system, such as a planetary gear system or a conventional gear system. The first and second gear systems 140 a , 140 b may have the same transmission, or may have different transmissions.

[0652] exist Figure 13a In an embodiment, the first and second gear systems are coaxially positioned (e.g., with reference to Figure 8 (further described) so that the first gear system 140a can transmit force axially to the second gear system 140b. The force transmitted between the first and second gear systems is preferably a rotational force, which can be transmitted centrally in both gear systems, peripherally in both gear systems, or from the center of the first gear system 140a to the periphery of the second gear system 140b.

[0653] Figure 13b An alternative embodiment of the gear system is schematically shown, wherein the first and second gear systems are connected in series. Figure 13b In the alternative embodiment shown in FIG, the first gear system 140a is located "within" the second gear system 140b (e.g., referring to FIG. Figure 16 140b). In the alternative shown, both the first and second gear systems 140a, 140b are configured according to reference Figure 2a 5, wherein the first gear of the first gear system is connected to the operable element of the second gear system, such that movement of the first gear of the first gear system relative to the second gear of the first gear system moves the operable element of the second gear system 140b. The first gear system can include operable elements according to any of the embodiments herein. In embodiments where the operable elements include planetary gears, the total transmission achieved is: the transmission of the planetary gears multiplied by the transmission of the first gear system 140a multiplied by the transmission of the second gear system 140b.

[0654] Figure 14a Another alternative is shown, in which three gear systems are coaxially stacked and connected in series, so that the transmission is further improved. The total transmission is thus realized as: the transmission of the first gear system multiplied by the transmission of the second gear system multiplied by the transmission of the third gear system. Similarly, Figure 14b In the system shown, the first gear system 140a, the second gear system 140b, and the third gear system 140c are radially disposed within each other and in a manner similar to, for example, Figure 13b and Figure 16 The first and second gear systems are connected in the same way as they are coupled in series.

[0655] Figure 15 Show and reference Figure 4 The embodiment described is similar to the embodiment of the operable implant operating device 110, except that: Figure 15 The embodiment shown in FIG includes first and second gear systems 140 a and 140 b coaxially positioned along their axes of rotation and connected in series. Each of the first and second gear systems 140 a and 140 b includes a force input end 142 a and 142 b as part of a planetary gear system for pushing an operable element 143 ″ a and 143 ″ b. The operable elements 143 ″ a and 143 ″ b, in turn, engage a first gear 144, wherein the first gear 144 has a hollow cylindrical shape and includes a first number of teeth on the outer periphery thereof. The first gear 144 has a deflectable wall adapted to be engaged and deflected by the two operable elements 143 ″ a and 143 ″ b, such that the outer side of the first gear 144 is pressed against the inner side of the second gear 145, thereby causing the teeth of the first gear 144 and the teeth of the second gear 145 to engage with each other in two positions, which are separate from the position where the teeth do not engage with each other. The second gear 145 has a greater number of teeth on its inner surface than the first gear 144 , and operation of the operable elements 143 ″ ′a , 143 ′ ″b thus advances the mutually engaged position, thereby causing relative rotation between the first gear 144 and the second gear 145 .

[0656] The first and second gear systems 140a and 140b further include a third gear 146 having a hollow cylindrical shape. The inner side 146a of the third gear 146 includes the same number of teeth as the outer side of the first gear 144. The teeth of the third gear 146 are adapted to interengage with the teeth of the first gear 144, allowing the third gear 146 to rotate relative to the second gear 145 at at least one interengaging position. The third gear 146 of the first gear system 140a is connected to a radially extending connection structure that connects the peripherally positioned third gear 146 and the centrally positioned force output 149a of the first gear system and the force input 142b of the second gear system 140b. Thus, by connecting the third gear 146 of the first gear system 140a to the force input 142b of the second gear system 140b, the first and second gear systems 140a and 140b are connected in series.

[0657] exist Figure 15 In the embodiment shown in FIG, the force output end 149b of the second gear system 140b comprises a hollow shaft connected to a threaded member 441 which in turn operates the reservoir 160. For details of the operation of the threaded member 441 refer to Figure 4Further description. Although the first and second gear systems 140a, 140b are described for a hydraulic embodiment having a torus-shaped reservoir 160 that changes volume to force hydraulic fluid to a hydraulically operable body-engaging portion, the details of the first and second gear systems 140a, 140b connected in series can be applied to any other embodiment described herein. Examples of alternative embodiments include: the threaded member 441 is directly connected to the body-engaging portion, which can be directly connected to the patient's body, and the first and second gear systems 140a, 140b are connected to a pump for pumping hydraulic fluid; the pump can be, for example, a peristaltic pump or a diaphragm pump.

[0658] The first and second gear systems 140a, 140b are preferably enclosed in the same sealed space so that force transmission between the first and second gear systems 140a, 140b can be achieved without transmitting force through a seal. Figure 8 In the embodiment shown in , the force input end 142a of the first gear system 140a penetrates the enclosure, but in alternative embodiments, the operating device (e.g., an electric motor) is tightly fitted to the gear system enclosure, or is packaged together with the first and / or second gear systems 140a, 140b, so that no penetrating seal is required between the first and second gear systems 140a, 140b.

[0659] Figure 16 Shows the Figure 15 The embodiment shown in FIG. 1 similarly includes an operating device 110 of an alternative embodiment of a gear system 140 . Figure 16The left half of the operating device 110 is shown in cross-section. The operating device includes a housing 111, which is a rigid part, for example, made of a hard polymer material, ceramic material or metal. A portion of the housing 111 constitutes a coil enclosure 131 to encapsulate the coil 132, so that the coil 132 is sealed against body fluids and scar tissue when implanted. The coil 132 is a component of an electric motor, which further includes a magnet 133 mounted to a rotatable structure 135, the rotatable structure 135 having a radially extending portion 147 suitable for transmitting force from the periphery of the operating device to the center of the operating device. The rotatable structure 135 is rotatably mounted to the housing 110 using a first bearing Ba, so that the rotatable structure can rotate relative to the housing 110. The central portion of the rotatable structure 135 constitutes a force input end of the first gear system 140a, which is suitable for pushing the operable element 143"'a so that the operable element 143"'a engages the first gear 144a of the first gear system 140a, so that the teeth of the first gear 144a engage with the teeth of the second and third gears 145a, 146a of the first gear system 140a. The second gear 145a of the first gear system 140a has more teeth than the first gear 144a of the first gear system 140a, so that the contact portion between the first gear 144a and the second gear 145a rotates (as further described above). The third gear 146a has the same number of teeth as the first gear 144a and thus rotates with the contact position. The third gear 146a is connected to a radially extending portion 147, which is suitable for transmitting force from the periphery of the central portion of the operating device to the force input end 140a of the second gear system 140b. The structure including the third gear 146a, the radially extending structure 147, and the force input end 142b of the second gear system 140b is rotatably connected to the force input end 142a of the first gear system 140a using a bearing Bb, and is rotatably connected to the force output end 149c of the second gear system 140b using a bearing Bc. The operation of the second gear system 140b is similar to that of the first gear system 140a. The structure including the third gear 146b, the radially extending portion 147, and the force output end 149c of the second gear system 140b is rotatably connected to the housing 110 of the operating device 110 using a bearing Bd.

[0660] exist Figure 16In the operating device shown in FIG, sequential energization of coils 132 pushes magnets 133 connected to a rotatable structure 135, which in turn pushes a first gear system 140a. First gear system 140a is connected in series with a second gear system 140b, which in turn provides a force output 149c that can be used to power the body-engaging portion of an operable implant using operating device 110. With first and second gear systems 140a and 140b connected in series, the total transmission of operating device 110 is equal to the transmission of first gear system 140a multiplied by the transmission of second gear system 140b. Thus, force output 149c outputs force at a rate equal to the speed of the rotatable structure including magnets 133 multiplied by the transmission of first gear system 140a multiplied by the transmission of second gear system 140b.

[0661] Figure 17 Shows similarity to reference Figure 16 The embodiment of the operating device 110 of the operating device is different in that: Figure 17 The operating device has first and second force output ends 149a, 149c extending out of the package 111 of the operating device 110, so that the operating device 110 can supply first and second types of mechanical work, that is, a first form of mechanical work having a first force and velocity, and a second form of mechanical work having a second force and velocity.

[0662] In more detail, coils 132 enclosed within enclosure 131 are sequentially energized, pushing magnets 133, which are secured to a rotatable structure 135 connected to a force input 142a of a first gear system. Rotatable structure 135 is also connected to a force output 149a of operating device 110, enabling a high-speed force output to be provided from operating device 110. High-speed force output 149a can, for example, be coupled to a generator within the patient's body for generating electrical current. Because the first and second gear systems are connected in series, the first gear system pushes the second gear system, ultimately providing a force output via third gear 146b of the second gear system and, consequently, a low-speed force output 149c via a connection via radially extending rotatable structure 147. Low-speed force output 149c can, for example, be coupled to a portion of an operable implant that engages the patient's body and requires low-speed, high-force mechanical work.

[0663] Figure 18a An embodiment of the operating device is shown in which the first gear system 140a is positioned radially inside the second gear system 140b, such that the second gear system 140b overlaps the first gear system 140a in the axial direction (axially relative to the axis of rotation of the operating device 110). Figure 16 and 17As in the operating device described above, the operating device includes an electric motor having a coil 132, the coil 132 including a coil winding 132' and a coil core 132" (e.g., an iron core). The coil is suitable for being energized to generate a magnetic field, which is suitable for influencing and pushing a magnet 133 fixed to a rotatable structure 135. In an alternative embodiment, the magnet 133 can be replaced by any magnetic material that can be attracted by the magnetic field generated by the coil 132. The rotatable structure 135 in turn pushes the force input end 142a of the first gear system 140a, the force input end 142a engages the operable elements 143'"a, 143'"b, and the operable elements 143'"a, 143'"b in turn engage the inner side of the first gear 144a of the first gear system, so that the first gear 144a is offset and operates the third gear 146a similarly to the function of the aforementioned gear system. The first gear system 140a The third gear 146a is connected to a radially extending structure 147, which constitutes the operable element 143:2 of the second gear system 140b. The operable element 143:2 of the second gear system 140b engages the first gear 144b of the second gear system 140b. The first gear 144b of the second gear system 140b has teeth that intermesh with the teeth of the third gear 146b of the second gear system 140b and perform a similar function. The third gear 146b of the second gear system 140b is further connected to a radially extending structure 147, which transmits force from the periphery of the operating device to the center of the operating device 110, thereby pushing the force output end 149c of the second gear system 140b. Placing the electric motor and the first and second gear systems 140a and 140b in the same plane allows for an extremely thin design suitable for subcutaneous implantation.

[0664] The force output end 149c of the second gear system 140b is connected to a threaded member 441 that converts the rotational force into a linear reciprocating force. The threaded member 441 operates the torus-shaped reservoir 160, as shown in FIG. Figure 4 Further described.

[0665] The housing of the operating device 111 encloses the operating device so that bodily fluids do not affect the operating device 110. The housing / encapsulation 111 can be made, for example, of a biocompatible metal material (e.g., titanium or tantalum) to prevent bodily fluids from migrating into the operating device 110. In alternative embodiments, the encapsulation 111 can be made of a ceramic material (e.g., silicon carbide or zirconium carbide), a polymer material (e.g., UHWPE or PTFE), or glass. In any case, the encapsulation should be made of a material with low permeability to prevent bodily fluids from migrating through the walls of the encapsulation 111.

[0666] exist Figure 18aIn the embodiment shown in FIG, the coil 132 is additionally encapsulated in the coil encapsulation 131 , so that the coil 132 is additionally sealed from other components of the operating device 110 and / or body fluids.

[0667] Figure 18a The operating device 110 further includes a sealed space containing a battery 190 adapted to power the electric motor and a control unit 195 adapted to control the electric motor and / or other operable elements of the operable implant. The battery 190 and / or the control unit 195 are connected to wires 192, wherein the wires 192 connect the battery 190 and / or the control unit 195 to a wireless energy receiver, and / or a wireless communication unit, and / or another battery for powering the operating device with additional energy. In an alternative embodiment, the battery 190 may be adapted to power only the control unit 195, while the electric motor is powered directly from the wireless energy receiver. In other embodiments, the wireless energy receiver may be integrated and enclosed in the same enclosure 111 as the operating device 110.

[0668] Figure 18b Shown in exploded view Figure 11aThe lowermost parts are the stationary parts of the operating device 110, which include: the second gear 145a of the first gear system and the second gear 145b of the second gear system 145b; the coil 132 of the electric motor, including the coil core 132" and the coil winding 132'; and the coil enclosure 131, which is suitable for sealingly enclosing the coil 132 so that the coil 132 is sealed from body fluids and / or lubricants suitable for lubricating the first and / or second gear systems and / or hydraulic fluids for transmitting force from the operating device 110 to the hydraulically operable body engaging portion of the operable implant (reference is made to other parts described herein). (Other embodiments are further described). A rotatable structure 135 is shown above the stationary parts 132, 145a, and 145b. The rotatable structure 135 includes a magnet 133 adapted to be magnetically coupled to the coil 132, such that sequential energization of the coil 132 pushes the magnet 133 and the rotatable structure 135 to which the magnet 133 is fixed. The rotatable structure 145 also includes a force input end 142a of the first gear system 140a, adapted to push a planetary gear 143', serving as an operable element 143:1 of the first gear system 140a, using interengaging teeth or frictional force. The operable element 143'" engages and deflects the first gear 144a of the first gear system 140a so that the teeth 144t on the outside of the first gear 144a engage with the teeth 145t on the inside of the second gear 145a of the first gear system, which is part of the stationary part. Since the first gear 144a of the first gear system includes fewer teeth 144t than the second gear 145b of the second gear system, the mutually engaged position between the first and second gears 144a, 145a advances, and since the third gear 146b of the first gear system The third gear 146a includes the same number of teeth 146t as the first gear 144a, so that the third gear 146a moves with the position of travel. The third gear 146a of the first gear system is an integral part of the operable element 143:2 of the second gear system. The operable element 143:2 also includes: a force output end 149b of the second gear system; and a radially extending structure 147, which connects the third gear 146a of the first gear system and the rolling operable element 143:2' of the operable element 143:2.

[0669] The rolling operable element 143:2' of the second gear system's operable element 143:2 engages and deflects the first gear 144b of the second gear system, causing the second gear system to push the third gear 146b of the second gear system similarly to the first gear system. The third gear 146b of the second gear system is integrated into a structure (the uppermost structure shown), which further includes a radially extending element 147 that connects the third gear 146b and a force output end 149b of the second gear system (of the operating device), so that the mechanical work generated by the electric motors 132 and 133 can be output as rotational force through the force output end 149b.

[0670] exist Figure 18b In the embodiment shown, the first and second gear systems have the same transmission. However, it is conceivable that the second gear system has a higher transmission than the first gear system, i.e., the gears of the second gear system have more teeth than the gears of the first gear system, while the difference in the number of teeth between the first and second gears 144a, 144b, 145a, 145b of the first and second gear systems is the same. For example, the first gear 144a of the first gear system has 98 teeth, the second gear 145a of the first gear system has 100 teeth, the first gear 144b of the second gear system has 198 teeth, and the second gear 144b of the second gear system has 200 teeth. This results in a 1:50 transmission for the first gear system (plus the transmission of the planetary gear system provided by the operable element) and a 1:100 transmission for the second gear system. In some applications, it may be advantageous for the gears of the second gear system to have the same number of teeth as the gears of the first gear system (and therefore be larger) because the gears of the second gear system need to transmit higher forces at lower speeds.

[0671] Figure 19 Show and reference Figure 18a and Figure 18b The operating device is similar to an alternative embodiment of the operating device 110. The difference is that the first gear system 140a is a peripherally arranged gear system, while the second gear system 140b is a centrally arranged gear system. Figure 19 The coil 132 in the embodiment shown in FIG is disposed within a rotatable structure 135 that includes a magnet 133 . Figure 19 The rotatable structure 135 in the embodiment shown in FIG is integrated with the operable element 143 of the first gear system 140a. Figure 19In the embodiment shown in FIG, the operable element 143:1 comprises a rolling operable element 143:1' adapted to engage an inner side of the first gear 144a to offset the first gear 144a. The first gear 144a is engaged with the third gear 146a of the first gear system 140a, pushing the third gear 146a of the first gear system 140a. The third gear 146a of the first gear system 140a is connected to the force input end 142b suitable for pushing the operable element 143". The force input end 142b then offsets the first gear 144b of the second gear system 140b to push the third gear 146b of the second gear system 140b, which serves as the force output end of the operating device 110. The structures 131 and 145b that encapsulate the coil 132 constitute the stationary parts of the operating device 110 and are directly or indirectly connected to the second gear 145a of the first gear system 140a, so that the second gear 145a of the first gear system 140a is stationary along with the second gear 145b of the second gear system 140b and the coil encapsulation body 131.

[0672] Figure 20 Shown in cross-section Figure 19 The structure 131 and 145b encapsulating the coil 132 constitutes a stationary part of the operating device 110 and is connected to the second gear 145a of the first gear system 140a, so that the second gear 145a of the first gear system 140a is stationary along with the second gear 145b of the second gear system 140b and the coil encapsulation body 131. Figure 12 and 13a In the embodiment of FIG-13b, the entire lower portion 111' of the enclosure 111 rotates to transfer force from the periphery of the operating device 110 to the center of the operating device 110, thereby forming the first gear system 140a to the second gear system 140b. The operating device 110 can be enclosed by another enclosure, which is preferably connected to the stationary portion 131, 145b, 145a of the operating device, so that the rotatable lower portion of the enclosure 111' does not need to be directly connected to the patient's body.

[0673] exist Figure 20 In the embodiment shown in , the force input end 142b of the second gear system 140b (included in the same structure as the second gear system 140b of the first gear system) is rotatably fixed by a recess r to a structure including a force output end 149b of the second gear system 140b, a third gear 146b of the second gear system 140b, and a radially extending rotatable structure 147, wherein the radially extending rotatable structure 147 connects the third gear 146b of the second gear system 140b to the force output end 149c of the second gear system 140b.

[0674] Figure 21An embodiment of an implantable operating device 110 is shown, comprising: a magnetic coupler 460 connected to the force input end 142 of the operating device 110. The magnetic coupler 460 includes a first set of magnets 461a, 461b connected to an external rotatable structure 463, the external rotatable structure 463 including a radially extending portion 147 that connects the rotating structure to a force output end 149a of an electric motor (not shown). Operation of the electric motor rotates the force output end 149a, which in turn drives the rotatable structure 463 including the magnets 461a, 461b. The external magnets 461a, 461b are magnetically connected to internal magnets 462a, 462b connected to an internal rotatable structure 464, wherein the internal rotatable structure 464 is connected to the force input end 142 of the gear system 140. The external rotatable structure 463 is disposed on the radially outer side of the internal rotatable structure 464. The gear system 140 is a device that is adapted to move the gear system 140, for example, Figure 3b or 4 further described gear system. Figure 21 In the embodiment shown in FIG, the force output end 149b of the gear system 140 operates the operable reservoir 160, for example, by moving hydraulic fluid from the reservoir 160 to the hydraulically operable body engaging portion connected to the reservoir 160 using a fluid conduit 162. The operation of the operable reservoir 160 is described with reference to FIG. Figure 4 Further description. In an alternative embodiment, the force output end 149b can be connected to a hydraulic pump for delivering hydraulic fluid to the hydraulically operable body engaging portion, such as a non-valve pump, a valve pump, a peristaltic pump, a diaphragm pump, a gear pump, or a bellows pump. Moreover, it is also contemplated that the force output end 149b of the gear system 140 can be connected to some other mechanism for operating the body engaging portion, such as a mechanical mechanism.

[0675] The inner rotatable structure 464 is encapsulated by the enclosure 111m, so that the gear system 140 and the inner rotatable structure 464 are hermetically encapsulated and thus sealed from body fluids when implanted. The enclosure 111m is preferably made of a non-metallic and non-magnetic material, for example, a polymer material such as ultra-high molecular weight polyethylene (UHMWPE), polyetheretherketone (PEEK), or polyurethane (PUR). However, it is also conceivable that the enclosure can be made of any of the following materials: carbon materials, boron materials, material mixtures, material alloys, metal materials, titanium, aluminum, ceramic materials, polymer materials, silicon, and Silicon coating.

[0676] The internal and / or external magnets 461a, 461b, 462a, 462b may be, for example, neodymium magnets. It is also conceivable that one of the group of internal magnets 431a, 461b and the group of external magnets 462a, 462b is a magnet, while one of the group of internal magnets 461a, 461b and the group of external magnets 462a, 462b is made solely of a material suitable for being attracted by magnetic forces, such as iron.

[0677] The electric motor (not shown) connected to the external rotatable structure 463 may be, for example: an alternating current (AC) electric motor, a direct current electric motor, a linear electric motor, an axial electric motor, a piezoelectric motor, a three-phase motor, a motor with more than one phase, a bimetallic motor, and a memory metal motor.

[0678] Figure 22 An embodiment of an implantable operating device 110 is shown, comprising: a magnetic coupling 470 connected to the force output end 149b of the operating device 110, or more particularly connected to the force output end 149b of the second gear system 140b of the operating device 110. The operating device 110 that provides force to the force output end 149b is an operating device 110 that includes an electric motor 130 and first and second gear systems 140a, 140b, with reference to Figure 18a However, the magnetic coupling 470 can be added to any operating device disclosed herein, such as the one described in Figure 6 、 7 , 8, 9, 10a, 10b, 11a, 11b, 12, 16, 17, and 19 disclose an operating device. Operation of the operating device 110 causes the force output end 149b to rotate, thereby driving a rotatable structure 464 including magnets 471a and 471b. The internal magnets 471a and 471b are magnetically coupled to external magnets 472a and 472b coupled to an external rotatable structure 463, wherein the external rotatable structure 463 is coupled to the force output end 149c. The external rotatable structure 463 is positioned radially outwardly of the internal rotatable structure 464.

[0679] The force output end 149c is directly or indirectly connected to the operable body engaging portion so that the operating device 110 operates the operable body engaging portion via the magnetic coupling 470. The internal rotatable structure 464 is encapsulated by the encapsulation body 111m so that the operating device 110 (i.e., the electric motor 130 and the first and second gear systems 140a, 140b) are hermetically encapsulated and thus sealed against body fluids when implanted. The encapsulation body 111m is preferably made of a non-metallic and non-magnetic material, for example a polymer material such as UHMWPE, PEEK, or PUR. However, it is also conceivable that the encapsulation body 111m can be made of any of the following materials: carbon materials, boron materials, material mixtures, material alloys, metal materials, titanium, aluminum, ceramic materials, polymer materials, silicon, and Silicon coating.

[0680] exist Figure 22 In the operating device 110, a sealed space is further provided in the operating device sealing body 111, and the sealed space includes: a battery 190 suitable for providing power to the electric motor 130; and a control unit 195 suitable for controlling the electric motor 130 and / or other operable elements of the operable implant.

[0681] Battery 190 and / or control unit 195 are connected to wires 192, which connect battery 190 and / or control unit 195 to a wireless energy receiver, and / or a wireless communication unit, and / or another battery 190 for powering the operating device with additional energy. Electric motor 130 is an alternating current (AC) electric motor 130, and control unit 195 includes an inverter for changing the AC frequency to control the AC electric motor. In an alternative embodiment, when power is provided directly from the wireless energy receiver to the electric motor 130, battery 190 is only adapted to power control unit 195.

[0682] Figure 23 An embodiment of an implantable peristaltic pump 150' is shown, which is adapted to pump and thereby deliver hydraulic fluid to a hydraulically operable body engaging portion of an operable implant. The peristaltic pump 150' may be adapted to be connected to a force output of an operating device, such as any operating device (110) disclosed herein. The implantable peristaltic pump 150' comprises a deflectable hollow member 152 for fluid delivery, the deflectable hollow member 152 being in the form of a tube made of an elastic material, such as an elastic polymer material, such as silicon, Coated silicone, nitrile rubber (NBR), chlorosulfonated polyethylene (Hypalon), fluororubber (Viton), polyvinyl chloride (PVC), ethylene propylene diene monomer (EPDM), polyurethane, or natural rubber. The deflectable hollow member ...

Claims

1. An operable implant adapted to be implanted into a patient's body, the operable implant comprising an operating device and a body engaging portion, wherein the operating device comprises: Unit 1 includes: a receiving unit for receiving wireless energy; and a first gear system adapted to receive mechanical work having a first force and a first speed and output mechanical work having a second, different force and a second, different speed; A second unit comprising: an electric motor adapted to convert electrical energy into mechanical work; and Spacing elements, including: a conductor for transferring electrical energy from the first unit to the second unit; and a mechanical transmission member adapted to transmit mechanical work from the electric motor in the second unit to the gear system in the first unit, wherein The distance element is adapted to separate the first and second units so that the receiving unit is not significantly affected by the second unit when receiving wireless energy.

2. An operable implant according to claim 1, wherein The receiving unit includes: at least one coil, adapted to convert the received wireless energy in the form of a magnetic field into electrical energy.

3. An operable implant according to claim 2, wherein: The receiving unit includes: at least one first coil having a first number of windings; and at least one second coil having a second, different number of windings.

4. An operable implant according to claim 2 or 3, wherein the first gear system comprises: operable elements; a first gear having a shape of a hollow cylinder and including a first number of teeth on an outer peripheral side thereof; and a second gear having a hollow cylindrical shape and including a greater number of teeth on its inner surface than the first gear, wherein the operable element is adapted to engage an inner side of the first gear so that the outer side of the first gear is pressed against the inner side of the second gear, thereby causing the teeth of the first gear and the teeth of the second gear to engage with each other in at least one position that is separate from a position in which the teeth do not engage with each other, wherein operation of the operable element causes the position to advance, thereby causing relative rotation between the first gear and the second gear, a third gear, wherein an inner side of the third gear includes the same number of teeth as an outer side of the first gear, wherein the teeth of the third gear are adapted to interengage with the teeth of the first gear, thereby causing the third gear to rotate relative to the second gear with the at least one interengaged position.

5. An operable implant according to claim 4, wherein: The operable element comprises at least one of a planetary gear, a structure or a wheel that interconnects with the first gear at least in part using friction.

6. An operable implant according to claim 1, wherein: The second unit includes: a second gear system, adapted to receive as input the mechanical work having a second different force and a second different speed output from the first gear system, and output mechanical work having a third different force and a third different speed, wherein the gear system of the second unit is connected in series with the gear system of the first unit via the mechanical transmission member of the spacing element.

7. An operable implant according to claim 1, wherein: The first unit comprises a second gear system adapted to receive mechanical work of a first force and speed as input and output mechanical work of a different force and speed, wherein the second gear system is connected in series with the first gear system.

8. An operable implant according to claim 1, wherein: The first unit is suitable for being placed in at least one of the following locations: subcutaneously, subcutaneously in the abdominal wall, or in the abdomen.

9. The operable implant of claim 1, wherein: The electric motor includes a magnetic material, wherein during wireless energy transfer, the first unit is substantially unaffected by the magnetic material in the second unit.

10. The operable implant of claim 8, wherein: The second unit includes at least one fixing portion for fixing the second unit to at least one of a fibrous layer, a fascia layer, and a muscle layer facing the inside of the subcutaneous space of the patient.

11. An operable implant according to claim 10, wherein: The distance element is adapted to at least one of be placed through the muscle layer of the abdominal wall and be secured to the muscle fascia facing the subcutaneous space.

12. The operable implant of claim 1, wherein: The distance element is flexible such that the first unit and the second unit can move relative to each other.

13. The operable implant of claim 1, wherein: The mechanical transmission member includes a mechanical transmission member selected from the following: Hydraulic pipes used to transmit hydraulic pressure, Rotating shaft for transmitting rotational force, Flexible components for transmitting rotational force, Silk, bring, Great, worm gear, and A gear used to change the direction of rotational force by approximately 90 degrees.

14. The operable implant of claim 1 , further comprising: A packaging body is adapted to hermetically enclose the operable implant.

15. The operable implant of claim 1 , further comprising: A metal package is adapted to package at least one of the second unit and the distance element.

16. An operable implant according to claim 15, wherein The metal package includes at least one of the following: a titanium package, an aluminum package, and a stainless steel package.

17. An operable implant according to claim 1, wherein: At least one of the first unit and the second unit includes a battery adapted to store the electric energy received at the receiving unit.

18. An operable implant according to claim 1, wherein: The electric motor includes an electric motor selected from the following: AC electric motors, Direct current (DC) electric motors, Linear electric motors, Axial electric motor, Piezoelectric motors, Three-phase motor, Motors with more than one phase, Bimetallic motors, and Memory metal motor.

19. An operable implant according to claim 1, wherein: The first gear system further comprises: a control unit for controlling at least one parameter of at least one of the following: operating devices; and Body joints.

20. An operable implant according to claim 19, wherein The electric motor is an alternating current (AC) electric motor, The control unit includes a frequency converter for changing an AC frequency to control the AC electric motor.

21. An operable implant according to claim 1, wherein: The first unit comprises a hydraulic pump adapted to convert mechanical work into hydraulic power for powering the hydraulically operable body engaging part, wherein the hydraulic pump is connected to a force output of the first gear system.

22. An operable implant according to claim 21, wherein The hydraulic pump is a hydraulic pump selected from the following: at least one reservoir acting as a pump utilizing walls moved by mechanical work; at least one reservoir that acts as a pump by changing volume to move fluid; at least one non-valve pump; at least one valve pump; at least one peristaltic pump; at least one diaphragm pump; at least one gear pump; and At least one bellows pump.

23. An operable implant according to claim 1, wherein: The first unit comprises a reservoir for supplying fluid to the hydraulically operable body engaging portion.

24. An operable implant according to claim 1, wherein: The operable implant comprises a third unit comprising a second reservoir for supplying fluid to the hydraulically operable body engaging portion.

25. An operable implant according to any one of claims 23 and 24, wherein The reservoir is operable and includes at least one movable wall portion.

26. An operable implant according to claim 25, wherein The reservoir comprises at least one of: at least one bellows-shaped portion, a shape suitable for allowing movement even when covered with fibrous matter, and a plate-shaped surface, in each case enabling movement of the at least one movable wall portion.

27. An operable implant according to claim 26, wherein The reservoir is in fluid connection with the hydraulically operable body engaging portion, wherein the reservoir is adapted to operate the hydraulically operable body engaging portion by movement of the at least one movable wall portion.

28. An operable implant according to claim 27, wherein The reservoir is at least one of circular and torus-shaped.

29. The operable implant of claim 22, further comprising: A threaded member is arranged to move a wall portion of the reservoir.

30. The operable implant of claim 22, further comprising: At least one of a pressure sensor, a flow sensor, and a position sensor, wherein the at least one of the pressure sensor, the flow sensor, and the position sensor is arranged to be connected to at least one of the pump and the reservoir for determining at least one of the pressure or volume in the reservoir and the pressure or flow from the hydraulic pump.

31. An operable implant according to claim 25, wherein: The first unit comprises an injection port for supplying fluid to at least one of: the reservoir, the hydraulically operable body engaging portion.

32. An operable implant according to claim 1, wherein: At least one of the first unit and the distance element does not include at least one of: a metallic component and a magnetizable component.

33. An operable implant according to claim 1, wherein: At least one of the first unit and the distance element does not include a magnetic component.

34. An operable implant according to claim 1, wherein The first unit comprises a communication unit adapted for wireless communication with an external unit on the outside of the patient's body.

35. An operable implant according to claim 4, wherein: The operable element is adapted to offset the first gear and to maintain the offset first gear so that the teeth of the first gear engage with the teeth of the second gear in at least one of one position, two positions, three positions, four positions or more, wherein the two, three, and four positions are angularly separated positions that are separate from positions where the teeth do not engage with each other.

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