U.S. patent application number 10/269949 was filed with the patent office on 2003-02-13 for mechanical anal incontinence.
This patent application is currently assigned to Obtech Medical AG. Invention is credited to Forsell, Peter.
Application Number | 20030032857 10/269949 |
Document ID | / |
Family ID | 24000910 |
Filed Date | 2003-02-13 |
United States Patent
Application |
20030032857 |
Kind Code |
A1 |
Forsell, Peter |
February 13, 2003 |
Mechanical anal incontinence
Abstract
An anal incontinence treatment apparatus comprises an adjustable
restriction device implanted in a patient, who suffers from anal
incontinence. The device engages a portion of the colon or rectum
of the patient to restrict the fecal passageway. An adjustment
device mechanically adjusts the restriction device to restrict or
release the fecal passageway, i.e. to normally close the fecal
passageway and open the fecal passageway when the patient wants to
relieve himself or herself.
Inventors: |
Forsell, Peter; (Menzingen,
CH) |
Correspondence
Address: |
NIXON & VANDERHYE P.C.
8th Floor
1100 North Glebe Road
Arlington
VA
22201-4714
US
|
Assignee: |
Obtech Medical AG
|
Family ID: |
24000910 |
Appl. No.: |
10/269949 |
Filed: |
October 15, 2002 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10269949 |
Oct 15, 2002 |
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09503148 |
Feb 11, 2000 |
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6464628 |
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Current U.S.
Class: |
600/30 |
Current CPC
Class: |
A61N 1/3787 20130101;
A61F 2/0036 20130101; A61F 2250/0001 20130101 |
Class at
Publication: |
600/30 |
International
Class: |
A61F 002/02 |
Claims
What is claimed is:
1. An anal incontinence treatment apparatus, comprising: an
adjustable restriction device implanted in a patient, who suffers
from anal incontinence, and engaging a portion of the colon or
rectum of the patient to restrict the fecal passageway therein, and
an adjustment device which mechanically adjusts said restriction
device to restrict or release the fecal passageway.
2. The apparatus according to claim 1, wherein said adjustment
device adjusts said restriction device in a non-magnetic
manner.
3. The apparatus according to claim 1, further comprising a powered
operation device for operating said adjustment device.
4. The apparatus according to claim 1, wherein said restriction
device comprises at least one elongated restriction member and
forming means for forming said restriction member into at least a
substantially closed loop around said portion of the colon or
rectum, said loop defining a restriction opening, whereby said
adjustment device adjusts said restriction member in said loop to
change the size of said restriction opening.
5. The apparatus according to claim 1, wherein said restriction
device is implanted in the base of the rectum or the prolongation
thereof.
6. The apparatus according to claim 1, wherein said restriction
device comprises at least two elements on different sides of said
portion of the colon or rectum, and said adjustment device squeezes
said portion of the colon or rectum between said elements to
decrease the fecal passageway.
7. The apparatus according to claim 1, wherein said restriction
device comprises one element on one side of said portion of the
colon or rectum, and said adjustment device squeezes said portion
of the colon or rectum between said element and the human bone or
tissue to decrease the fecal passageway.
8. The apparatus according to claim 4, wherein said restriction
device comprises several elongated restriction members extending
around the colon or rectum.
9. The apparatus according to claim 1, wherein said restriction
device is non-inflatable.
10. The apparatus according to claim 4, wherein said adjustment
device adjusts the longitudinal extension of said elongated
restriction member.
11. The apparatus according to claim 10, wherein said restriction
member comprises a main portion and two elongated end portions, and
said adjustment device establishes a longitudinal relative
displacement between said end portions of said restriction member,
such that the size of said restriction opening is adjusted.
12. The apparatus according to claim 11, wherein said adjustment
device comprises a movement transferring member in engagement with
at least one of said end portions of said restriction member and
operable to displace said one end portion relative to said other
end portion of said restriction member.
13. The apparatus according to claim 12, further comprising a
motor, which is fixed relative to said main portion of said
restriction member and has a rotating drive shaft operatively
connected to said movement transferring member.
14. The apparatus according to claim 13, wherein said motor is
positioned relative to said elongated restriction member such that
said drive shaft extends in parallel with a chord in said loop of
the restriction member.
15. The apparatus according to claim 10, wherein said elongated
restriction member is longitudinally resilient and said adjustment
device comprises a contraction device, which longitudinally
contracts said resilient restriction member.
16. The apparatus according to claim 15, wherein said elongated
restriction member comprises a substantially nonresilient main
portion and an end portion forming an elongated helical spring,
which is contractable by said contraction device.
17. The apparatus according to claim 16, wherein said contraction
device comprises an elongated flexible pulling member connected to
said main portion of said restriction member and extending through
said helical spring to contract said helical spring against an
arresting member, which is fixed relative to said main portion of
said restriction member.
18. The apparatus according to claim 10, wherein said restriction
member comprises an elongated helical spring having a free end, and
a body to which said spring is nonrotatably secured at its opposite
end, said adjustment device rotates said helical spring in one
direction to enlarge the coils of said helical spring to
longitudinally contract said elongated helical spring and to rotate
said helical spring in the opposite direction to reduce the size of
the coils of said helical spring to longitudinally extend said
helical spring.
19. The apparatus according to claim 18, wherein said restriction
member comprises a further elongated helical spring having a free
end and nonrotatably secured to said body at its opposite end, and
said adjustment device comprises a drive shaft having two opposite
end portions connected to said helical springs, respectively, at
their free ends, said helical coils forming left and right hand
helices, respectively.
20. The apparatus according to claim 19, wherein said restriction
member comprises a further elongated helical spring having a free
end and nonrotatably secured to said body at its opposite end, and
said adjustment device comprises a gearing having an input shaft
and two opposite aligned output shafts connected to said helical
springs, respectively, at their free ends, said input shaft being
connected to said output shafts such that said output shafts rotate
in opposite directions upon rotation of said input shaft, said
helical coils forming the same helices.
21. The apparatus according to claim 4, wherein said restriction
member forms a radially innermost at least partly circumferential
confinement surface of said restriction member, and said adjustment
device mechanically adjusts said restriction member such that at
least a portion of said confinement surface is substantially
radially displaced in said loop.
22. The apparatus according to claim 21, wherein said adjustment
device comprises an elongated voltage responsive element forming
part of said confinement surface and capable of bending into a bow
in response to a voltage applied across said element, the radius of
curvature of said bow being adjustable by changing the level of
said voltage.
23. The apparatus according to claim 21, wherein said restriction
member comprises an elastic annular element forming said
confinement surface, and said adjustment device changes the
diameter of said elastic annular element.
24. The apparatus according to claim 21, wherein said forming means
comprises a substantially rigid outer annular element, and said
restriction member comprises an elongated helical spring extending
internally along said outer annular element and contacting the
latter, said helical spring forming part of said circumferential
confinement surface and having a free end, and a body to which said
helical spring is nonrotatably secured at its opposite end, and
said adjustment device rotates said helical spring in one direction
to enlarge the coils of said helical spring to contract said
circumferential confinement surface and rotates said helical spring
in the opposite direction to reduce the size of the coils of said
helical spring to expand said circumferential confinement
surface.
25. The apparatus according to claim 21, wherein said forming means
comprises a substantially rigid outer annular element, and said
restriction member comprises a first and a second elongated helical
spring extending internally along said outer annular element and
contacting the latter, said helical springs forming part of said
circumferential confinement surface, said first and said second
spring, respectively, having a free end, and a body to which said
first and said second spring, respectively, is nonrotatably secured
at its opposite end, and said adjustment device rotates said first
and said second spring, respectively, in one direction to enlarge
the coils of said spring to contract said circumferential
confinement surface and rotates said first and said second spring,
respectively, in the opposite direction to reduce the size of the
coils of said spring to expand said circumferential confinement
surface.
26. The apparatus according to claim 4, wherein said restriction
member comprises at least two separate elements, at least one of
which is pivoted such that it may turn in a plane in which said
loop of said restriction member extends, and said adjustment device
turns said pivoted element to change the size of said restriction
opening.
27. The apparatus according to claim 1, wherein said restriction
device comprises at least two frame elements, which are foldable
towards each other by said adjustment device.
28. The apparatus according to claim 27, wherein said foldable
frame elements comprise two substantially or partly semi-circular
frame elements. which are hinged together such that said
semi-circular elements are swingable relative to each other from a
fully open state in which they substantially or partly form a
circle to a fully folded state in which they substantially form a
semi-circle.
29. The apparatus according to claim 4, wherein said elongated
restriction member is elastic and varies in thickness as seen in a
cross-section therethrough, and said adjustment device turns said
restriction member around the longitudinal extension thereof.
30. The apparatus according to claim 1, further comprising a motor
operatively connected to said adjustment device.
31. The apparatus according to claim 30, wherein said motor is
fixed to said restriction device.
32. The apparatus according to claim 31, wherein said motor is
remote from said restriction device and is connected to said
adjustment device by a power transmission conduit.
33. The apparatus according to claim 1, further comprising a
hydraulic device which operates said adjustment device.
34. The apparatus according to claim 33, further comprising a
reservoir containing a predetermined amount of fluid for supplying
said hydraulic device with fluid.
35. The apparatus according to claim 34, wherein said reservoir
defines a chamber for said predetermined amount of fluid and said
hydraulic device changes the size of said chamber.
36. The apparatus according to claim 34, wherein said hydraulic
device comprises an activatable pump for pumping fluid between said
reservoir and said adjustment device.
37. The apparatus according to claim 34, wherein said hydraulic
device comprises a servo means.
38. The apparatus according to claim 37, wherein said hydraulic
device comprises first and second wall portions of said reservoir,
and said servo means provides relative displacement between said
first and second wall portions of said reservoir.
39. The apparatus according to claim 1, further comprising a
wireless remote control for controlling said adjustment device.
40. The apparatus according to claim 39, wherein said remote
control comprises a separate signal transmitter and/or receiver and
a signal receiver and/or transmitter implanted in the patient.
41. The apparatus according to claim 40, wherein said signal
receiver comprises a control unit for controlling said adjustment
device in response to a control signal received from said signal
transmitter.
42. The apparatus according to claim 41, further comprising an
energizer unit implanted in the patient for providing energy to
energy consuming components of said restriction device.
43. The apparatus according to claim 42, further comprising a motor
implanted in the patient for operating said adjustment device.
44. The apparatus according to claim 43, wherein said control unit
powers said motor with energy provided by said energizer unit in
response to a control signal received from said signal
transmitter.
45. The apparatus according to claim 43, wherein said motor
comprises an electric motor.
46. The apparatus according to claim 42, wherein said energizer
unit transfers energy from said control signal, as the latter is
transmitted to said signal receiver, into electric energy.
47. The apparatusaccording to claim 46, further comprising an
electric motor implanted in the patient for operating said
adjustment device, said energizer unit comprising a rechargeable
electric power supply for storing said electric energy and said
control unit powers said electric motor with energy from said
rechargeable electric power supply in response to a control signal
received from said signal transmitter.
48. The apparatus according to claim 42, wherein said energizer
unit comprises a battery, an electrically operable switch for
connecting said battery to said signal receiver in an "on" mode
when said switch is powered and to keep said battery disconnected
from said signal receiver means in a "standby" mode when said
switch is unpowered, and a rechargeable electric power supply for
powering said switch.
49. The apparatus according to claim 48, wherein said control unit
powers said electric motor with energy from said battery in
response to a control signal received from said signal transmitter,
when said switch is in its "on" mode.
50. The apparatus according to claim 42, further comprising an
external energy transmitter for transmitting wireless energy,
wherein said energizer unit comprises a battery and an operable
switch for connecting said battery to said signal receiver in an
"on" mode when said switch is powered and to keep said battery
disconnected from said signal receiver in a "standby" mode when
said switch is unpowered, said external energy transmitter for
powering said switch.
51. The apparatus according to claim 50, wherein said energy
transmitter directly powers said switch with said wireless energy
to switch into said "on" mode.
52. The apparatus according to claim 39, wherein said remote
control comprises means for wireless transfer of energy from
outside the patient's body to energy consuming components of said
restriction device.
53. The apparatus according to claim 52, wherein said means for
wireless transfer of energy directly powers said energy consuming
components of said restriction device.
54. The apparatus according to claim 52, further comprising a motor
implanted in the patient for operating said adjustment device,
wherein said means for wireless transfer of energy directly powers
said motor with transferred energy.
55. The apparatus according to claim 52, wherein said energy
transferred by said means for transfer of energy comprises a wave
signal.
56. The apparatus according to claim 52, wherein said energy
transferred by said means for transfer of energy comprises an
electric or magnetic field.
57. The apparatus according to claim 40, wherein said signal
transmitter and signal receiver transmit and receive a signals in
the form of digital pulses.
58. The apparatus according to claim 57, wherein said digital
pulses comprise an electric or magnetic field.
59. The apparatus according to claim 40, wherein said signal
transmitter and signal receiver transmit and receive a wave
signal.
60. The apparatus according to claim 59, wherein said wave signal
comprises an electromagnetic wave signal, a sound wave signal or a
carrier wave signal for a remote control signal.
61. The apparatus according to claim 42, wherein said energizer
unit transfers said energy from said control signal into a direct
or alternating current.
62. The apparatus according to claim 39, wherein said remote
control is capable of obtaining information related to the pressure
against the restriction device, directly or indirectly, and of
commanding said adjustment device to directly or indirectly adjust
said restriction device in response to obtained information.
63. The apparatus according to claim 4, wherein said adjustment
device changes the size of said restriction opening such that the
outer circumferential confinement surface of said restriction
member is changed.
64. The apparatus according to claim 4, wherein said adjustment
device changes the size of said restriction opening such that the
outer circumferential confinement surface of the restriction member
is unchanged.
65. The apparatus according to claim 4, wherein said forming means
comprises a spring material forming said elongated restriction
member into said loop, such that said restriction opening has a
predetermined size, and said adjustment device adjusts said
restriction member against the spring action of said spring
material.
66. The apparatus according to claim 65, wherein said spring
material is integrated in said restriction member.
67. The apparatus according to claim 4, wherein said forming means
form said restriction member into a loop having a predetermined
size.
68. The apparatus according to claim 4, wherein said elongated
restriction member is flexible, and said adjustment device pulls a
first portion of said flexible restriction member from a second
portion of said flexible restriction member opposite said first
portion in said loop to squeeze said portion of the rectum or colon
between two opposite lengths of said elongated flexible restriction
member to decrease the fecal passageway.
69. The apparatus according to claim 1, wherein said restriction
device comprises at least two elements rotating in opposite
direction thereof and being located spaced apart engaging the colon
or rectum, and said adjustment device squeezes said portion of the
colon or rectum between said elements when they are rotated to
decrease the fecal passageway.
70. The apparatus according to claim 1, wherein said restriction
device comprises at least two articulated clamping elements
positioned on different sides of said portion of the colon or
rectum, and said adjustment device moves said clamping elements
towards each other to clamp said portion of the colon or rectum
between said clamping elements to decrease the fecal
passageway.
71. The apparatus according to claim 1, wherein said restriction
device bends said portion of the colon or rectum.
72. The apparatus according to claim 71, wherein said restriction
device comprises at least two bending members positioned on
opposite or diferent sides of said portion of the colon or rectum,
and said adjustment device moves said bending members against said
portion of the colon or rectum in two opposite spaced apart
directions to bend said portion of the colon or rectum to restrict
the fecal passageway.
73. The apparatus according to claim 72, wherein said bending
members comprise rollers.
74. The apparatus according to claim 1, wherein said restriction
device rotates a portion of the colon or rectum.
75. The apparatus according to claim 1, wherein the colon or rectum
form a fecal passageway and said restriction device controls the
cross-sectional area of said fecal passageway.
76. The apparatus according to claim 75, wherein said restriction
device is operable to open and close said fecal passageway to
respectively allow, or substantially completely prevent, the
passage of fecal material through said passageway.
77. The apparatus according to claim 76, wherein said restriction
device steplessly controls the cross-sectional area of said fecal
passageway.
78. The apparatus according to claim 1, further comprising a
pressure sensor for directly or indirectly sensing the pressure
against the restriction device.
79. The apparatus according to claim 78, wherein said restriction
device is controlled in response to signals from said pressure
sensor.
80. The apparatus according to claim 1, further comprising an
implanted energy transfer device transferring wireless energy
directly or indirectly into kinetic energy for operation of said
restriction device.
81. The apparatus according to claim 1, further comprising a
reversing device implanted in the patient, wherein said restriction
device is capable of performing a reversible function and said
reversing device reverses said function.
82. The apparatus according to claim 30, comprising a reversing
device implanted in the patient for reversing said motor.
83. The apparatus according to claim 1, wherein said adjustment
device or other energy consuming components of the apparatus are
energised with wirelessly transmitted energy from outside the
patient's body.
84. The apparatus according to claim 1, further comprising an
implanted accumulator or battery and means for controlling said
accumulator or battery from outside the patient's body to supply
energy to said adjustment device or other implanted energy
consuming components of the apparatus
85. The apparatus according to claim 42, wherein said energizer
unit comprise an implanted battery or accumulator for providing
energy to energy consuming components of said restriction
device.
86. The apparatus according to claim 1, wherein said adjustment
device adjusts said restriction device in a non-manual manner.
87. A method for treating anal incontinence, comprising: surgically
implanting in the body of a patient suffering from anal
incontinence an adjustable restriction device which directly
engages the colon or rectum to form a normally closed fecal
passageway therein, and when desired, mechanically adjusting the
restriction device to temporarily open the fecal passageway to
allow the passage of fecal material therethrough.
88. A surgical method as recited in claim 87, further comprising
implanting the adjustable restriction device in the base or
prolongation of the patient's rectum.
89. A surgical method as recited in claim 87, further comprising
implanting at least two restriction devices engaging the colon or
rectum
90. A method for treating anal incontinence, comprising the steps
of: placing at least two laparascopical trocars in the body of a
patient suffering from anal incontinence, inserting a dissecting
tool through the trocars and dissecting an area of the colon or
rectum in the abdominal or pelvic or retoperitoneal surroundings,
placing at least one adjustable restriction device in the dissected
area engaging the rectum or colon, and'adjusting the restriction
device to normally restrict the fecal passageway in the rectum or
colon to substantially prevent the passage of fecal material
therethrough, and when defaecation is needed release the fecal
passageway to allow the passage of fecal material therethrough.
91. A surgical method as recited in claim 90, further comprising
mechanically adjusting the restriction device.
92. A surgical method as recited in claim 90, further comprising
adjusting the restriction device in a non-manual manner.
93. A surgical method as recited in claim 90, further comprising
implanting a source of energy in the patient and providing a
control device for controlling the source of energy from outside
the patient's body to supply energy to the restriction device
Description
BACKGROUND OF THE INVENTION
[0001] The present invention relates to an anal incontinence
treatment apparatus and method. More specifically, the invention
relates to an anal incontinence treatment apparatus and method for
surgical application in the body of an anal incontinence patient
for restricting the colon or rectum of a patient.
[0002] Anal incontinence is a widespread problem. Many different
solutions to this problem have been tried. Several kinds of
sphincter plastic surgery are used today to remedy anal
incontinence. There is a prior manually operated sphincter system
in an initial clinical trial phase with the hydraulic sphincter
system connected to a reservoir placed in the scrotum. Disadvantage
of this system is that hard fibrosis created around the reservoir
over time may cause malfunction of pumping components. Thus, the
created fibrosis will sooner or later become a hard fibrotic layer
which may make it difficult to pump the reservoir. Yet a further
disadvantage is that the use of hydraulic fluid always entails a
risk of fluid leaking from the prosthetis. Furthermore, it is a
rather complicated task to mechanically manually pump the reservoir
when defaecation is needed. U.S. Pat. No. 5,593,443 discloses
hydraulic anal sphincter under both reflex and voluntary control.
An inflatable artificial sphincter with the pump system in scrotum
is disclosed in U.S. Pat. No. 4,222,377.
SUMMARY OF THE INVENTION
[0003] A prime object of the present invention is to provide an
anal incontinence treatment apparatus and method in which the risk
of liquid leakage within the patient's body is substantially
reduced or completely eliminated.
[0004] A further object of the invention is to provide an anal
incontinence treatment apparatus and method, which does not require
a manual manipulation of a combined reservoir a pump mechanism in
the scrotum or labia majora region of the patient. Accordingly, the
present invention provides an anal incontinence treatment
apparatus, comprising:
[0005] an adjustable restriction device implanted in a patient, who
suffers from anal incontinence, and engaging a portion of the colon
or rectum of the patient to restrict the fecal passage-way therein,
and
[0006] an adjustment device which mechanically adjusts the
restriction device to restrict or release the fecal passageway.
[0007] The adjustment device may be non-manually operated, i.e. the
adjustment may be operated by any powered means, not manipulated by
touching the skin of the patient. Preferably, the adjustment device
adjusts the restriction device in non-invasive manner.
[0008] The adjustment device may adjust the restriction device in a
non-magnetic manner, i.e. magnetic forces may not be involved when
adjusting the restriction device. Furthermore, as opposed to prior
art anal incontinence treatment devices the adjustment device of
the invention is not operated by manual forces, such as by manually
compressing a fluid containing balloon implanted in the scrotum.
Instead the apparatus of the invention may further comprise a
powered operation device for operating the adjustment device.
[0009] In the various embodiments hereinafter described the
restriction device generally forms an at least substantially closed
loop. However, the restriction device may take a variety of
different shapes, such as the shape of a square, rectangle or
ellipse. The substantially closed loop could for example be totally
flat, i.e. thin as seen in the radial direction. The shape of
restriction device may also be changed during use, by rotation or
movements of the restriction device in any direction.
[0010] A physical lumen, like the colon or rectum or the
prolongation thereof, is often easier to restrict by contracting at
least two opposite or different side walls of the lumen against
each other. The expression "colon or rectum or the prolongation
thereof" should be understood to mean the rectum extended all the
way out to the anal sphincter and following the passage of the
large intestine in the other direction.
[0011] Either mechanical or hydraulic solutions may be employed to
operate the restriction device. Alternatively, the restriction
device may comprise an adjustable cuff, a clamp or a roller for
bending the colon or rectum or the prolongation thereof to restrict
the fecal passageway therein. Such a cuff, clamp or roller may also
be utilized for squeezing the colon or rectum or the prolongation
thereof against human material inside the body of the patient for
an example the sacral bone of the patient.
[0012] Preferably, the restriction device comprises an elongated
restriction member and forming means for forming the restriction
member into at least a substantially closed loop around the portion
of the tissue, the loop defining a restriction opening, whereby the
adjustment device adjusts the restriction member in the loop to
change the size of the restriction opening.
[0013] The restriction device may be implanted in the abdomen or
retroperitoneum of the patient and preferably may engage the colon
or rectum or the prolongation thereof.
[0014] The adjustment device may be incorporated in the restriction
device as well as being controlled by hydraulic means.
[0015] In accordance with a preferred first adjustment principle,
the adjustment device mechanically adjusts the longitudinal
extension of the elongated restriction member in a loop form.
[0016] In a preferred embodiment of the invention utilizing the
first adjustment principle, the restriction member comprises a main
portion and two elongated end portions, and the adjustment device
establishes longitudinal relative displacement between the end
portions of the restriction member, so that the size of the
restriction opening is adjusted. The forming means may comprise any
suitable known or conventional device capable of practicing the
desired function, such as a spring material forming the elongated
restriction member into the loop, so that the restriction opening
has a predetermined size, and the adjustment device may adjust the
restriction member against the spring action of the spring
material. In other words, the restriction member may comprise a
spring clip. The spring material may be integrated in the
restriction member.
[0017] Preferably, the adjustment device comprises a movement
transferring member, suitably a drive wheel, in engagement with at
least one of the end portions of the restriction member and
operable to displace the one end portion relative to the other end
portion of the restriction member. The drive wheel may
advantageously be in engagement with both of the end portions of
the restriction member and be operable to displace said end
portions relative to each other. An elongated flexible drive shaft
may be operatively connected to the drive wheel, for transferring
manual or motor generated power from a location remote from the
restriction member. In its simplest embodiment, the drive wheel may
comprise a pulley in frictional engagement with the restriction
member. As an alternative, a gear rack may be formed on at least
one of the end portions of the restriction member and the drive
wheel may comprise a gear wheel in mesh with the gear rack. Other
suitable known or conventional mechanisms may also or alternatively
be used as the adjustment device.
[0018] The movement transferring member may alternatively comprise
at least one cylinder and a piston, which is movable therein and is
connected to one of the end portions of the restriction member, the
piston being operable to longitudinally displace the one end
portion of the restriction member relative to the other end portion
of the restriction member. Alternatively, the movement transferring
means may comprise two interconnected cylinders and two pistons in
the respective cylinders connected to said end portions,
respectively, of the restriction member, the pistons being operable
to longitudinally displace the end portions of the restriction
member relative to each other. Other known or conventional devices
also or alternatively can be used as the movement transferring
member.
[0019] A motor, which is fixed relative to the main portion of the
restriction member and has a rotating drive shaft operatively
connected to the movement transferring member, may be positioned
relative to the elongated restriction member such that the drive
shaft extends transverse thereto. Alternatively, the motor may be
positioned relative to the elongated restriction member such that
the drive shaft extends substantially tangentially to the loop of
the restriction member.
[0020] In another embodiment of the invention utilizing the first
adjustment principle, the elongated restriction member is
longitudinally resilient and the adjustment device comprises a
contraction device for longitudinally contracting the resilient
restriction member. Preferably, the elongated restriction member
comprises a substantially nonresilient main portion and an end
portion forming an elongated helical spring, which is contractable
by the contraction device. The contraction device may suitably
comprise an elongated flexible pulling member connected to the main
portion of the restriction member and extending through the helical
spring to contract the helical spring against an arresting member,
which is fixed relative to the main portion of the restriction
member. The pulling member may extend in an elongated tube joined
at one end thereof to the arresting member, so that a motor remote
from the restriction member may be attached to the other end of the
elongated tube and pulls the pulling member through the tube to
contract the helical spring.
[0021] In yet another embodiment of the invention utilizing the
first adjustment principle, the elongated restriction member
comprises an elongated helical spring having a free end, and a body
to which the spring is nonrotatably secured at its opposite end.
The adjustment device rotates the helical spring in one direction
to enlarge the coils of the helical spring to longitudinally
contract the spring and to rotate the spring in the opposite
direction to reduce the size of the coils of the spring to
longitudinally extend the spring. As a preferred alternative, the
restriction member comprises a further elongated helical spring
having a free end and nonrotatably secured to the body at its
opposite end, and the adjustment device comprises a drive shaft
having two opposite end portions connected to the springs,
respectively, at their free ends, the helical coils forming left
and right hand helices, respectively. The adjustment device may
alternatively comprise a gearing having an input shaft and two
opposite aligned output shafts connected to the helical springs,
respectively, at their free ends, the input shaft being connected
to said output shafts so that the output shafts rotate in the
opposite directions upon rotation of the input shaft, the helical
coils forming the same helices.
[0022] In accordance with a second adjustment principle, the
adjustment device mechanically adjusts the restriction member so
that at least a portion of a radially innermost circumferential
confinement surface formed by the restriction member is
substantially radially displaced.
[0023] In one embodiment of the invention utilizing the second
adjustment principle, the restriction member comprises an elongated
voltage responsive element forming part of the confinement surface
and capable of bending into a bow in response to a voltage applied
across the element, the radius of curvature of the bow being
adjustable by changing the level of the voltage.
[0024] In another embodiment of the invention utilizing the second
adjustment principle, the adjustment device changes the diameter of
an elastic annular element of the restriction member, which forms
the confinement surface. Preferably, the forming means comprises a
substantially rigid outer annular element coaxially surrounding the
elastic annular element, and the adjustment device comprises means
for pulling the elastic annular element radially outwardly towards
the outer annular element to expand the elastic annular element.
For example, the pulling means may comprise a plurality of threads
secured to the elastic annular element along the circumference
thereof and running from the elastic annular element via guide
members attached to the outer annular element.
[0025] In yet another embodiment of the invention utilizing the
second adjustment principle, the forming means comprises a
substantially rigid outer annular element, and the restriction
member comprises an elongated helical spring extending internally
along the outer annular element and contacting the latter. The
helical spring forms part of the circumferential confinement
surface and has a free end. The restriction member further
comprises a body to which the spring is nonrotatably secured at its
opposite end. The adjustment device rotates the helical spring in
one direction to enlarge the coils of the spring to contract the
circumferential confinement surface and rotates the spring in the
opposite direction to reduce the size of the coils of the spring to
expand the circumferential confinement surface. As an alternative,
which is preferred, the restriction member comprises two elongated
helical springs forming part of the circumferential confinement
surface and connected to the body of the restriction member. The
adjustment device rotates each spring in one direction to enlarge
the coils of the spring to contract the circumferential confinement
surface and rotates the spring in the opposite direction to reduce
the size of the coils of the spring to expand the circumferential
confinement surface.
[0026] In accordance with a third adjustment principle, the
restriction member comprises at least two separate elements, at
least one of which is pivoted so that it may turn in a plane in
which the the restriction member extends, and the adjustment device
turns the pivoted element to change the size of the restriction
opening. Preferably, the restriction member comprises a plurality
of separate pivoted elements disposed in series, each pivoted
element being turnable in the plane, and the adjustment device
turns all of the pivoted elements to change the size of the
restriction opening. For example, the pivoted elements may comprise
lamellae arranged like the conventional adjustable aperture
mechanism of a camera.
[0027] In accordance with a fourth adjustment principle, the
adjustment device folds at least two foldable frame elements of the
restriction member towards each other. Preferably, the foldable
frame elements comprise two substantially or partly semi-circular
frame elements which are hinged together so that the semi-circular
elements are swingable relative to each other from a fully open
state in which they form part of a circle to a fully folded state
in which they form part of a semi-circle. The same principal may be
used with the swingable parts mounted together in one end and not
in the other end. Alternatively, the restriction device may
comprises two preferable rigid articulated clamping elements
positioned on opposite or different sides of colon rectum or the
prolongation thereof, and the adjustment device turns the clamping
elements toward each other to clamp the colon or rectum or the
prolongation thereof between the clamping elements, thereby
restricting the fecal passageway in the colon or rectum or the
prolongation thereof.
[0028] In accordance with a fifth adjustment principle, the
adjustment device turns the restriction member around a
longitudinal extension thereof, the elongated restriction member
being elastic and varying in thickness as seen in a cross-section
therethrough. Suitably, the elongated restriction member comprises
an elastic belt.
[0029] In accordance with a sixth adjustment principle, the
adjustment device changes the size of the restriction opening such
that the outer circumferential confinement surface of the
restriction member is changed.
[0030] In accordance with a seventh adjustment principle, the
adjustment device changes the size of the restriction opening such
that the outer circumferential confinement surface of the
restriction member is unchanged.
[0031] In accordance with an eighth adjustment principle, the
elongated restriction member may be flexible, and the adjustment
device pulls a first portion of the flexible restriction member
from a second portion of the flexible restriction member opposite
the first portion in the loop to squeeze the colon or rectum or the
prolongation thereof between the opposite lengths of the elongated
flexible restriction member to restrict the fecal passageway in the
colon or rectum or the prolongation thereof.
[0032] In accordance with a ninth adjustment principle, the
restriction device comprises at least two elements on opposite or
different sides of the colon or rectum or the prolongation thereof,
and the adjustment device decreases the distance between the
elements to squeeze the colon or rectum or the prolongation thereof
between the elements, thereby restricting the fecal passageway in
the colon or rectum or the prolongation thereof. It is also
possible to use only one element and squeeze the colon or rectum or
the prolongation thereof against human bone or tissue. The elements
above may as well as all the restriction members mentioned in this
application be everything from rigid to soft.
[0033] In accordance with a tenth adjustment principle, the
restriction device bends or rotates a portion of colon or rectum or
the prolongation thereof to restrict the fecal passageway in the
same. For example, the restriction device may comprise at least two
bending members, such as cylindrical or hour-glass shaped rollers,
positioned on opposite or different sides of the colon or rectum or
the prolongation thereof and displaced relative to each other along
the colon or rectum or the prolongation thereof, and the adjustment
device may move the bending members against the colon or rectum
thereof to bend the latter to restrict the fecal passageway in the
colon or rectum or the prolongation thereof Suitably, the
displacement members may comprise rollers. The restriction device
may also rotate a portion of the esophagus or stomach. The bending
or rotating members may have any shape or form and be either
hydraulic or non-inflatable.
[0034] Two holding members one placed more distal than the other
comprising two at least substantially closed loops may be rotated
in opposite direction to each other. With interconnecting material
for example flexable bands between the holding members a
restriction will occure betwenn the holding members when they are
rotated.
[0035] The restriction device may in all applicable embodiments
have any shape or form and be either hydralic or
non-inflatable.
[0036] In all of the above-described embodiments of the invention
the adjustment device is conveniently operated by any suitable
motor, preferably an electric motor, which may be fixed directly to
or be placed in association with the restriction device, or
alternatively be located remote from the restriction device,
advantageously in the abdomen or pelvic region or subcutaneously or
in the retroperitoneum of the patient. In the latter alternative
the motor is advantageously connected to the adjustment device by a
flexible power transmission conduit to permit a suitable
positioning of the motor in the abdomen of the patient. The motor
may be manually activatable, for example by an implanted
switch.
[0037] In some of the above described embodiments of the invention,
however, the adjustment device may conveniently be operable by a
hydraulic operation device, which preferably is manually
activatable. The hydraulic operation device may advantageously
include hydraulic servo means to facilitate manual activation. As
an alternative, the hydraulic device may be powered by an electric
motor, which may be manually activatable or controlled by remote
control means. The components of such a hydraulic operation device
may be placed in association with the restriction device and/or be
located at a suitable place in the abdomen or subcutaneously.
[0038] More specifically, a reservoir may be provided containing a
predetermined amount of fluid for supplying the hydraulic operation
device with fluid. The reservoir defines a chamber for the
predetermined amount of fluid and the hydraulic operation device
changes the size of the chamber. The hydraulic operation device may
comprise first and second wall portions of the reservoir, which are
displaceable relative to each other to change the size of the
chamber of the reservoir. The first and second wall portions of the
reservoir may be designed to be displaceable relative to each other
by manual manipulation thereof, preferably to permit manual
pushing, pulling or rotation of any of the wall portions in one
direction. Alternatively, the wall portions may be displaceable
relative to each other by magnetic means (such as a permanent
magnet and magnetic material reed switch, or other known or
conventional magnetic devices), hydraulic means or electrical
control means such as an electric motor. The magnetic means,
hydraulic means, or electrical control means may all be activated
by manual manipulation, preferably using a subcutaneously located
manually manipulatable device. This control may be indirect, for
example via a switch.
[0039] The hydraulic operation device may operate the adjustment
device with fluid from the reservoir in response to a predetermined
first displacement of the first wall portion of the reservoir
relative to the second wall portion of the reservoir, to adjust the
restriction device to release the tissue, and to operate the
adjustment device with fluid from the reservoir in response to a
predetermined second displacement of the first wall portion of the
reservoir relative to the second wall portion of the reservoir, to
adjust the restriction device to restrict the blood flow leaving
the penis. In this embodiment, no pump is used, only the volume of
the reservoir is varied. This is of great advantage compared to the
solution described below when a pump is used to pump fluid between
the reservoir and the adjustment device because there is no need
for a non-return valve and it is still possible to have fluid going
both to and from the reservoir.
[0040] As an alternative, the hydraulic operation device may
comprise an activatable pump for pumping fluid between the
reservoir and the adjustment device. The pump may pump fluid both
to and away from the adjustment device, or hydraulic means
controlling the adjustment device. A mechanical manual solution is
proposed in which it is possible to pump in both directions just by
pushing an activating member in one direction. Another alternative
is a pump pumping in only one direction and an adjustable valve to
change the direction of fluid to either increase or decrease the
amount of fluid in the reservoir. This valve may be manipulated
manually, mechanically, electrically, magnetically, or
hydraulically. Any kind of motor could of course be used for all
the different operations as well as wireless remote solutions. The
pump may comprise a first activation member for activating the pump
to pump fluid from the reservoir to the adjustment device and a
second activation member for activating the pump to pump fluid from
the adjustment device to the reservoir. The activation members may
be operable by manual manipulation, preferably to permit manual
pushing, pulling or rotating thereof in one direction. Suitably, at
least one of the activation members is adapted to operate when
subjected to an external pressure exceeding a predetermined
magnitude.
[0041] Alternatively, at least one of the first and second
activating members may be operable by magnetic means, hydraulic
means or electrical control means such as an electric motor. The
magnetic means, hydraulic means, or electrical control means may
all be activated by manual manipulating means preferably located
subcutaneously. This activation may be indirect, for example via a
switch.
[0042] Advantageously, especially when manual manipulation means
are used, a servo system could be used. With servo means less force
is needed for controlling the adjustment device. Hydraulic means is
preferably used with servo means. One example is a closed system
that controls another closed system in which the hydraulic devices
of the adjustment device is incorporated. Minor changes in the
amount of fluid in a reservoir of the first system could then lead
to major changes in the amount of fluid in a reservoir in the
second system. In consequence, the change of volume in the
reservoir of the second system affects the hydraulic device of the
adjustment device, which is incorporated in the second closed
system. The great advantage of this servo system is that the larger
volume system could be placed inside the abdomen or retroperitoneum
where there is more space and still would be possible to use manual
manipulation means of the smaller system subcutaneously. The servo
reservoir could control the reservoir of the larger volume. The
servo reservoir could be controlled directly or indirectly by a
fluid supply means. The fluid supply means may be a small
reservoir, which may be placed subcutaneously and may be activated
by manual manipulation means controlling the servo reservoir.
[0043] Preferably, the servo means comprises hydraulic means and a
servo reservoir and eventually a fluid supply reservoir. Both
reservoirs define a chamber containing servo fluid, and the
hydraulic means comprises first and second wall portions of the
servo reservoir, which are displaceable relative to each other to
change the size of the chamber of the servo reservoir. The
hydraulic means may control the adjustment device indirectly, e.g.
via an increased amount of fluid in the servo reservoir, in
response to a predetermined first displacement of the first wall
portion of any of the reservoirs relative to the second wall
portion of the reservoir to restrict blood flow leaving the penis,
and to control the adjustment device in response to a second
displacement of the first wall portion of any reservoir relative to
the second wall portion, to indirectly adjust the restriction
device to release the tissue. The wall portions of the reservoirs
may be designed to be displaceable relative to each other by manual
manipulation thereof or be displaceable relative to each other by
manually pushing, pulling or rotating any of the wall portions of
the reservoir in one direction. Alternatively, the wall portions of
the servo reservoir may be displaceable relative to each other by
magnetic means, hydraulic means or electric control means including
an electric motor.
[0044] The magnetic means, hydraulic means, or electrical control
means may all be activated by manually manipulated means preferably
located subcutaneously. This control may be indirect for example
via a switch.
[0045] Even in the broadest embodiment of the invention the
adjustment device may comprise a servo means. The servo means may
comprise a hydraulic operation means, an electrical control means,
a magnetic means, mechanical means or a manual manipulation means.
The hydraulic operation means, electrical control means, mechanical
means or magnetic means may be activated by manual manipulating
means. Using a servo system will save the use of force when
adjusting the adjustment device which may be of importance in many
applications, for example when a battery cannot put out enough
current although the total energy in the battery is more than
enough to power the system.
[0046] All solutions may be controlled by a wireless remote control
for controlling the adjustment device. The remote control may
advantageously be capable of obtaining information related to the
fecal passageway or the pressure against the restriction device or
colon or rectum or other important physical parameters and of
commanding the adjustment device to adjust the restriction device
in response to obtained information. With the wireless remote
control the apparatus of the invention is conveniently controlled
by the patient when he so desires, which is of great advantage
compared to the prior art procedures. With the remote control the
apparatus of the invention is conveniently controlled to adjust the
implanted restriction device, which controls the defecation. The
restriction device may be operable to open and close fecal
passageway. The restriction device may steplessly control the
cross-sectional area of the passageway.
[0047] The apparatus may further comprise a pressure sensor for
directly or indirectly sensing the pressure against the restriction
device and the restriction device may control the blood flow in
response to signals from the pressure sensor. The pressure sensor
may be any suitable known or conventional pressure sensor such as
shown in U.S. Pat. Nos. 5,540,731, 4,846,181, 4,738,267, 4,571,749,
4,407,296 or 3,939,823; or an NPC-102 Medical Angioplasty Sensor.
The adjustment device preferaby non-invasively adjusts the
restriction device to change the size of the cross-sectional
area.
[0048] The adjustment device and/or other energy consuming
components of the apparatus may be energised with wirelessly
transmitted energy from outside the patient's body or be powered by
an implanted battery or accumulator.
[0049] The apparatus may further comprise an implanted energy
transfer device for transferring wireless energy directly or
indirectly into kinetic energy for operation of the restriction
device.
[0050] The wireless remote control may comprise means for wireless
transfer of energy from outside the patient's body to energy
consuming implantable components of the apparatus. A motor may
suitably be implanted in the patient for operating the adjustment
device and the means for wireless transfer of energy may directly
power the motor with transferred energy. The energy transferred by
the means for transfer of energy may comprise any suitable kind of
energy signals including wave signals, an electric field or a
magnetic field.
[0051] Preferably, the wireless remote control comprises a separate
signal transmitter or receiver and a signal receiver or transmitter
implanted in the patient. For example, the signal transmitter and
signal receiver may transmit and receive a signal in the form of
digital pulses, which may comprise a magnetic or electric field.
Alternatively, which is preferred, the signal transmitter and
signal receiver may transmit and receive an electromagnetic wave
signal, a sound wave signal or a carrier wave signal for a remote
control signal. The receiver may comprise an implanted control unit
for controlling the adjustment device in response to a control
signal from the signal transmitter.
[0052] The apparatus of the invention may further comprise an
implanted energizer unit for providing energy to energy consuming
implanted components of the apparatus, such as electronic circuits
and/or a motor for operating the adjustment device. The control
unit may power such an implanted motor with energy provided by the
energizer unit in response to a control signal received from the
signal transmitter. Any known or conventional signal transmitter or
signal receiver that is suitable for use with a human or
mammal-patient may be provided as the signal transmitter or signal
receiver of the invention. Generally, the signals may comprise
electromagnetic waves, such as infrared light, visible light, laser
light, micro waves, or sound waves, such as ultrasonic waves or
infrasonic waves, or any other type of wave signals. The signals
may also comprise electric or magnetic fields, or pulses. All of
the above-mentioned signals may comprise digital signals. The
control signals may be carried by a carrier wave signal, which in
an alternative embodiment may be the same signal as the wireless
energy signal. Preferably a digital control signal may be carried
by an electromagnetic wave signal. The carrier wave or control
signal may be amplitude or frequency modulated.
[0053] The motor may be any type of motor, such as a pneumatic,
hydraulic or electric motor and the energizer unit may power the
motor with pressurized gas or liquid, or electric energy, depending
on the type of motor. Where the motor is an electric motor, it may
power pneumatic or hydraulic equipment.
[0054] The energizer unit may comprise a power supply and the
control unit may power the motor with energy from the power supply.
Preferably, the power supply is an electric power supply, such as a
battery, and the motor is an electric motor. In this case, the
battery also continuously powers at least part of the circuitry of
the signal receiver in a standby mode between the adjustments, in
order to keep the signal receiver prepared for receiving signals
transmitted from the signal transmitter.
[0055] The energizer unit may transfer energy from the control
signal, as the control signal is transmitted to the signal
receiver, into electric energy for powering the implanted
electronic components. For example, the energizer unit may transfer
the energy from the control signal into a direct or alternating
current.
[0056] In case there is an implanted electric motor for operating
the adjustment device the energizer unit may also power the motor
with the transferred energy. Advantageously, the control unit
directly powers the electric motor with electric energy, as the
energizer unit transfers the signal energy into the electric
energy. This embodiment is particularly simple and does not require
any recurrent invasive measures for exchanging empty power
supplies, such as batteries, that is required in the first
embodiment described above.
[0057] For adjustment devices of the type that requires more, but
still relatively low, power for its operation, the energizer unit
may comprise a rechargeable electric power supply for storing the
electric energy obtained and the control unit may power the
electric motor with energy from the rechargeable electric power
supply in response to a control signal received from the signal
transmitter. In this case, the rechargeable power supply can be
charged over a relatively long time (e.g. a few seconds up to a
half hour) without powering the electric motor.
[0058] The electric power supply suitably comprises an inexpensive
simple capacitor. In this case, the electric motor may be a
stepping motor. In all embodiments the motor may preferable be able
to perform a reversing function.
[0059] The signal transmitter may transmit an electromagnetic
signal and the energizer unit may draw radiant energy from the
electromagnetic wave signal, as the latter is transmitted to the
signal receiver, and transfer the radiant energy into electric
energy.
[0060] Alternatively, the energizer unit may comprise a battery or
accumulator, an electrically operable switch adapted to connect the
battery to the signal receiver in an on mode when the switch is
powered and to keep the battery disconnected from the signal
receiver in a standby mode when the switch is unpowered, and a
rechargeable electric power supply for powering the switch. The
control unit may power the electric motor with energy from the
battery in response to a control signal received from the signal
transmitter, when the switch is in its on mode. Advantageously, the
energizer unit may transfer wave energy from the control signal, as
the latter is transmitted to the signal receiver, into a current
for charging the rechargeable electric power supply, which suitably
is a capacitor. Energy from the power supply is then used to change
the switch from off (standby mode) to on. This embodiment is suited
for adjustment devices of the type that require relatively high
power for their operation and has the advantage that the electronic
circuitry of the signal receiver does not have to be powered by the
battery between adjustments. As a result, the life-time of the
battery can be significantly prolonged. The switch may be switched
with magnetic, manual or electric energy.
[0061] As an example, the signal transmitter may transmit an
electromagnetic wave signal and the energizer unit may draw radiant
energy from the electromagnetic wave signal, as the latter is
transmitted to the signal receiver, and may transfer the radiant
energy into said current. The energizer unit suitably comprises a
coil of the signal receiver for inducing an alternating current as
the electromagnetic wave signal is transmitted through the coil and
a rectifier for rectifying the alternating current. The rectified
current is used for charging the rechargeable power source.
[0062] Alternatively, the signal transmitter and receiver may
solely be used for a control signal and a further-pair of signal
transmitter and receiver may be provided for transferring signal
energy to implanted components. By such a double system of signal
transmitters and receivers the advantage is obtained that the two
systems can be designed optimally for their respective purposes,
namely to transmit a control signal and to transfer energy from an
energy signal. Accordingly, the apparatus may further comprise an
external energy transmitter for transmitting wireless energy,
wherein the energizer unit comprises a battery and an operable
switch for connecting the battery to the signal receiver in an on
mode when the switch is powered and for keeping the battery
disconnected from the signal receiver in a standby mode when the
switch is unpowered, and the external energy transmitter powers the
switch. Suitably, the energy transmitter may directly power the
switch with the wireless energy to switch into the on mode. As
should be realized by a skilled person, in many of the
above-described embodiments of the invention the adjustment device
may be operated by control means or manual manipulation means
implanted under the skin of the patient, such as a pump, an
electrical switch or a mechanical movement transferring means. In
the manual embodiment it is not necessary to use a motor for
operating the adjustment device.
[0063] In embodiments including hydraulic transmission means, an
injection port connected to the hydraulic means may be provided for
enabling, normally single, once-and-for-all, calibration of the
amount of fluid in the hydraulic system.
[0064] In all embodiments a motor may be operatively connected to
the adjustment device. A reversing device may be implanted in the
patient for reversing the motor. The adjustment device preferably
adjusts the restriction device in a non-manual manner without the
patient touching his skin.
[0065] The restriction device is operable to open and close the
fecal passageway steplessly and preferable controled with a remote
control. Preferably, a pressure sensor is used for directly or
indirectly sensing the pressure against the restriction device or
the colon or the rectum to prevent any necrosis of the human
tissue. The restriction device may preferably be controlled in
response to signals from the pressure sensor. The motor which
preferably is used to adjust the restriction device must then be
capable of performing a reversible function, that is to say
reversed direction of the motor. Preferably the adjustment device
may be engergised directly with wirelessly transmitted energy from
outside the patient's body. Preferable, the inplanted energy
transfer device transfers wireless energy directly or indirectly
into kinetic energy for operation of the restriction device. In
another embodiment it would also be possible to use an implanted
accumulator or battery and control this implanted energy source
from outside the patient's body to supply energy to the adjustment
device or other energy consuming parts of the implanted
apparatus.
[0066] The invention also provides a method for treating a patient
suffering from anal incontinence comprising surgically implanting
in the body of the an adjustable restriction device which directly
engages the colon or rectum like an artificial sphincter around the
fecal passageway therein, normally closed, and when desired,
mechanically adjusting the restriction device to temporarily open
the fecal passageway.
[0067] The adjustable restriction device may preferably be
inplanted in the base or prolongation of the patients rectum. It is
possible to use one or serveral restricting devices engages the
colon or rectum.
[0068] In accordance with the invention, there is further provided
a method for treating anal incontince, comprising the steps of
placing at least two laparascopical trocars in the body of a
patient suffering from anal incontinence, inserting a dissecting
tool through the trocars and dissecting an area of the colon or
rectum in the abdominal or pelvic or retroperitoneal surroundings,
placing at least one adjustable restriction device in the dissected
area engaging the rectum or colon, adjusting the restriction device
to normally restrict the fecal passageway in the rectum or colon to
substantially prevent the passage of fecal material therethrough,
and adjusting the restriction device to open the fecal passageway
to allow the passage of fecal material therethrough when the
patient wants to relieve himself or herself. A mechanically
adjustable restriction device may be used when practicing this
method, preferably in a non-manual manner, i.e. without touching
subcutaneously implanted components of the apparatus.
[0069] The method may further comprise implanting a source of
energy in the patient and providing a control device for
controlling the source of energy from outside the patient's body to
supply energy to the restriction device.
[0070] It should generally be understood that all the above
embodiments may be combined in any working combination.
BRIEF DESCRIPTION OF THE DRAWINGS
[0071] FIG. 1 is a schematic sectional view of a preferred first
embodiment of the anal incontinence treatment apparatus in
accordance with the invention;
[0072] FIGS. 2 and 3 are cross-sectional views taken along the
lines II-II and III-III, respectively, of FIG. 1;
[0073] FIGS. 4 and 5 schematically show two alternative designs of
the embodiment of FIG. 1;
[0074] FIG. 6 schematically illustrates a motor arrangement for the
design according to FIG. 5;
[0075] FIG. 7 is a schematic sectional view of a second embodiment
of the apparatus in accordance with the invention;
[0076] FIG. 8 schematically illustrates a hydraulic transmision
conduit for the embodiment of FIG. 7;
[0077] FIG. 9 is a schematic sectional view of a third embodiment
of the apparatus in accordance with the invention;
[0078] FIG. 10 is a modification of the embodiment of FIG. 9;
[0079] FIG. 11 is a schematic view of a fourth embodiment of the
apparatus in accordance with the invention;
[0080] FIGS. 12 and 13 are enlarged details of the embodiment of
FIG. 11;
[0081] FIG. 14 is a cross-section along the line XIV-XIV of FIG.
11;
[0082] FIG. 15 is a schematic view of a fifth embodiment of the
apparatus in accordance with the invention;
[0083] FIG. 16 is an enlarged detail of FIG. 15;
[0084] FIG. 17 is a cross-section along the line XVII-XVII of FIG.
15;
[0085] FIGS. 18 to 21 are schematic sectional views of a sixth,
seventh, eighth and ninth embodiments, respectively, of the
apparatus in accordance with the invention;
[0086] FIGS. 22 and 23 illustrate a fully open and a reduced
restriction opening, respectively, of the embodiment of FIG.
21;
[0087] FIG. 24 is a schematic view of a tenth embodiment of the
apparatus in accordance with the invention;
[0088] FIG. 25 is an enlarged detail of the embodiment of FIG.
24;
[0089] FIGS. 26 and 27 illustrate a fully open and a reduced
restriction opening, respectively, of the embodiment of FIG.
24;
[0090] FIG. 28 schematically illustrates a cushion arrangement for
protecting the tissue of the patient;
[0091] FIG. 29A-D is a block diagram of four different principal
embodiments of the invention;
[0092] FIG. 30A-D are cross-sectional views of a pump mechanism
according to FIG. 29C, which pumps fluid in opposite directions by
mechanically pushing a wall portion in only one direction;
[0093] FIG. 31 is a cross-sectional view of a reservoir having a
variable volume controlled by a remote control motor, in accordance
with a particular embodiment of the principal embodiment shown in
FIG. 29B or 30B;
[0094] FIG. 32 is a cross-sectional view of a reservoir having a
variable volume adjustable by manual manipulation, in accordance
with a particular embodiment of the principal embodiment shown in
FIG. 29B or 29D;
[0095] FIG. 33A is a front view of a hydraulic, pneumatic or
mechanical servo system in accordance with a particular embodiment
of the principal embodiment shown in FIG. 29D;
[0096] FIG. 33B is a cross-sectional view taken along line VB-VB of
FIG. 33A;
[0097] FIG. 34 is a block diagram illustrating remote control
components of the apparatus of the invention;
[0098] FIG. 35 is a schematic view of a circuitry used for the
system of the block diagram of FIG. 34;
[0099] FIGS. 36A and 36B are schematic views of an eleventh
embodiment of the apparatus in accordance with the invention;
[0100] FIGS. 37A and 37B are schematic views of a twelfth
embodiment of the apparatus in accordance with the invention;
[0101] FIG. 38 is a schematic view of a thirteenth embodiment of
the apparatus in accordance with the invention;
[0102] FIGS. 39A, 39B and 39C are a schematic front view and
schematic sectional views, respectively, of a fourteenth embodiment
of the apparatus in accordance with the invention;
[0103] FIGS. 40A through 44B are five modifications of the
embodiment of FIGS. 39A-39C;
[0104] FIG. 45 illustrates the apparatus of the invention with a
restriction device implanted around the colon
DETAILED DESCRIPTION OF THE DRAWINGS
[0105] Referring to the drawing FIGURES, like reference numerals
designate identical or corresponding elements throughout the
several FIGURES.
[0106] FIGS. 1-3 show a preferred embodiment of the anal
incontinence treatment apparatus of the invention comprising a
restriction device having an elongated restriction member in the
form of a circular resilient core 2 with two overlapping end
portions 4,6. The core 2 defines a substantially circular
restriction opening and is enclosed in an elastic soft hose 8
except at a releasable and lockable joint 10 of the core 2, which
when released enables application of the core 2 with its hose 8
around a tissue of a patient, such as the colon or rectum or one or
more exit rectum from the patient's colon or rectum. The materials
of all of these elements are bio-compatible so that the patient'
body will not reject them. A mechanical adjustment device 12 for
mechanically adjusting the longitudinal extension of the core 2 to
change the size of the restriction opening comprises a drive wheel
14 in frictional engagement with the overlapping end portions 4,6
of the core 2. The drive wheel 14 is journalled on a holder 16
placed in the hose 8 and provided with two counter pressure rollers
18,20 pressing the respective end portions 4, 6 of the core 2
against the drive wheel 14 to increase the frictional engagement
there between. An electric motor 22 is connected to the drive wheel
14 via a long flexible drive shaft 24 and is moulded together with
a remote controlled power supply unit 26 in a body 28 of silicone
rubber. The length of the flexible drive shaft 34 is selected so
that the body 28 can be placed in a desired position in the
patient_s body, suitably in the abdomen.
[0107] When the patient doesn't want to relieve himself
(defaecation), he controls the power supply unit 26 to power the
electric motor 22 to turn the drive wheel 14 in one direction to
reduce the diameter of the core 2, so that the tissue is squeezed
and the fecal passageway is restricted. When the patient wishes to
relieve himself he controls the power supply unit 26 to power the
electric motor 22 to turn the drive wheel 14 in the opposite
direction to increase the diameter of the core 2, so that the fecal
passageway is open.
[0108] Alternatively, a rack gear may be formed on one of the end
portions 4,6 of the core 2 and the drive wheel 14 may be replaced
by a drive gear wheel connected to the other end portion of the
core 2 and in mesh with the rack gear.
[0109] FIG. 4 shows an embodiment of the invention which is
identical to the embodiment of FIGS. 1-3, except that the motor 22
is encapsulated in a lateral protrusion 30 of the hose 8 so that it
is fixed to the core 2 and has a short drive shaft 32 onto which
the drive wheel 14 is mounted, and that the motor 22 is positioned
relative to the circular core 2 such that the drive shaft 32
extends radially thereto.
[0110] FIG. 5 shows an embodiment of the invention which likewise
is identical to the embodiment of FIGS. 1-3, except that the motor
22 is encapsulated in the hose 8 so that it is fixed to the core 2
and has a short drive shaft 32, and that the motor 22 is positioned
relative to the core 2 such that the drive shaft 32 extends
substantially tangentially to the circular core 2. There is an
angular gearing 34 connecting the drive shaft 32 to the drive wheel
14.
[0111] FIG. 6 shows a suitable arrangement for the motor 22 in the
embodiment of FIG. 5, comprising a first clamping member 36 secured
to one end portion of the core 2 and a second clamping member 38
secured to the other end portion 6 of the core 2. The motor 22 is
secured to the first clamping member 36 and is operatively
connected to a worm 40 via a gear transmission 42. The worm 40 is
journalled at its opposite ends on holders 44 and 46, which are
rigidly secured to the clamping member 36 and the motor 22,
respectively. The second clamping member 38 has a pinion in mesh
with the worm 40. When the motor 22 is powered the worm 40 rotates
and will thereby pull the end portion 6 of the core 2 in one or the
opposite longitudinal direction, so that the diameter of the
substantially circular core 2 is either increased or decreased.
[0112] FIG. 7 shows an embodiment of the invention in which the
elongated restriction member comprises a core 48 and a helical
spring 50. A spring contracting means in the form of a flexible
pulling member 52, i.e. a string, wire or cable, is connected to
the core 48 at one end thereof and extends through the helical
spring 50. A hydralic motor in the form of a cylinder/piston unit
54 is adapted to pull the flexible pulling member 52 to contract
the helical spring 50 against an arresting member 56, which is
fixed relative to the core 48. A tube 58 hinged to the arresting
member 56 extends between the cylinder/piston unit 54 and the
arresting member 56, the flexible pulling member 52 running through
the tube 58 and being connected to the piston of the
cylinder/piston unit 54. FIG. 8 shows a similar embodiment in which
a hydraulic transmission conduit 59 is provided between two
piston-cylinder assemblies 54, for use as the hydraulic
motor/device in FIG. 7.
[0113] FIG. 9 shows an embodiment of the invention in which the
restriction member comprises two elongated helical springs 60 and
62 having free ends, and a body 64 to which the springs 60,62 are
nonrotatably secured at their opposite ends. The body 64 comprises
two separate parts secured to opposite end portions of the
enclosing elastic hose 8 and is designed with a releasable and
lockable joint between the separate parts. An adjustment device in
the form of a drive shaft 66 has two opposite end portions
connected to the helical springs 60,62, respectively, at their free
ends. The coils of the springs 60,62 form left and right hand
helices, respectively. A motor 68 is adapted to rotate the drive
shaft 66 in one direction to enlarge the coils of the helical
springs 60,62 to longitudinally contract the springs 60,62 and to
rotate the drive shaft 66 in the opposite direction to reduce the
size of the coils of the springs 60,62 to longitudinally extend the
springs 60,62. Thus, the elongated helical springs 60,62 defines a
restriction opening, the size of which is increased when the
springs 60,62 are extended and decreased when the springs 60,62 are
contracted.
[0114] FIG. 10 shows an embodiment according to the invention which
is identical to the embodiment of FIG. 9, except that the
adjustment decice comprises a gearing having an input shaft 72 and
two opposite aligned output shafts 74 and 76 connected to the
helical springs 60 and 62, respectively, at their free ends. The
input shaft 72 is connected to the output shafts 74,76 such that
they rotate at opposite directions upon rotation of the input shaft
72. The coils of the springs 60, 62 form the same helices.
[0115] FIGS. 11-14 show an embodiment of the device of the
invention in which a hydraulic motor comprises two interconnected
cylinders 78 and 80 and two pistons 82 and 84 in the respective
cylinders 78,80. The cylinders 78,80 have a common fluid supply
inlet member 86, which together with the cylinders 78,80 takes the
shape of a Y-pipe. The restriction member comprises an elongated
resilient arcuate core 88. The adjustment device comprises two bars
90 and 92 secured to opposite ends of the core 88 and connected to
the pistons 82 and 84, respectively. The core 88 defines a
restriction opening and is provided with a releasable and lockable
joint 94 (FIG. 13) to permit application of the core 88 around the
tissue. The core 88 and the cylinders 90,92 are enclosed by a soft
elastic hose 96 except at the joint 94 and the inlet member 86. The
hose 96 has an outer tubular wall 98 and a central coaxial inner
tubular wail 100, which is fixed to the outer wall 98 by spoke
members 102 (FIG. 14). The core 88 is loosely fit in the inner
tubular wall 100. By supplying fluid to or withdrawing fluid from
the inlet 86 the pistons 82 and 84 will move towards or from each
other, so that the restriction opening defined by the core 88 is
changed by the longitudinal displacement of the bars 90,92.
[0116] FIGS. 15-17 show an embodiment of the invention which is
identical to the embodiment of FIGS. 11-14, except that the
adjustment device comprises an elongated voltage responsive element
104 secured to the opposite ends of the core 88, so that the core
88 and the element 104 form the restriction member. The element 104
is capable of bending inwardly into a bow in response to a voltage
applied across the element 104. The radius of curvature of said bow
is adjustable by changing the level of the voltage applied to
element 104.
[0117] FIG. 18 shows an embodiment of the invention comprising a
loop forming means in the form of a substantially rigid outer
circular element 106 with a releasable and lockable joint 108. In
this embodiment the restriction member comprises an elastic inner
circular element 110 formed by the innermost wall portion of an
elastic hose 112 extending along the outer element 106. The inner
circular element 110 is disposed concentrically within the outer
circular element 106. The adjustment device comprises a plurality
of threads 114 secured to the elastic inner element 110 along the
circumference thereof and running from the inner element 110 via
guide members 116 attached to the outer element 106. By pulling all
the threads 114 the inner elastic element 110 is pulled under
expansion radially outwardly towards the outer element 106.
[0118] FIG. 19 shows an embodiment which is identical to the
embodiment of FIG. 9, except that it comprises a loop forming means
in the form of a substantially rigid outer circular element 118
supporting the helical springs 60,62, and a soft elastic inner wall
120 extending along the springs 60,62. When the motor 68 rotates
the helical springs 60, 62 in a direction that enlarges the coils
of the springs 60,62, the coils are forced by the rigid outer
element 118 to expand radially inwardly thereby reducing the size
of the restriction opening formed by the circumferential
confinement surface of the restriction member (springs 60,62 and
body 64).
[0119] FIG. 20 shows an embodiment of the invention in which a
restriction member comprises a plurality of arcuate lamellae 122
arranged like the conventional adjustable aperture mechanism of a
camera. The adjustment device, not shown, is conventional and is
operated by a motor 124 to adjust the lamellae 122 to change the
size of an restriction opening defined by the lamellae 122.
[0120] FIGS. 21-23 show an embodiment of the invention in which a
restriction member comprises two semi-circular elements 126 and 128
which are hinged together such that the semi-circular elements
126,128 are swingable relative to each other between a fully open
state in which they substantially form a circle, illustrated in
FIG. 22 and an angular state, in which the size of the restriction
opening defined by the semi-circular elements 126,128 is reduced,
illustrated in FIGURE, 23. The adjustment device, not shown, is
conventional and is operated by a motor 130 to swing the
semi-circular elements 126,128 relative to each other.
[0121] FIGS. 24-27 show an embodiment of the invention in which a
restriction member comprises an elastic belt 130 forming a circle
and having a substantially oval cross-section. The restriction
member 130 is provided with a releasable and lockable joint 132. An
elastic double walled hose 134 encloses the belt 130 except at the
joint 132. The adjustment device, not shown, is conventional and is
operated by a motor 136 to turn the belt 130 around the
longitudinal extension thereof between a fully open state, in which
the inner broader side of the belt 130 forms a substantially
cylindrical surface, illustrated in FIG. 26, and a reduced open
state, in which the inner broader side of the belt 130 forms a
substantially conical surface, illustrated in FIG. 27.
[0122] FIG. 28 schematically illustrates a cushion arrangement for
protecting the tissue, comprising a plurality of cushions 138
disposed in series along a substantially circular holding member
140. This cushion arrangement may be utilized in any of the above
described embodiments of the invention.
[0123] FIGS. 29A-D provide a block diagram of four different
hydraulic transmission conFIGUREurations. FIG. 29A shows an
adjustment device 202, a separate reservoir 204, a one way pump 206
and an alternate valve 208. FIG. 29B shows the adjustment device
202 and an adjustable reservoir 210. FIG. 29C shows the adjustment
device 202, a two way pump 212 and the reservoir 204. FIG. 30D
shows a servo system with a first closed system controlling a
second system. The servo system comprises the adjustable reservoir
210 and a passive adjustable reservoir 214. Any of the reservoirs
can be the active reservoir, either the servo reservoir 210 or the
fluid supply reservoir 214. The reservoir 214 controls a larger
adjustable reservoir 216 which is used for the operation of the
adjustment device 202 for changing the restriction opening of the
restriction member.
[0124] FIGS. 30A-D are cross-sectional views of a pump mechanism
adapted to pump fluid in both directions only by mechanically
pushing a separate sealing wall portion 218 in one direction. FIG.
30A shows a piston 220 pushed forwards against a spring 222 towards
the wall portion 218 and located in a pump housing 224 conducting
fluid from a right upper fluid passage 226 of the housing 224 to a
left fluid passage 228 of the housing 224. A main valve 230 is open
and a nonreturn valve 232 is closed. FIG. 30B illustrates the first
pump movement in which the piston 220 has moved forwards and
reaches the wall portion 218. FIG. 30C illustrates how the piston
220 moves backwards by the action of the spring 222. The main valve
230 is now closed and the nonreturn valve 232 is open for fluid
from the right upper passage 226. FIG. 30D illustrates how the
piston 220 is moved further downwards from its position according
to FIG. 30B while pushing the wall portion 218 downwards against a
second spring 234 that is stronger than spring 222, so that fluid
escapes from a right lower fluid passage 236. When moving the
piston 220 backwards from the position of FIG. 30D, fluid enters
the left fluid passage 228 and a valve 238 in the lower right fluid
passage 236 closes.
[0125] FIG. 31 is a cross-sectional view of a reservoir 240
defining a chamber 242, the size of which is variable and is
controlled by a remote controlled motor 244, in accordance with
FIG. 29B or 29D. The reservoir 240 and the motor 244 are placed in
a housing 246. The chamber 242 is varied by moving a large wall
248. The wall 248 is secured to a nut 250, which is threaded on a
rotatable spindle 252. The spindle 252 is rotated by the motor 244
via an angular gearing, which comprises two conical gear wheels 254
and 256 in mesh with each other. The motor 244 is powered by a
battery 258 placed in the housing 246. A signal receiver 260 for
controlling the motor 244 is also placed in the housing 246.
Alternatively, the battery 258 and the signal receiver 260 may be
mounted in a separate place. The signal receiver may comprise any
known or conventional device which is capable of receiving a
control signal and then operating the motor 244.
[0126] FIG. 32 is a cross-sectional view of a reservoir 262
defining a chamber 264, the size of which is variable and is
controlled by manual manipulation. A gable wall portion 266 of an
open ended inner cylindrical housing 68 is adapted to be pushed
downwards to fit in a desired locking groove 270 of a plurality of
locking grooves 270 on the mantle wall of the cylindrical housing
268, to reduce the size of the chamber 64. The inner cylindrical
housing 268 is suspended by springs 272 and is telescopically
applied on an outer cylindrical housing 274. When pushing the inner
cylindrical housing 268 it moves downwards relative to the outer
cylindrical housing 274 causing the gable wall portion 266 to
release from the locking groove 270 and move upwards relative to
the inner cylindrical housing 268. When the inner housing 268 is
moved upwardly by the action of the springs 272 the size of the
chamber 264 is increased.
[0127] FIGS. 33A and 33B show a servo means comprising a main
ring-shaped fluid reservoir 276 defining a chamber 278, the size of
which is variable. Centrally positioned in the main ring-shaped
reservoir 276 there is a servo fluid reservoir 280 defining a
chamber 282, the size of which is variable. The chamber 282 of the
servo reservoir 280 is significantly smaller than the chamber 278
of the main reservoir 276. The two reservoirs 276 and 280 are
situated between two opposite separate walls 284 and 286, and are
secured thereto. When changing the amount of fluid in the servo
reservoir 280, the two opposite walls 284,286 are moved towards or
away from each other, whereby the size of the chamber 278 of the
main reservoir 276 is changed.
[0128] FIG. 34 shows the basic parts of a remote control system of
the apparatus of the invention including a motor, for instance the
electric motor 22. In this case, the remote control system is based
on the transmission of an electromagnetic wave signal, often of a
high frequency in the order of 100 kHz-1 gHz, through the skin 330
of the patient. In FIG. 34, all parts placed to the left of the
skin 330 are located outside the patient_s body and all parts
placed to the right of the skin 330 are implanted in the patient_s
body.
[0129] An external signal transmitting antenna 332 is to be
positioned close to a signal receiving antenna 334 implanted in the
patient_s body close to the skin 330. As an alternative, the
receiving antenna 334 may be placed for example inside the abdomen
of the patient. The receiving antenna 334 comprises a coil,
approximately 1-100 mm, preferably 25 mm in diameter, wound with a
very thin wire and tuned with a capacitor to a specific high
frequency. A small coil is chosen if it is to be implanted under
the skin of the patient and a large coil is chosen if it is to be
implanted in the abdomen of the patient. The transmitting antenna
332 comprises a coil having about the same size as the coil of the
receiving antenna 334 but wound with a thick wire that can handle
the larger currents that is necessary. The coil of the transmitting
antenna 332 is tuned to the same specific high frequency as the
coil of the receiving antenna 334.
[0130] An external control unit 336 comprises a microprocessor, a
high frequency electromagnetic signal generator and a power
amplifier. The microprocessor of the control unit 336 is adapted to
switch on/off the generator and to modulate signals generated by
the generator to send digital information via the power amplifier
and the antennas 332,334 to an implanted control unit 338. To avoid
that accidental random high frequency fields trigger control
commands, digital signal codes are used. A keypad placed on the
external control unit 336 is connected to the microprocessor
thereof. The keypad is used to order the microprocessor to send a
digital signal to either increase or decrease the size of the
restriction opening defined by the loop of the restriction member
(e.g. as described above). The microprocessor starts a command by
applying a high frequency signal on the antenna 332. After a short
time, when the signal has energized the implanted parts of the
control system, commands are sent to increase or decrease the size
of the restriction opening of the restriction member in predefined
steps. The commands are sent as digital packets in the form
illustrated below.
1 Start pattern, Command, Count, Checksum, 8 bits 8 bits 8 bits 8
bits
[0131] The commands are sent continuously during a rather long time
period (e.g. 30 seconds or more). When a new increase or decrease
step is desired the Count byte is increased by one to allow the
implanted control unit 338 to decode and understand that another
step is demanded by the external control unit 336. If any part of
the digital packet is erroneous, its content is simply ignored.
[0132] Through a line 340, an implanted energizer unit 326 draws
energy from the high frequency electromagnetic wave signal received
by the receiving antenna 334. The energizer unit 326 stores the
energy in a power supply, such as a large capacitor, powers the
control unit 338 and powers the electric motor 22 via a line
342.
[0133] The control unit 338 comprises a demodulator and a
microprocessor. The demodulator demodulates digital signals sent
from the external control unit 336. The microprocessor of the
control unit 338 receives the digital packet, decodes it and,
provided that the power supply of the energizer unit 326 has
sufficient energy stored, sends a signal via a signal line 344 to
the motor 22 to either increase or decrease the size of the
restriction opening of the restriction member depending on the
received command code.
[0134] Alternatively, the energy stored in the power supply of the
energizer unit may only be used for powering a switch, and the
energy for powering the motor 22 may be obtained from another
implanted power source of relatively high capacity, for example a
battery. In this case the switch is adapted to connect the battery
to the control unit 338 in an_on_mode when said switch is powered
by said power supply and to keep said battery disconnected from the
control unit in a_standby_mode when the switch is unpowered.
[0135] With reference to FIG. 35, the remote control system
schematically described above will now be described in accordance
with a more detailed embodiment. The external control unit 336
comprises a microprocessor 346, a signal generator 348 and a power
amplifier 350 connected thereto. The microprocessor 346 is adapted
to switch the signal generator 348 on/off and to modulate signals
generated by the signal generator 348 with digital commands that
are sent to implanted components of the device of the invention.
The power amplifier 350 amplifies the signals and sends them to the
external signal transmitting antenna 332. The antenna 332 is
connected in parallel with a capacitor 352 to form a resonant
circuit tuned to the frequency generated by the signal generator
348.
[0136] The implanted signal receiving antenna coil 334 forms
together with a capacitor 354 a resonant circuit that is tuned to
the same frequency as the transmitting antenna 332. The signal
receiving antenna coil 334 induces a current from the received high
frequency electromagnetic waves and a rectifying diode 360
rectifies the induced current, which charges a storage capacitor
358. A coil 356 connected between the antenna coil 334 and the
diode 360 prevents the capacitor 358 and the diode 360 from loading
the circuit of the signal receiving antenna 334 at higher
frequencies. Thus, the coil 356 makes it possible to charge the
capacitor 358 and to transmit digital information using amplitude
modulation.
[0137] A capacitor 362 and a resistor 364 connected in parallel and
a diode 366 forms a detector used to detect amplitude modulated
digital information. A filter circuit is formed by a resistor 368
connected in series with a resistor 370 connected in series with a
capacitor 372 connected in series with the resistor 368 via ground,
and a capacitor 374, one terminal of which is connected between the
resistors 368,370 and the other terminal of which is connected
between the diode 366 and the circuit formed by the capacitor 362
and resistor 364. The filter circuit is used to filter out
undesired low and high frequencies. The detected and filtered
signals are fed to an implanted microprocessor 376 that decodes the
digital information and controls the motor 22 via an H-bridge 378
comprising transistors 380,382,384 and 386. The motor 22 can be
driven in two opposite directions by the H-bridge 378.
[0138] The microprocessor 376 also monitors the amount of stored
energy in the storage capacitor 358. Before sending signals to
activate the motor 22, the microprocessor 376 checks whether the
energy stored in the storage capacitor 358 is enough. If the stored
energy is not enough to perform the requested operation, the
microprocessor 376 waits for the received signals to charge the
storage capacitor 358 before activating the motor 22.
[0139] FIGS. 36A and 36B show an embodiment of the apparatus of the
invention comprising a restriction device 402 having an elongated
flexible restriction member 404, such as a belt, a cord or the
like. The flexible member 404 extends in a loop around the tissue,
suitably the rectum or colon or its prolongation. (Alternatively,
the flexible member 404 may comprise two separate parts on opposite
sides of the colon or rectum or the prolongation thereof) One
portion 404A of member 404 is attached to a frame 408 and another
portion 404B of member 404 opposite portion 404A in the loop of the
flexible member 404 is connected to an adjustment device 410, which
is fixed to the frame 408. The adjustment device 410 pulls the
flexible member 404 in the direction from portion 404A to squeeze
the colon or rectum or the prolongation thereof between two
opposite lengths of the flexible member 404 to thereby restrict the
fecal passageway in the colon or rectum or the prolongation thereof
406, see FIG. 36A, and releases the colon or rectum or the
prolongation thereof from the flexible member 404 to thereby
increase the fecal passageway to allow defaecation 406, see FIG.
36B.
[0140] FIGS. 37A and 37B show an embodiment of the apparatus of the
invention comprising a restriction device 412 having two plate or
bar elements 414 on opposite sides of the rectum 406. An adjustment
device 416 moves the elements 412 in parallel towards each other to
squeeze the rectum 406 between the elements 412 to thereby restrict
the blood flow in the rectum 406, see FIG. 37A, and moves the
elements 412-away from each other to release the rectum 406, see
FIG. 37B.
[0141] FIG. 38 shows an embodiment of the apparatus of the
invention comprising a restriction device 418 having two rigid
articulated clamping elements 420 positioned on opposite sides of
the rectum 406. An adjustment device 422 turns the clamping
elements 420 toward each other to clamp the rectum 406 between the
clamping elements 420 to thereby restrict the fecal passageway in
the rectum 406, and turns the clamping elements 420 away from each
other to release the rectum 406 from the clamping elements 420 to
thereby increase the restriction of the fecal passageway to allow
defaecation.
[0142] FIGS. 39A, 39B and 39C show an embodiment of the apparatus
of the invention comprising a restriction device 424 having three
bending members in the form of cylindrical rollers 426, 428 and 430
displaced relative one another in a row along the rectum 406 and
positioned alternately on opposite sides of the rectum 406.
(Alternatively, each roller 426, 428 and 430 may take the shape of
an hour-glass.) An adjustment device 432 moves the two outer
rollers 426,430 laterally against the rectum 406 in one direction
and the intermediate roller 428 against the rectum 406 in the
opposite direction to bend the rectum to thereby restrict the fecal
passageway in the rectum 406, see FIG. 39B. To increase the fecal
passageway to allow defaecation 406, the adjustment device 432
moves the rollers 426-430 away from the rectum 406 to release the
latter from the rollers 426-430, see FIG. 39C.
[0143] FIGS. 40A through 44B schematically illustrates
modifications of the above embodiment according to FIGS. 39A-39C.
Thus, FIGS. 40A and 40B show an embodiment similar to that of FIGS.
39A-39C except that the bending members are oval and not rotatable.
FIGS. 41A and 41B show an embodiment similar to that of FIGS. 40A
and 40B except that the oval bending members are rotatable to
release the rectum, see FIG. 41A, and squeeze the rectum, see FIG.
41B. FIGS. 42A and 42B show an embodiment similar to that of FIGS.
39A-39C except that the intermediate roller has a changeable
diameter to release the rectum, see FIG. 42A, and squeeze the
rectum, see FIG. 42B. FIGS. 43A and 43B show an embodiment similar
to that of FIGS. 37A-37C except that the rigid elements are
replaced by two cylindrical rollers positioned on opposite sides of
the rectum. Finally, FIGS. 44A and 44B show an embodiment
substantially similar to that of FIGS. 43A and 43B except that the
restriction device is curved to form an S-shaped curvature of the
rectum.
[0144] FIG. 45 schematically illustrates how any of the
above-described embodiments of the anal incontinence treatment
apparatus of the invention may be implanted in a patient. Thus, the
apparatus comprises an adjustable restriction device 434 extending
around the the rectum 435 of the patient and a motor operated
adjustment device 436 for mechanically adjusting the restriction
device 434 to squeeze rectum to thereby restrict the fecal
passageway in the rectum. The motor, not shown, is integrated in
the adjustment device 436 and is reversible to operate the
adjustment device 436 to release the rectum from the restriction
device 434 to allow defaecation. A wireless remote control of the
apparatus comprises an external signal transmitter 438 incorporated
in a portable remote-control unit and an implanted signal receiver
440, which comprises a control unit for controlling the adjustment
device 436 in response to a control signal, for example an
electromagnetic wave signal, from the transmitter 438. The signal
receiver 440 further comprises an energizer unit which transfers
energy from the control signal transmitted by the transmitter 438
into electric energy for energy consuming implanted components of
the apparatus, such as the motor for operating the adjustment
device 436. The electric energy is conducted via an implanted
conductor 442 from the signal receiver 440 to the motor. When the
patient needs to relieve himself (defaecation), he readily uses the
portable remote control unit to activate the implanted adjustment
device 436 to temporarily adjust the implanted restriction device
434 to start release the fecal passageway to allow defaecation.
[0145] A pressure sensor 439 is implanted for sensing the pressure
on the restriction device 434. The control unit of the signal
receiver 449 controls the adjustment device 436 to release the
restriction device 434 in response to the pressure sensor 439
sensing an abnormal high pressure.
[0146] In the practice of the present invention the details of the
elongated restriction device (such as a gastric band) and the
adjustment/operation device (which may have electric, hydraulic, or
mechanical, etc. actuation), may be as described in copending
application Ser. No. 09/133,319, filed Aug. 13, 1998 (Atty Ref:
2333-12), Ser. No. 09/133,320, filed Aug. 13, 1998 (Atty Ref:
2333-11) and Ser. No. 09/133,322, filed Aug. 13, 1998 (Atty Ref:
2333-13), the disclosures of which are incorporated by reference
herein.
[0147] There are a number of other conceivable alternative
embodiments of the invention that give the same result as the
above-described embodiments. For example, the microprocessor of the
external and implanted, respectively, control unit may be replaced
by discrete components. The power amplifier of the external control
unit may be omitted if the signals generated by the signal
generator are strong enough. Therefore the invention is to be
accorded the broadest interpretation of the appended claims to
encompass all equivalent structures and assemblies.
* * * * *