Non-injection port food intake restriction device

• US 6,460,543 B1
• Filed: 08/13/1998
• Issued: 10/08/2002
• Est. Priority Date: 08/13/1998
• Status: Expired due to Term

• Current Assignee: Obtech Medical AG (Johnson & Johnson)
• Original Assignee: Obtech Medical AG (Johnson & Johnson)
• Inventors: Forsell, Peter
• Primary Examiner(s): Lacyk, John P.
• Application Number:
  US09/133,322
• Time in Patent Office: 1,517 Days
• Field of Search: 128/897-98, 600/593, 600/31, 606/151, 606/157, 606/191, 606/192, 606/195, 606/213, 606/228, 604/28, 604/51, 604/97, 604/99
• US Class Current: 128/898
• CPC Class Codes: A61F 5/0003 Apparatus for the treatment of obesity; Anti-eating devices surgical instruments or methods for treatment of obesity, devices specially adapted therefor A61B17/00; hollow or tubular parts of organs A61F2/04
• CPC Class Codes: A61F 5/0053 remotely adjustable

Abstract

A food intake restriction device for forming a stoma opening in the stomach or esophagus of a patient, comprises an elongated restriction member forming an expandable and contractible cavity formed into an at least substantially closed loop defining a restriction opening, the size of which is reduced upon expansion of the cavity and increased upon contraction of said cavity. A reservoir containing a predetermined amount of hydraulic fluid and connected to the cavity of the restriction member, and a hydraulic operation device for distributing fluid from the reservoir to the cavity to expand the cavity and for distributing fluid from the cavity to the reservoir to contract the cavity, are also implanted in a patient with morbid obesity and operated from outside the patient'"'"'s body in a non-invasive manner. A non-inflatable restriction member may alternatively be use, and hydraulically adjusted.

Claims

1. A food intake restriction device for forming a stoma opening in the stomach or esophagus of a patient, comprising:

an elongated restriction member implanted in the patient forming an expandable and contractible cavity, said elongated restriction member formed into an at least substantially closed loop surrounding the patient'"'"'s stomach or esophagus, and defining a restriction opening, the size of which is reduced upon expansion of said cavity and increased upon contraction of said cavity;

a reservoir implanted in the patient containing a predetermined amount of hydraulic fluid and connected to said cavity of said restriction member,

hydraulic operation means implanted in the patient for distributing fluid from said reservoir to said cavity to expand said cavity, and for distributing fluid from said cavity to said reservoir to contract said cavity, to thereby control the size of the restriction opening, and

wherein said hydraulic operation means comprises an activatable pump for pumping fluid between said reservoir and said cavity of said restriction member; and

wherein said pump comprises a first activation member for activating said pump to pump fluid from said reservoir to said cavity of said restriction member and a second activation member for activating said pump to pump fluid from said cavity to said reservoir; and

wherein at least one of said first and second activating members are operable by magnetic means, or by hydraulic means, or by electric control means such as an electric motor.

2. The device according to claim 1, wherein said reservoir defines a chamber for said predetermined amount of fluid and said hydraulic operation means changes the size of said chamber.

3. The device according to claim 2, wherein said hydraulic operation means comprises first and second wall portions of said reservoir, which are displaceable relative to each other to change the size of said chamber of said reservoir.

4. A device according to claim 3, wherein said hydraulic operation means comprise 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 to change the volume of said chamber of said reservoir.

5. A device according to claim 4, wherein said servo means comprises magnetic means, or electric means.

6. A device according to claim 3, wherein said servo means comprises hydraulic means.

7. A device according to claim 6, wherein said servo means comprises a servo reservoir defining a chamber containing servo fluid, and said hydraulic operation means comprise first and second wall portions of said servo reservoir, which are displaceable relative to each other to change the volume of said chamber of said servo reservoir.

8. A device according to claim 7, wherein said first and second wall portions of said servo reservoir are displaceable relative to each other by manual manipulation thereof, by magnetic means, by hydraulic means, or by electric control means.

9. A device according to claim 6, wherein said servo means comprises a servo reservoir and a fluid supply reservoir connected in a closed system and containing a further predetermined amount of fluid.

10. A device according to claim 9, wherein said fluid supply reservoir defines a chamber for said further predetermined amount of fluid and said hydraulic operation means are adapted to change the volume of said chamber and thereby control the amount of fluid in said servo reservoir.

11. A device according to claim 10, wherein said fluid supply reservoir comprises first and second wall portions, which are displaceable relative to each other to change the volume of said chamber of said fluid supply reservoir.

12. A device according to claim 11, wherein said fluid supply reservoir operates to servo reservoir with fluid from said fluid supply reservoir in response to a predetermined first displacement of said first wall portion of said fluid supply reservoir relative to said second wall portion of said fluid supply reservoir to increase the amount of fluid in said servo reservoir and operates said servo reservoir with fluid from said fluid supply reservoir in response to a predetermined second displacement of said first wall portion of said fluid supply reservoir relative to said second wall portion of said fluid supply reservoir to decrease the amount of fluid in said servo reservoir.

13. A device according to claim 2, further comprising a wireless remote control means for controlling said hydraulic operation means and for wireless transmission of energy from outside the patient'"'"'s body to energy consuming implanted components of the food intake restriction device.

14. A device according to claim 13, wherein said wireless remote control means transmits signals, and further comprising an implanted energizer unit that draws energy from said signals.

15. A device according to claim 14, wherein said wireless remote control means transmits digital signals.

16. A device according to claim 14, wherein said wireless remote control means transmits said signals in the form of electromagnetic wave signals, and said energizer unit draws radiant energy from said electromagnetic wave signals as they are transmitted and transfers said radiant energy into electric energy.

17. A device according to claim 16, wherein said energizer unit comprises a coil for inducing an alternating current as electromagnetic wave signals are transmitted through said coil, and a rectifier for rectifying said alternating current.

18. A device according to claim 17, wherein said energizer unit comprises a capacitor adapted to tune said coil to a specific high frequency.

19. A device according to claim 13, further comprising a motor implanted in the patient for operating said hydraulic operation means.

20. A device according to claim 19, wherein said wireless remote control means transmits signals, and further comprising an implanted energizer unit that draws energy from said signals for the power of said motor.

21. A device according to claim 20, further comprising an implanted control unit for controlling said energizer unit to power said motor with energy in response to said signals transmitted by said wireless remote control means.

22. A device according to claim 20, wherein said wireless remote control means transmits said signals in the form of electromagnetic wave signals, said motor is an electric motor and said energizer unit draws radiant energy from said electromagnetic wave signals as they are transmitted and transfer said radiant energy into electric energy for powering said electric motor.

23. A device according to claim 22, wherein said energizer unit comprises a coil for inducing an alternating current as electromagnetic wave signals are transmitted through said coil, and a rectifier for rectifying said alternating current.

24. A device according to claim 23, wherein said energizer unit comprises a capacitor adapted to tune said coil to a specific high frequency.

25. A device according to claim 22, wherein said energizer unit comprises a rechargeable electric power supply for storing said electric energy and said control unit controls said rechargeable electric power supply to power said electric motor with energy in response to said signals.

26. A device according to claim 25, wherein said electric power supply comprises a capacitor.

27. A device according to claim 22, wherein said electric motor is a stepping motor.

28. A device according to claim 16, wherein said energizer unit comprises a battery, an electrically operable switch that connects said battery to said energy consuming implanted components in an “

on”

mode when said switch is powered and keeps said battery disconnected from said components in a “

standby”

mode when said switch is unpowered, and an electric power supply rechargeable with said electric energy for powering said switch.

29. A device according to claim 28, further comprising an electric motor implanted in the patient for operating said hydraulic operation means, wherein said switch connects said battery to said electric motor in said “

on”

mode when said switch is powered with electric energy from said electric power supply and keeps said battery disconnected from said electric motor in said “

standby”

mode when said switch is unpowered.

30. A device according to claim 29, further comprising an implanted control unit for controlling said energizer unit to power said electric motor with energy from said battery in response to said signals, when said switch is in its “

on”

mode.

31. A device according to claim 30, wherein said wireless remote control means transmits said signals in the form of electromagnetic wave signals, and said energizer unit draws radiant energy from said electromagnetic wave signals as they are transmitted and transfers said radiant energy into electric energy for charging said rechargeable electric power supply.

32. A device according to claim 31, wherein said energizer unit comprises a coil for introducing an alternating current as electromagnetic wave signals are transmitted through said coil, and a rectifier for rectifying said alternating current.

33. A device according to claim 32, wherein said energizer unit comprises a capacitor adapted to tune said coil to a specific high frequency.

34. A device according to claim 31, wherein said electric power supply comprises a capacitor.

35. A device according to claim 29, wherein said electric motor is a stepping motor.

36. A device according to claim 30, wherein said hydraulic operation means comprises a pump.

37. A device according to claim 36, wherein said. pump pumps in only one direction, and further comprising an adjustable valve that changes the direction of hydraulic fluid to either increase or decrease the amount of fluid in the reservoir.

38. A device according to claim 37, wherein said valve is manipulated either manually, mechanically, electrically, magnetically, or hydraulically.

47. A device according to claim 37, further comprising a motor implanted in the patient for operating said hydraulic operation means.

39. A food intake restriction device for forming a stoma opening in the stomach or esophagus of a patient, comprising:

an elongated restriction member implanted in the patient forming an expandable and contractible cavity, said elongated restriction member formed into an at least substantially closed loop surrounding the patient'"'"'s stomach or esophagus, and defining a restriction opening, the size of which is reduced upon expansion of said cavity and increased upon contraction of said cavity,

a reservoir implanted in the patient defining a chamber for a predetermined amount of hydraulic fluid and connected to said cavity of said restriction member, and

hydraulic operation means implanted in the patient for distributing fluid from said reservoir to said cavity to expand said cavity, and for distributing fluid from said cavity to said reservoir to contract said cavity, to thereby control the size of said restriction opening,

wherein said reservoir defines a chamber for said predetermined amount of fluid and said hydraulic operation means changes the size of said chamber, and

wherein said hydraulic operation means comprises first and second wall portions of said reservoir, which are displaceable relative to each other to change the volume of said chamber of said reservoir.

40. A device according to claim 39, wherein said first and second wall portions of said reservoir are displaceable relative to each other by manual manipulation thereof.

41. A device according to claim 40, wherein said first and second wall portions of said reservoir are displaceable relative to each other by manually pushing, pulling or rotating any of said wall portions in one direction.

42. A device according to claim 39, wherein said first and second wall portions of said reservoir are displaceable relative to each other by magnetic means, by hydraulic means, or by electric control means, such as an electric motor.

43. A device according to claim 39, wherein said hydraulic operation means distributes fluid from said reservoir to said cavity of said restriction member in response to a predetermined first displacement of said first wall portion of said reservoir relative to said second wail portion of said reservoir and distributes fluid from said cavity to said reservoir in response to a predetermined second displacement of said first wall portion relative to said second wall portion.

44. A device according to claim 39, further comprising a wireless remote control means for controlling said hydraulic operation device.

45. A device according to claim 44, wherein said wireless remote control means transmits digital signals for controlling said hydraulic operation device.

46. A device according to claim 44, wherein said wireless remote control means transmits energy wireless from outside the patient'"'"'s body to energy consuming implanted components of the food intake restriction device.

48. A food intake restriction device for forming a stoma opening in the stomach or esophagus of a patient, comprising:

an elongated restriction member implanted in the patient forming an expandable and contractible cavity, said elongated restriction member formed into an at least substantially closed loop surrounding the patient'"'"'s stomach or esophagus, and defining a restriction opening, the size of which is reduced upon expansion of said cavity and increased upon contraction of said cavity,

a reservoir implanted in the patient containing a predetermined amount of hydraulic fluid and connected to said cavity of said restriction member, and

hydraulic operation means implanted in the patient for distributing fluid from said reservoir to said cavity to expand said cavity, and for distributing fluid from said cavity to said reservoir to contract said cavity, to thereby control the size of said restriction opening, said hydraulic operation means comprising an activatable pump for pumping fluid between said reservoir and said cavity of said restriction member,

wherein said pump comprises a first activation member for activating said pump to pump fluid from said reservoir to said cavity of said restriction member and a second activation member for activating said pump to pump fluid from said cavity to said reservoir.

49. A device according to claim 48, wherein said first and second activation members are operable by manual manipulation thereof.

50. A device according to claim 49, wherein said first and second activation members are operable by manually pushing, pulling or rotating thereof in one direction.

51. A device according to claim 48, wherein at least one of said activation members operates when subjected to an external pressure exceeding a predetermined magnitude.

52. A device according to claim 48, wherein at least one of said first and second activating members are operable by magnetic means, or by hydraulic means, or by electric controls means such as an electric motor.

53. A device according to claim 48, further comprising a wireless remote control means for controlling said hydraulic operation device.

54. A device according to claim 53, wherein said wireless remote control means transmits digital signals for controlling said hydraulic operation device.

55. A device according to claim 53, wherein said wireless remote control means transmits energy wireless from outside the patient'"'"'s body to energy consuming implanted components of the food intake restriction device.

56. A device according to claim 48, further comprising a motor implanted in the patient for operating said hydraulic operation means.

57. A food intake restriction device for forming a stoma opening in the stomach or esophagus of a patient, comprising:

an elongated restriction member implanted in the patient forming an expandable and contractible cavity, said elongated restriction member formed into an at least substantially closed loop surrounding the patient'"'"'s stomach or esophagus, and defining a restriction opening, the size of which is reduced upon expansion of said cavity and increased upon contraction of said cavity,

a reservoir implanted in the patient containing a predetermined amount of hydraulic fluid and connected to said cavity of said restriction member, and

hydraulic operation means implanted in the patient for distributing fluid from said reservoir to said cavity to expand said cavity, and for distributing fluid from said cavity to said reservoir to contract said cavity, to thereby control the size of said restriction opening,

wherein said hydraulic operation means comprises a servo means.

58. A. device according to claim 57, wherein said hydraulic operation means comprises first and second wall portions of said reservoir, and said servo means provides relative displacement between said first and second wall portions of reservoir.

59. A device according to claim 57, wherein said servo means comprises magnetic means or electric means.

60. A device according to claim 57, wherein said servo means comprises hydraulic means.

61. A device according to claim 60, wherein said servo means comprises a servo reservoir defining a chamber containing servo fluid and said hydraulic operation means comprises first and second wall portions of said servo reservoir, which are displaceable relative to each other to change the volume of said chamber of said servo reservoir.

62. A device according to claim 61, wherein said first and second wall portions of said servo reservoir are displaceable relative to each other by manual manipulation thereof.

63. A device according to claim 62, wherein said first and second wall portions of said servo reservoir are displaceable relative to each other by manually pushing, pulling or rotating.

64. A device according to claim 61, wherein said first and second wall portions of said servo reservoir are displaceable relative to each other by magnetic means, by hydraulic means, or by electric control means such as an electric motor.

65. A food intake restriction device for forming a stoma opening in the stomach or esophagus of a patient, comprising:

an elongated restriction member implanted in the patient forming an expandable and contractible cavity, said elongated restriction member formed into an at least substantially closed loop surrounding the patient'"'"'s stomach or esophagus, and defining a restriction opening, the size of which is reduced upon expansion of said cavity and increased upon contraction of said cavity,

a reservoir implanted in the patient containing a predetermined amount of hydraulic fluid connected to said cavity of said restriction member,

hydraulic operation means implanted in the patient for distributing fluid from said reservoir to said cavity to expand said cavity, and for distributing fluid from said cavity to said reservoir to contract said cavity, to thereby control the size of said restriction opening, and

a wireless remote control means for controlling said hydraulic operation means and for wireless transmission of energy from outside the patient'"'"'s body to energy consuming implanted components of the food intake restriction device.

66. A device according to claim 65, wherein said wireless remote control means transmits signals, and further comprising an implanted energizer unit that draws energy from said signals.

67. A device according to claim 66, wherein said wireless remote control means transmits digital signals.

68. A device according to claim 66, wherein said wireless remote control means transmits and signals in the form of electromagnetic wave signals, and said energizer unit draws radiant energy from said electromagnetic wave signals as they are transmitted and transfers said radiant energy into electric energy.

69. A device according to claim 68, wherein said energizer unit comprises a coil for inducing an alternating current as electromagnetic wave signals are transmitted through said coil, and a rectifier for rectifying said alternating current.

70. A device according to claim 69, wherein said energizer unit comprises a capacitor adapted to tune said coil to a specific high frequency.

71. A device according to claim 65, further comprising a motor implanted in the patient for operating said hydraulic operation means.

72. A device according to claim 71, wherein said wireless remote control means transmits signals, and further comprising an implanted energizer unit that draws energy from said signals for the power of said motor.

73. A device according to claim 72, further comprising an implanted control unit for controlling said energizer unit to power said motor with energy in response to said signals transmitted by said wireless remote control means.

74. A device according to claim 72, wherein said wireless remote control means transmits said signals in the form of electromagnetic wave signals, said motor is an electric motor and said energizer unit draws radiant energy from said electromagnetic wave signals as they are transmitted and transfers said radiant energy into electric energy for powering said electric motor.

75. A device according to claim 74, wherein said energizer unit comprises a coil for inducing an alternating current as electromagnetic wave signals are transmitted through said coil, and a rectifier for rectifying said alternating current.

76. A device according to claim 75, wherein said energizer unit comprises a capacitor adapted to tune said coil to a specific high frequency.

77. A device according to claim 74, wherein said energizer unit comprises a rechargeable electric power supply for storing said electric energy and said control unit controls said rechargeable electric power supply to power said electric motor with energy in response to said signals.

78. A device according to claim 77, wherein said electric power supply comprises a capacitor.

79. A device according to claim 74, wherein said electric motor is a stepping motor.

80. A device according to claim 66, wherein said energizer unit comprises a battery, an electrically operable switch that connects said battery to said energy consuming implanted components in an “

on”

mode when said switch is powered and keeps said battery disconnected from said components in a “

standby”

mode when said switch it unpowered, and an electric power supply rechargeable with said electric energy for powering said switch.

81. A device according to claim 80, further comprising an electric motor implanted in the patient for operating said hydraulic operation means, wherein said switch connects said battery to said electric motor in said “

on”

mode when said switch is powered with electric energy from said electric power supply and keeps said battery disconnected from said electric motor in said “

standby”

mode when said switch is unpowered.

82. A device according to claim 81, further comprising an implanted control unit for controlling said energizer unit to power said electric motor with energy from said battery in response to said signals, when said switch is in its “

on”

mode.

83. A device according to claim 82, wherein said wireless remote control means transmits said signals in the form of electromagnetic wave signals, and said energizer unit draws radiant energy from said electromagnetic wave signals as they are transmitted and transfers said radiant energy into electric energy for charging said rechargeable electric power supply.

84. A device according to claim 83, wherein said energizer unit comprises a coil for inducing an alternating current as electromagnetic wave signals are transmitted. through said coil, and a rectifier for rectifying said alternating current.

85. A device according to claim 84, wherein said. energizer unit comprises a capacitor adapted to tune said coil to a specific high frequency.

86. A device according to claim 83, wherein said electric power supply comprises a capacitor.

87. A device according to claim 81, wherein said electric motor is a stepping motor.

88. A device according to claim 65, wherein said hydraulic operation means comprises a pump.

89. A device according to claim 88, wherein said pump pumps in only one direction, and further comprising an adjustable valve that changes the direction of hydraulic fluid to either increase or decrease the amount of fluid in the reservoir.

90. A device according to claim 89, wherein said valve is manipulated either manually, mechanically, electrically, magnetically, or hydraulically.

91. A food intake restriction device for forming a stoma opening in the stomach or esophagus of a patient, comprising:

an elongated restriction member implanted in the patient forming an expandable and contractible cavity, said elongated restriction member formed into an at least substantially closed loop surrounding the patient'"'"'s stomach or esophagus, and defining a restriction opening, the size of which is reduced upon expansion of said cavity and increased upon contraction of said cavity,

a reservoir implanted in the patient containing a predetermined amount of hydraulic fluid and connected to said cavity of said restriction member,

hydraulic operation means implanted in the patient for distributing fluid from said reservoir to said cavity to expand said cavity, and for distributing fluid from said cavity to said reservoir to contract said cavity, to thereby control the size of restriction opening,

a battery implanted in the patient for powering implanted electric components of the food intake restriction device,

a switch implanted in the patient for switching the electric connection between said battery and said electric components, and

a wireless control means for wireless transmission of energy from outside the patient'"'"'s body to energy consuming implanted components of the food intake restriction device including said switch.

92. A device according to claim 91, further comprising an electric motor implanted in the patient for operating said hydraulic operation means, wherein said battery powers said electric motor and said switch switches the electric connection between said battery and electric motor.

93. A device according to claim 91, wherein said wireless remote control means transmits signals, and further comprising an implanted energizer unit that draws energy from said signals.

94. A device according to claim 93, wherein said wireless remote control means transmits digital signals.

95. A device according to claim 93, wherein said wireless remote control means transmits and signals in the form of electromagnetic wave signals, and said energizer unit draws radiant energy from said electromagnetic wave signals as they are transmitted and transfers said radiant energy into electric energy.

96. A device according to claim 95, further comprising an implanted electric power supply rechargeable with said electric energy for powering said switch.

97. A device according to claim 96, wherein said electric power supply comprises a capacitor.

98. A device according to claim 91, wherein said wireless control means controls said hydraulic operation device.

99. A device according to claim 91, wherein said hydraulic operation means comprises a pump.

100. A device according to claim 99, wherein said pump pumps in only one direction, and further comprising an adjustable valve that changes the direction of hydraulic fluid to either increase or decrease the amount of fluid in the reservoir.

101. A device according to claim 100, wherein said valve is manipulated either manually, mechanically, electrically, magnetically, or hydraulically.

102. A. method of treating a patient with morbid obesity, comprising:

inflating the patient'"'"'s abdomen with gas by penetration of the patient'"'"'s skin;

introducing at least two laparoscopic trocars into the abdomen;

using the trocars to introduce into the abdomen one or more medical instruments and an elongated restriction member of a food intake restriction device having a cavity that can be expanded and contracted by the supply of hydraulic fluid thereto;

forming the restriction member into an at least substantially closed loop around the stomach or esophagus of the patient, the loop defining a restriction opening;

using the trocars to introduce into the abdomen a reservoir of the food intake restriction device for a predetermined amount of hydraulic fluid;

connecting the reservoir to the cavity of the restriction member,

using the trocars to introduce into the abdomen a hydraulic operation means of the food intake restriction device for distributing fluid between the reservoir and the cavity;

connecting the hydraulic operation means to the reservoir and cavity; and

then

when necessary for the patient'"'"'s health or desired progress, in a non-invasive procedure, controlling the hydraulic operation means from a point outside the patient'"'"'s body without physically penetrating the patient'"'"'s body to change the size of the restriction opening.

103. A method according to claim 102, further comprising controlling the hydraulic operation means by a wireless remote control means.

104. A method according to claim 103, comprising using the wireless remote control means to transmit digital signals for controlling the hydraulic operation means.

105. A method according to claim 102, further comprising implanting in the patient an energizer unit capable of receiving wireless energy transmitted from outside the patient'"'"'s body for powering implanted energy consuming components of the food intake restriction device including the hydraulic operation means.

106. A method of treating a patient with morbid obesity, comprising:

implanting in the patient an elongated restriction member of a food intake restriction device having a cavity that can be expanded and contracted by the supply of hydraulic fluid thereto, so that the restriction member is formed into an at least substantially closed loop around the stomach or esophagus of the patient, the loop defining a restriction opening;

implanting in the patient a reservoir of the food intake restriction device for a predetermined amount of hydraulic fluid and connecting the reservoir to the cavity of the restriction member;

implanting in the patient a hydraulic operation means of the food intake restriction device for distributing fluid between the reservoir and the cavity;

implanting in the patient an energizer unit capable of receiving wireless energy transmitted from outside the patient'"'"'s body for powering implanted energy consuming components of the food intake restriction device including the hydraulic operation means; and

when necessary for the patient'"'"'s health or desired progress, in a non-invasive procedure, controlling the hydraulic operation means from a point outside the patient'"'"'s body without physically penetrating the patient'"'"'s body to change the size of the restriction opening.

107. A method according to claim 106, further comprising controlling the hydraulic operation means by a wireless remote control means.

108. A method according to claim 107, comprising using the wireless remote control means to transmit digital signals for controlling the hydraulic operation means.

109. A food intake restriction device for forming surgical application in the abdomen of a patient for forming a stoma opening in the stomach or esophagus of a patient, the device comprising:

an elongated non-inflatable restriction member formed into at least substantially closed loop around the patient'"'"'s stomach or esophagus, and defining a restriction opening,

an adjustment device which mechanically adjusts said restriction member in said loop to change the size of restriction opening, said adjustment device comprising a servo means,

a hydraulic operation means implanted in the patient for operating said adjustment device, and

a reservoir implanted in the patient containing a first predetermined amount of fluid for supplying said hydraulic operation means with hydraulic fluid, wherein said servo means comprises a servo reservoir and a fluid supply reservoir connected in a closed system and containing a second predetermined amount of fluid.

110. A device according to claim 109, wherein said fluid supply reservoir defines a chamber for said second predetermined amount of fluid and said hydraulic operation means are adapted to change the volume of said chamber and thereby control the amount of fluid in said servo reservoir.

111. A device according to claim 110, wherein said fluid supply reservoir comprises first and second wall portions, which are displaceable relative to each other to change the volume of said chamber of said fluid supply reservoir.

112. A device according to claim 111, wherein said fluid supply reservoir operates said servo reservoir with fluid from said fluid supply reservoir in response to a predetermined first displacement of said first wall portion of said fluid supply reservoir relative to said second wall portion of said fluid supply reservoir to increase the amount of fluid in said servo reservoir and operates said servo reservoir with fluid from said fluid supply reservoir in response to a predetermined second displacement of said first wall portion of said fluid supply reservoir relative to said second wall portion of said fluid supply reservoir to decrease the amount of the fluid in said servo reservoir.