Apparatus for controlling flow in a bodily organ

• US 9,662,117 B2
• Filed: 04/12/2010
• Issued: 05/30/2017
• Est. Priority Date: 10/11/2007
• Status: Active Grant

• Current Assignee: Kirk Promotion Ltd.
• Original Assignee: Kirk Promotion Ltd.
• Inventors: Forsell, Peter
• Primary Examiner(s): Wu, Eugene T
• Application Number:
  US12/758,684
• Publication Number:
  US 20110087337A1
• Time in Patent Office: 2,605 Days
• Field of Search: 607 1- 3, 607 40, 607 41, 607115, 607116, 607133, 600 29- 31, 600 37
• CPC Class Codes: A61B 17/12 for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord specially adapted for vas deferens or fallopian tubes A61F6/20; materials for ligaturing blood vessels A61L17/00
• CPC Class Codes: A61F 2/0036 implantable A61F2/0018 takes precedence
• CPC Class Codes: A61F 2/004 inflatable
• CPC Class Codes: A61F 2002/045 Stomach, intestines
• CPC Class Codes: A61F 2250/0002 for data transfer
• CPC Class Codes: A61F 2250/001 for adjusting a diameter
• CPC Class Codes: A61F 7/02 Compresses or poultices for effecting heating or cooling
• CPC Class Codes: A61N 1/0509 Stomach and intestinal electrodes
• CPC Class Codes: A61N 1/0551 Spinal or peripheral nerve electrodes
• CPC Class Codes: A61N 1/36007 of urogenital or gastrointestinal organs, e.g. for incontinence control
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: A61N 1/403 for thermotherapy, e.g. hyperthermia

Abstract

An apparatus for controlling a flow of fluid and/or other bodily matter in a lumen formed by a tissue wall of a patient'"'"'s organ comprises an implantable constriction device for gently constricting (i.e. without substantially hampering the blood circulation in the tissue wall) at least one portion of the tissue wall to influence the flow in the lumen, and a stimulation device for stimulating the wall portion of the tissue wall. A control device controls the stimulation device to stimulate the wall portion, as the constriction device constricts the wall portion, to cause contraction of the wall portion constricted by the constriction device to further influence the flow in the lumen. The apparatus can be used for restricting or stopping the flow in the lumen, or for actively moving the fluid in the lumen, with a low risk of injuring the organ. Such an organ may be the esophagus, stomach, intestines, urine bladder, urethra, ureter, renal pelvis, aorta, corpus cavernosum, exit veins of erectile tissue, uterine tube, vas deference or bile duct, or a blood vessel.

Claims

1. A flow control apparatus for controlling a flow of fluid and/or other matter in a lumen formed by a tissue wall of a patient'"'"'s organ, the apparatus comprising:

a control device adapted to control contraction of the tissue wall to influence the flow in the lumen,

an implantable constriction device adapted to gently and simultaneously constrict a series of wall portions comprising three or more wall portions of the tissue wall to influence the flow in the lumen, wherein the constriction device gently constricts the series of wall portions by constricting the series of wall portions to a constricted state in which the blood circulation in the constricted series of wall portions is substantially unrestricted and the flow in the lumen is at least restricted,

an implantable energized stimulation device adapted to individually and independently stimulate a selected wall portion of the series of wall portions, comprising three or more wall portions, and

wherein the control device is operable to control the stimulation device to stimulate the selected wall portion, as the constriction device constricts the series of wall portions, to cause contraction of the selected wall portion to further influence the flow in the lumen,

wherein the control device further is operable to control the stimulation device, when the constriction device is holding the series of wall portions in the constricted state, to intermittently and individually stimulate different wall portions of the series of wall portions, such that at least two of the different wall portions are stimulated at different points of time, wherein the control device is operable to control the stimulation device to intermittently stimulate the different wall portions during successive time periods, and wherein the control device is operable;

to control the constriction device to adjust the constriction of the series of the wall portions, such that the flow in the lumen is restricted but not stopped, and is operable to control the stimulation device to stimulate the constricted wall portions individually to cause contraction thereof, such that the flow in the lumen is further restricted but not stopped,

or

to control the stimulation device in a first mode to stimulate the constricted wall portions individually to stop the flow in the lumen and to control the stimulation device in a second mode to cease the stimulation of the wall portion to allow flow in the lumen.

2. The apparatus according to claim 1, wherein the control device is operable to control the constriction device to adjust the constriction of the series of wall portions, and the control device is operable to control the constriction and stimulation devices independently of each other.

3. The apparatus according to claim 1, wherein the control device is operable to control the constriction device to adjust the constriction of the series of wall portions, and

the control device is operable to control the stimulation device to stimulate or not to stimulate the series of wall portions, while the control device controls the constriction device to adjust the constriction of the series of wall portions, and

the control device is adapted to calibrate the constriction device by controlling the stimulation device to stimulate the series of wall portions while controlling the constriction device to adjust the constriction of the series of wall portions until the desired restriction of the flow in the lumen is obtained.

4. The apparatus according to claim 1, wherein the control device is operable to control the constriction device to adjust the constriction of the series of wall portions, such that the flow in the lumen is substantially stopped, and to control the stimulation device to stimulate the constricted series of wall portions to cause contraction thereof, such that the flow in the lumen is completely stopped, and wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted series of wall portions to completely stop the flow in the lumen, and to control the stimulation device in a second mode to cease the stimulation of the series of wall portions to allow flow in the lumen, or to control in the second mode the stimulation device to cease the stimulation of the series of wall portions and the constriction device to release the series of wall portions to restore the flow in the lumen.

5. The apparatus according to claim 1, wherein the control device is operable to control the constriction device in a first mode to constrict the constricted series of wall portions to stop the flow in the lumen and to control the constriction device in a second mode to cease the constriction of the series of wall portions to restore flow in the lumen.

6. The apparatus according to claim 1, wherein the control device comprises a manually operable switch for switching on and off the constriction device and/or stimulation device, the switch being adapted for subcutaneous implantation in the patient to be manually operated from outside the patient'"'"'s body.

7. The apparatus according to claim 1, wherein the constriction device is designed to normally keep the series of wall portions in a constricted state, in which the blood circulation in the constricted series of wall portions is substantially unrestricted and the flow in the lumen is at least restricted, wherein the control device is operable to control the stimulation device in a first mode to stimulate the constricted series of wall portions to cause contraction thereof to further restrict but not stop the flow in the lumen, or to stimulate the constricted series of wall portions to cause contraction thereof, such that the flow in the lumen is stopped, and wherein the control device is operable to control the stimulation device in a second mode to cease the stimulation of the series of wall portions to increase the flow in the lumen.

8. The apparatus according to claim 1, wherein the control device is operable to control the stimulation device to adjust the intensity of the stimulation of the series of wall portions in response to a sensed physical parameter of the patient or functional parameter of the apparatus.

9. The apparatus according to claim 1, wherein the control device is operable to control the stimulation device to increase the intensity of the stimulation in response to a sensed parameter related to an increase of pressure in the lumen, such that the flow in the lumen remains stopped, further comprising a sensor configured to sense a physical parameter of the patient that relates to the pressure in the lumen, the control device controlling the stimulation device in response to signals from the sensor, the physical parameter being related to a pressure in the patient'"'"'s body and the sensor being a pressure related sensor.

10. The apparatus according to claim 1, wherein the control device is operable to control the stimulation device to stimulate different areas of the series of wall portions at a time by sequentially stimulating the different areas of the series of wall portions, or by shifting over time the stimulation from one area to another, or by shifting over time the stimulation from one area to another such that both areas are temporarily stimulated at the same time during the stimulation shift.

11. The apparatus according to claim 1, wherein the control device is operable to control the stimulation device to intermittently and individually electrically stimulate different areas of the series of wall portions with electric pulses, and wherein the stimulation device comprises at least one electrical element for engaging the series of wall portions and for stimulating the series of wall portions with electric pulses.

12. The apparatus according to claim 11, wherein the pulses form pulse trains, and wherein the control device is operable to control the stimulation device to vary at least one of the following pulse parameters:

the off time periods between the individual pulses of each pulse train, the off time periods between the pulse trains, the width of each pulse of the pulse trains, the length of each pulse train, the pulse amplitudes of the pulses of the pulse trains, the frequency of the pulses of the pulse trains, the frequency of the pulse trains, and the number of pulses of each pulse train, wherein at least a first area and a second area of the areas of the series of wall portions are repeatedly stimulated with a first pulse train of the pulse trains and a second pulse train of the pulse trains, respectively, such that the first and second pulse trains over time are shifted relative to each other, and wherein the first area is stimulated with the first pulse train while the second area is not stimulated with the second pulse train, and vice versa, or the first and second pulse trains are shifted relative to each other such that the first and second pulse trains at least partially overlap each other.

13. The apparatus according to claim 11, wherein the series of wall portions includes muscle fibers and the stimulation device is configured to stimulate the series of wall portions including the muscle fibers with the electric pulses, to cause contraction of the muscle fibres to contract the series of wall portions.

14. The apparatus according to claim 11, wherein the stimulation device comprises a plurality of electrical elements and a structure holding the electrical elements in a the fixed orientation relative to one another, the structure being integrated in or separate from the constriction device, and wherein the electrical elements form an elongate pattern of electrical elements and the structure is applicable on the patient'"'"'s organ such that the elongate pattern of electrical elements extends along the series of wall portions of the organ in the direction of the flow in the lumen and the elements abut the respective areas of the series of wall portions.

15. The apparatus according to claim 11, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to electrically energize a number of the electrical elements with electric pulses, delivered either cyclically in predetermined sequence or delivered randomly, and wherein the control device is operable to control the stimulation device to energize the electrical elements one at a time or in a group at a time.

16. The apparatus according to claim 11, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form an elongate pattern of electrical elements, wherein the elements are applicable on the patient'"'"'s wall such that the elongate pattern of electrical elements extends along the series of wall portions of the organ in the direction of the flow in the lumen and the elements abut the respective areas of the series of wall portions, and wherein the control device is operable to control the stimulation device

to successively energize the electrical elements longitudinally along the elongate pattern of electrical elements, or

to successively energize the electrical elements along the elongate pattern of electrical elements in a direction opposite to, or in the same direction as, that of the flow in the lumen, when the stimulation device is applied on the patient'"'"'s organ, or

to successively energize the electrical elements from a position substantially at the center of the constricted series of wall portions towards both ends of the elongate pattern of electrical elements, when the stimulation device is applied on the patient'"'"'s organ.

17. The apparatus according to claim 11, wherein the stimulation device comprises a plurality of electrical elements and the control device is operable to control the stimulation device to energize the electrical elements, such that electrical elements currently energized form at least one group of adjacent energized electrical elements, wherein the elements in the group of energized electrical elements form a path of energized electrical elements, and wherein the path of energized electrical elements extends along the patient'"'"'s organ, or at least in part or completely around the patient'"'"'s organ, when the stimulation device is applied on the organ.

18. The apparatus according to claim 11, wherein the stimulation device comprises a plurality of electrical elements and the electrical elements form a plurality of groups of elements, the groups forming a series of groups configured to extend along the patient'"'"'s organ in the direction of flow in the patient'"'"'s lumen, when the stimulation device is applied on the organ, the electrical elements of each group of electrical elements forming a path of elements configured to extend along the patient'"'"'s organ, or at least in part or completely around the patient'"'"'s organ, and wherein the control device is operable to control the stimulation device

to successively energize the groups of electrical elements in the series of groups in a direction opposite to, or in the same direction as, that of the flow in the lumen, when the stimulation device is applied on the patient'"'"'s organ, or

to successively energize the groups of electrical elements in the series of groups from a position substantially at the center of the constricted series of wall portions in a direction opposite to and in the same direction as that of the flow in the lumen, when the stimulation device is applied on the patient'"'"'s organ.

19. The apparatus according to claim 1, wherein the stimulation device is configured to thermally stimulate the series of wall portions, by one of the following alternatives, either by;

cooling the constricted series of wall portions to cause contraction of the series of wall portions, wherein the constriction device is configured to constrict the series of wall portions to at least restrict the flow in the lumen, and the control device is operable to control the stimulation device to cool the constricted series of wall portions to cause further contraction thereof, such that the flow in the lumen is at least further restricted but not stopped, or further restricted and stopped, or

heating the series of wall portions, when the series of wall portions is gently constricted, to cause expansion of the series of wall portions, and thereby increase the flow in the lumen.

20. The apparatus according to claim 1, wherein the series of wall portions of the organ extends between an upstream end and a downstream end of the series of wall portions with respect to the direction of the flow in the lumen, and wherein the control device is operable to control at least one of the constriction and stimulation devices to affect the series of wall portions such that the fluid and/or other bodily matter is actively moved in the lumen.

21. The apparatus according to claim 1, wherein the constriction device is configured to constrict an entire series of wall portions between an upstream and downstream ends thereof to restrict the flow in the lumen, and the control device is operable to control the stimulation device to progressively stimulate the constricted series of wall portions in the downstream or upstream direction of the lumen to cause progressive contraction of the series of wall portions to move the fluid and/or other bodily matter in the lumen, or

to control the stimulation device to stimulate the constricted series of wall portions to close the lumen either at the upstream end or the downstream end of the series of wall portions and to simultaneously control the constriction device to increase the constriction of the entire series of wall portions to move the fluid and/or other bodily matter in the lumen.

22. The apparatus according to claim 1, wherein the control device is operable to control the constriction device to vary the constriction of the series of wall portions and to simultaneously control the stimulation device to progressively stimulate the constricted series of wall portions in the downstream or upstream direction of the lumen to cause progressive contraction of the series of wall portions to move the fluid and/or other bodily matter in the lumen.

23. The apparatus according to claim 1, wherein the control device is operable to control the stimulation device to stimulate the series of wall portions and to simultaneously control the constriction device to vary the constriction of different areas of the series of wall portions such that the series of wall portions is progressively constricted in the downstream or upstream direction of the lumen, and wherein

the control device is operable to control the stimulation device to progressively stimulate the constricted series of wall portions to cause progressive contraction thereof in harmony with the progressive constriction of the series of wall portions performed by the constriction device, or

the control device is operable to control an elongated constriction element of the constriction device extending along the series of wall portions to progressively constrict the series of wall portions in the downstream or upstream direction of the lumen, wherein the elongated constriction element comprises contact surfaces dimensioned to contact a length of the series of wall portions, when the constriction device constricts the series of wall portions, and the stimulation device comprises a plurality of stimulation elements distributed along the contact surfaces, such that the stimulation elements stimulate the different areas of the series of wall portions along the length of the series of wall portions, when the control device controls the stimulation device to stimulate the series of wall portions.

24. The apparatus according to claim 1, wherein the constriction device is further configured to constrict any one wall portion of the series of wall portions to at least restrict the flow in the lumen, the stimulation device is configured to stimulate the one wall portion of the series of wall portions constricted by the constriction device to close the lumen, and the control device is operable to control the constriction device to successively constrict each wall portion of the series of wall portions to move the fluid and/or other bodily matter in the lumen in a peristaltic manner, and wherein the constriction device comprises at least one constriction element that is moveable along the organ to successively constrict each wall portion of the series of wall portions of the organ, and the stimulation device comprises at least one stimulation element positioned on the constriction element for stimulating the one wall portion of the series of wall portions constricted by the constriction element to close the lumen.

25. The apparatus according to claim 24, wherein the control device is operable to control the constriction device to cyclically move the constriction element along each wall portion of the series of wall portions.

26. The apparatus according to claim 24, wherein the constriction device comprises a plurality of constriction elements, each of which is moveable along the organ to successively constrict each wall portion of the series of wall portions of the organ, wherein the stimulation device comprises stimulation elements positioned on the constriction elements for stimulating one wall portion of the series of wall portions constricted by the constriction elements to close the lumen, wherein the control device is operable to control the constriction device to cyclically move the constriction elements one after the other along each wall portion of the series of wall portions of the organ, wherein the constriction device comprises a rotor carrying the constriction elements, and the control device is operable to control the rotor to rotate such that each constriction element cyclically constricts each wall portion of the series of wall portions of the organ, and wherein each constriction element comprises a roller for rolling on the organ to constrict the latter.

27. The apparatus according to claim 1, wherein the constriction device comprises a first constriction element for constricting a first wall portion of the series of wall portions of the organ at the upstream end thereof, a second constriction element for constricting a second wall portion of the series of wall portions at the downstream end thereof, and a third constriction element for constricting a third wall portion of the series of wall portions between the upstream and downstream ends thereof, and the control device is operable to control the first, second and third constriction elements to constrict and release each wall portion independently of one another, and wherein

the control device is operable to control the first or second constriction element to constrict each respective first or second wall portion at the upstream or downstream end thereof to close the lumen and to control the third constriction element to constrict the third wall portion between the upstream and downstream ends thereof, whereby the fluid or other bodily matter contained in the third wall portion between the upstream and downstream ends thereof is moved downstream or upstream in the lumen, the control device controlling the stimulation device to stimulate the third wall portion between the upstream and downstream ends thereof, when the third constriction element constricts the third wall portion, or

the control device is operable to control the first constriction element to constrict the first wall portion at the upstream end thereof to restrict the flow in the lumen and to control the stimulation device to stimulate the constricted first wall portion at the upstream end to close the lumen, and wherein the control device is operable to control the third constriction element to constrict the third wall portion between the upstream and downstream ends thereof, whereby the fluid and/or other bodily matter contained in the third wall portion between the upstream and downstream ends thereof is moved downstream in the lumen, or

the control device is operable to control the second constriction element to constrict the second wall portion at the downstream end thereof to restrict the flow in the lumen and to control the stimulation device to stimulate the constricted second wall portion at the downstream end to close the lumen, and the control device is operable to control the third constriction element to constrict the third wall portion between the upstream and downstream ends thereof, whereby the fluid and/or other bodily matter contained in the third wall portion between the upstream and downstream ends thereof is moved upstream in the lumen.

28. The apparatus according to claim 1, wherein the constriction device is adjustable, and further comprising an operation device for operating the adjustable constriction device to change the constriction of the series of wall portions of the organ wherein the operation device mechanically or hydraulically operates the constriction device.

29. The apparatus according to claim 28, wherein the operation device mechanically operates the constriction device, and the constriction device comprises at least two elongated clamping elements extending along the organ in the direction of flow in the patient'"'"'s lumen on different sides of the organ, and the operation device operates the clamping elements to clamp the series of wall portions between the clamping elements to constrict the series of wall portions.

30. The apparatus according to claim 1, wherein the control device is operable to control the constriction device to close the lumen, either at an upstream end or a downstream end of the series of wall portions, and to control the constriction device to constrict the remaining part of the series of wall portions to move the fluid and/or other bodily matter in the lumen, and wherein the control device is operable to control the stimulation device to stimulate the series of wall portions as the constriction device constricts the remaining part of the series of wall portions.

31. The apparatus according to claim 1, wherein the constriction device is configured to constrict the series of wall portions to restrict but not stop the flow in the lumen, and the control device is operable to control the stimulation device to stimulate the series of wall portions constricted by the constriction device to close the lumen, either at an upstream end or a downstream end of the series of wall portions, and to simultaneously control the constriction device to increase the constriction of the series of wall portions to move the fluid and/or other bodily matter in the lumen.

32. The apparatus according to claim 1, wherein the constriction device comprises a plurality of separate constriction elements adapted to constrict any one wall portion of the series of wall portions, respectively, of the organ, and the control device is operable to control the constriction device to activate the constriction elements in random or in accordance with a predetermined sequence.

33. The apparatus according to claim 32, wherein the stimulation device comprises stimulation elements positioned on the constriction elements, and wherein the control device is operable to control the stimulation device to activate the stimulation elements to stimulate each wall portion of the series of wall portions constricted by the constriction elements.

34. The apparatus according to claim 33, wherein the control device is operable to control the constriction device to activate the constriction elements to constrict each wall portion of the series of wall portions without completely closing the lumen, and to control the stimulation device to activate the stimulation elements to stimulate the constricted series of wall portions one after the other, so that each wall portion of the series of wall portion is successively contracted along the organ to move the fluid and/or other bodily matter in the lumen, or

to constrict all of the wall portions of the series of wall portions, and to control the stimulation device to activate the stimulation elements to stimulate any constricted wall portions in random or in accordance with a predetermined sequence to close the organ'"'"'s lumen.

35. The apparatus according to claim 1, adapted to be included in a system, further comprising a hydraulic device having an implantable hydraulic reservoir, which is hydraulically connected to the device, wherein the device is adapted to be non-invasively regulated by manually pressing the hydraulic reservoir.

36. The apparatus according to claim 1, adapted to be included in a system, further comprising a wireless remote control for non-invasively controlling the device.

37. The apparatus according to claim 36, adapted to be included in a system, wherein the wireless remote control comprises at least one external signal transmitter and/or receiver, further comprising an internal signal receiver and/or transmitter implantable in the patient for receiving signals transmitted by the external signal transmitter or transmitting signals to the external signal receiver.

38. The apparatus according to claim 36, adapted to be included in a system, wherein the wireless remote control transmits at least one wireless control signal for controlling the device.

39. The apparatus according to claim 38, adapted to be included in a system, wherein the wireless control signal comprises a frequency, amplitude, or phase modulated signal or a combination thereof.

40. The apparatus according to claim 38, adapted to be included in a system, wherein the wireless remote control transmits an electromagnetic carrier wave signal for carrying the control signal.

41. The apparatus according to claim 1, adapted to be included in a system, further comprising a wireless energy-transmission device for non-invasively energizing implantable energy consuming components of the device with wireless energy.

42. The apparatus according to claim 41, adapted to be included in a system, wherein the wireless energy comprises a wave signal selected from the following:

a sound wave signal, an ultrasound wave signal, an electromagnetic wave signal, an infrared light signal, a visible light signal, an ultra violet light signal, a laser light signal, a micro wave signal, a radio wave signal, an x-ray radiation signal and a gamma radiation signal.

43. The apparatus according to claim 41, adapted to be included in a system wherein the wireless energy comprises one of the following:

an electric field, a magnetic field, a combined electric and magnetic field.

44. The apparatus according to claim 38, adapted to be included in a system, wherein the control signal comprises one of the following:

an electric field, a magnetic field, a combined electric and magnetic field.

45. The apparatus according to claim 38, adapted to be included in a, wherein the signal comprises an analogue signal, a digital signal, or a combination of an analogue and digital signal.

46. The apparatus according to claim 1, adapted to be included in a system, further comprising an implantable internal energy source for powering implantable energy consuming components of the device.

47. The apparatus according to claim 46, adapted to be included in a system, further comprising an external energy source for transferring energy in a wireless mode, wherein the internal energy source is chargeable by the energy transferred in the wireless mode.

48. The apparatus according to claim 47, adapted to be included in a system, further comprising a sensor or measuring device sensing or measuring a functional parameter correlated to the transfer of energy for charging the internal energy source, and a feedback device for sending feedback information from inside the patient'"'"'s body to the outside thereof, the feedback information being related to the functional parameter sensed by the sensor or measured by the measuring device.

49. The apparatus according to claim 1, adapted to be included in a system, further comprising a feedback device for sending feedback information from inside the patient'"'"'s body to the outside thereof, the feedback information being related to at least one of a physical parameter of the patient and a functional parameter related to the device.

50. The apparatus according to claim 1, adapted to be included in a system, further comprising a sensor and/or a measuring device and an implantable internal control unit for controlling the device in response to information being related to at least one of a physical parameter of the patient sensed by the sensor or measured by the measuring device and a functional parameter related to the device sensed by the sensor or measured by the measuring device.

51. The apparatus according to claim 50, adapted to be included in a system, wherein the physical parameter is a pressure or a motility movement.

52. The apparatus according to claim 1, adapted to be included in a system, further comprising an external data communicator and an implantable internal data communicator communicating with the external data communicator, wherein the internal communicator feeds data related to the device or the patient to the external data communicator and/or the external data communicator feeds data to the internal data communicator.

53. The apparatus according to claim 1, adapted to be included in a system, further comprising a motor or a pump for operating the device.

54. The apparatus according to claim 1, adapted to be included in a system, further comprising a hydraulic operation device for operating the device.

55. The apparatus according to claim 1, adapted to be included in a system, further comprising an operation device for operating the constriction device, wherein the operation device comprises a servo mechanism configured to decrease the force needed to operate the constriction device, wherein the decreased force results in a longer stroke and increased time.

56. The apparatus according to claim 41, adapted to be included in a system, further comprising an operation device for operating the device, wherein the wireless energy is used in its wireless state to directly power the operation device to create kinetic energy for the operation of the device, as the wireless energy is being transmitted by the energy-transmission device.

57. The apparatus according to claim 41, adapted to be included in a system, further comprising an energy-transforming device for transforming the wireless energy transmitted by the energy-transmission device from a first form into a second form energy.

58. The apparatus according to claim 57, adapted to be included in a system, wherein the energy-transforming device directly powers implantable energy consuming components of the device with the second form energy, as the energy-transforming device transforms the first form energy transmitted by the energy-transmission device into the second form energy.

59. The apparatus according to claim 57, adapted to be included in a system, wherein the second form energy comprises at least one of a direct current, pulsating direct current and an alternating current.

60. The apparatus according to claim 57, adapted to be included in a system, further comprising an implantable accumulator, wherein the second form energy is used at least partly to charge the accumulator.

61. The apparatus according to claim 57, adapted to be included in a system, wherein the energy of the first or second form comprises at least one of magnetic energy, kinetic energy, sound energy, chemical energy, radiant energy, electromagnetic energy, photo energy, nuclear energy thermal energy, non-magnetic energy, non-kinetic energy, non-chemical energy, non-sonic energy, non-nuclear energy and non-thermal energy.

62. The apparatus according to claim 1, adapted to be included in a system, further comprising implantable electrical components including at least one voltage level guard and/or at least one constant current guard.

63. The apparatus according to claim 41, adapted to be included in a system, further comprising a control device for controlling the transmission of wireless energy from the energy-transmission device, and an implantable internal energy receiver for receiving the transmitted wireless energy, the internal energy receiver being connected to implantable energy consuming components of the device for directly or indirectly supplying received energy thereto, the system further comprising a determination device adapted to determine an energy balance between the energy received by the internal energy receiver and the energy used for the implantable energy consuming components of the device, wherein the control device controls the transmission of wireless energy from the external energy-transmission device, based on the energy balance determined by the determination device.

64. The apparatus according to claim 63, adapted to be included in a system, wherein the determination device is adapted to detect a change in the energy balance, and the control device controls the transmission of wireless energy based on the detected energy balance change.

65. The apparatus according to claim 63, adapted to be included in a system, wherein the determination device is adapted to detect a difference between energy received by the internal energy receiver and energy used for the implantable energy consuming components of the device, and the control device controls the transmission of wireless energy based on the detected energy difference.

66. The apparatus according to claim 41, adapted to be included in a system, wherein the energy-transmission device comprises a coil placed externally to the human body, further comprising an implantable energy receiver to be placed internally in the human body and an electric circuit connected to power the external coil with electrical pulses to transmit the wireless energy, the electrical pulses having leading and trailing edges, the electric circuit adapted to vary first time intervals between successive leading and trailing edges and/or second time intervals between successive trailing and leading edges of the electrical pulses to vary the power of the transmitted wireless energy, the energy receiver receiving the transmitted wireless energy having a varied power.

67. The apparatus according to claim 66, adapted to be included in a system according to claim 66, wherein the electric circuit is adapted to deliver the electrical pulses to remain unchanged except varying the first and/or second time intervals.

68. The apparatus according to claim 1, adapted to be included in a system, wherein the electric circuit has a time constant and is adapted to vary the first and second time intervals only in the range of the first time constant, so that when the lengths of the first and/or second time intervals are varied, the transmitted power over the coil is varied.

69. The apparatus according to claim 49, adapted to be included in a system, further comprising an implantable internal energy receiver for receiving wireless energy, the energy receiver having an internal first coil and a first electronic circuit connected to the first coil, and an external energy transmitter for transmitting wireless energy, the energy transmitter having an external second coil and a second electronic circuit connected to the second coil, wherein the external second coil of the energy transmitter transmits wireless energy which is received by the first coil of the energy receiver, the system further comprising a power switch for switching the connection of the internal first coil to the first electronic circuit on and off, such that feedback information related to the charging of the first coil is received by the external energy transmitter in the form of an impedance variation in the load of the external second coil, when the power switch switches the connection of the internal first coil to the first electronic circuit on and off.

70. The apparatus according to claim 49, adapted to be included in a system, further comprising an implantable internal energy receiver for receiving wireless energy, the energy receiver having an internal first coil and a first electronic circuit connected to the first coil, and an external energy transmitter for transmitting wireless energy, the energy transmitter having an external second coil and a second electronic circuit connected to the second coil, wherein the external second coil of the energy transmitter transmits wireless energy which is received by the first coil of the energy receiver, the system further comprising a feedback device for communicating out the amount of energy received in the first coil as a feedback information, and wherein the second electronic circuit includes a determination device for receiving the feedback information and for comparing the amount of transferred energy by the second coil with the feedback information related to the amount of energy received in the first coil to obtain the coupling factors between the first and second coils.

71. The apparatus according to claim 70, adapted to be included in a system, wherein the energy transmitter regulates the transmitted energy in response to the obtained coupling factor.

72. The apparatus according to claim 70, adapted to be included in a system, wherein external second coil is adapted to be moved in relation to the internal first coil to establish the optimal placement of the second coil, in which the coupling factor is maximized.

73. The apparatus according to claim 72, adapted to be included in a system, wherein the external second coil is adapted to calibrate the amount of transferred energy to achieve the feedback information in the determination device, before the coupling factor is maximized.