DRUG DELIVERY SYSTEM

Technical field

[01] The present invention relates generally to the infusion of a substance, in particular drugs, into a patient’s body, in particular into a patient’s blood circulation system or in order to stimulate of penis erection, by means of an at least partly implantable drug delivery system.

Background

[02] Intestinally implantable drug delivery systems using one or more implantable infusion needles are known, e.g., from WO 2010/040548 Al which is particularly designed for the stimulation of penis erection. According to the teaching of WO 2010/040548 Al as well as according to the disclosure which will be presented hereinafter, the infusion needle is movably arranged in a housing so that it can be advanced in order to penetrate with a tip end thereof a septum, such as a silicone membrane, in the housing’s outer wall. Arranging the infusion needle inside the housing prevents any fibrosis from growing into the infusion needle. However, frequent piercing of the same body part may cause irritation, eventually making further piercing difficult or even impossible. Therefore, a plurality of infusion needles or a single laterally displaceable infusion needle is provided so as to penetrate the housing’s outer wall at different penetration sites. This allows for variation of the injection sites and penetration of different injection sites at different times, thereby giving the human tissue time to recover from the piercing by the infusion needle. A drive unit is provided for advancing and retracting as well as for laterally displacing the infusion needle or needles accordingly. A part of the drive unit may be provided for implantation remote from the injection area and may comprise a pull wire guided in a sheath to cause lateral movement of the infusion needle upon pulling the remote end of the wire. More specifically, pulling the wire may cause the tip end of the infusion needle or needles to displace laterally from a first to a second penetration site. A single pulling wire may be sufficient to cause lateral movement of the infusion needle in one direction, whereas a spring element urges the infusion needle back to a starting position, or two pulling wires may be provided to move the infusion needle laterally back and forth. A further pulling wire may be arranged to advance or retract the infusion needle and, again, a spring element may be provided to urge the infusion needle back to a starting position. Instead of one or more pulling wires, the drive unit may comprise one or more rotating shafts, with a worm screw at the end of the shaft cooperating with a gear for advancing and/or or retracting the infusion needle and/or for laterally moving the tip end of the infusion needle. The rotating shafts are flexible and guided in a sheath so as to transmit kinetic energy from a remote position towards the implantable infusion device. The system may further comprise one or more electric motors inside and/or outside the housing for driving the drive unit or parts of the drive unit, such as the wire/wires or drive shaft/shafts, and may further comprise at least one reservoir adapted for implantation inside the patient’s body and being in fluid connection with the infusion needle or needles so as to supply to the infusion needle the substance to be injected. Also, a pump, which is also adapted for implantation inside the patient’s body, may be provided to advance the substance from the reservoir to the infusion needle or needles.

[03] It is a general object of the present disclosure to improve the above-described implantable drug delivery system.

[04] As set out above, in WO 2010/040548 Al as well as according to the present disclosure, the drive unit is configured to advance and retract the infusion needle or needles. In WO 2010/040548 Al, this is generally achieved by mounting the infusion needle in a slidable manner and urge it back into a rest position by means of a return spring. However, there is no specific disclosure in WO 2010/040548 Al of how the drive unit needs to be configured in order to achieve this. As further set out above, in WO 2010/040548 Al as well as according to the present disclosure, the drive unit is configured to laterally displace the tip end of an infusion needle to different penetration sites or to actuate different ones of a plurality of infusion needles. In WO 2010/040548 Al, this is generally achieved by mounting the infusion needle or needles on a movable carriage, such as a turntable and/or a slide. However, again, there is no specific disclosure in WO 2010/040548 Al of how the drive unit needs to be configured in order to achieve this.

[05] It is therefore n particular object of the present disclosure to provide an improved drive unit for moving the infusion needle or needles, such as movement thereof in the advancing or retracting direction, in the lateral displacement direction or in both the advancing or retracting direction and the lateral displacement direction.

[06] As also set out above, in WO 2010/040548 Al as well as according to the present disclosure, there may be provided more than one infusion needle. In WO 2010/040548 Al a valve is used to distribute the substance to be injected to individual ones of the plurality of infusion needles. This requires actuation of the valve and, therefore, increases the complexity of operating the system.

[07] It is therefore another object of the present disclosure to facilitate the manner of supplying the substance to be injected to individual infusion needles where the system comprises a plurality of infusion needles.

[08] As also set out above, in WO 2010/040548 Al as well as according to the present disclosure, the infusion needle is advanced in order to penetrate with a tip end thereof a septum in the housing’s outer wall. There is a risk that material from the septum is taken into the patient’s body by such penetrations. [09] It is therefore a further object of the present disclosure to improve the system and/or the infusion needle in order to prevent or at least minimize the risk that material from a septum in the housing’s outer wall, through which the needle extends, is brought into the patient’s body.

Summary

[010] Accordingly, the at least partly implantable system for injecting a substance into a patient’s body according to the present disclosure comprises: a housing or casing adapted for implantation inside the patient’s body, the housing or casing having an outer wall with a penetration area, at least one infusion needle disposed in the housing or casing so as to penetrate the penetration area and configured for being advanced and retracted in opposite advancing and retraction directions between an advanced position and a retracted position, wherein the system is adapted to inject the substance into the patient’s body via the at least one infusion needle when the at least one infusion needle is in the advanced position, and wherein injection of the substance into the patient’s body via the at least one infusion needle is not possible when the at least one infusion needle is in the retracted position, and a drive unit arranged for advancing and retracting the infusion needle or needles in the opposite advancing and retracting directions so that, according to one variant, a tip end thereof penetrates, upon advancement, said penetration area so as to allow for injecting the substance through the penetration area via the needle or needles.

[Oi l] In this context, penetration of the penetration area by the tip end upon advancement of the infusion needle does not necessarily mean that, prior to such advancement, the tip end resides inside the housing spaced apart from the internal side of the housing’s or casing’s outer wall. Rather, the infusion needle may even extend with its tip end into the outer wall prior to its advancement and, upon advancement, penetrate the wall so as to extend from the external side of the wall. This is at least an option in those embodiments where the infusion needle is not displaced laterally between successive injection cycles.

[012] In another variant, instead of the tip end of the infusion needle or needles penetrating, upon advancement, said penetration area, the tip end is never retracted entirely backwards into the housing or casing. For instance, the tip end of the infusion needle or needles may extend from the penetration area when the infusion needle or needles is/are in the retracted position

[013] Also, while the penetration area may preferably be formed from a membrane which may be made of a material that can be easily penetrated by the infusion needle, in particular of an elastomeric polymer material, such as silicone, in some instances the penetration area may simply be a hole in the wall through which the needle can be advanced from inside of the housing or casing to the outside thereof, i.e. only the hole needs to be penetrated, rather than a membrane closing such hole.

FIRST ASPECT - Cross guide with needle cooperating member

[014] According to a first aspect of the present disclosure, the system may further comprise a needle cooperating member arranged to cooperate with the at least one infusion needle upon the advancing or retracting of the at least one infusion needle and a cross guide to which the needle cooperating member is coupled so as to be movable into different positions in a displacement direction which is different to the advancing and retracting directions. Thus, advancing or retracting the infusion needle may involve prior lateral displacement of the needle cooperating member along the cross guide to different injection site positions.

[015] Preferably, the cross guide is fixedly held between two opposing fixing points in order to provide a structure which is sufficiently stiff to ensure proper alignment of the needle cooperating member relative to the injection sites independent of the needle cooperating member’s position on, or relative to, the cross guide. To this end, the cross guide may comprise a shaft on which the needle cooperating member is slidably mounted.

[016] The cross guide preferably extends in a displacement direction that is perpendicular to the advancing and retracting directions of the needle or needles, but may alternatively extend in a direction that is inclined relative to the advancing and retracting directions of the needle or needles if the space where the housing is to be implanted in the patient’s body so requires.

[017] Preferably, the system comprises a translating frame arranged to move in the advancing and retracting directions of the needle or needles, wherein the cross guide is fixed to the translating frame so as to move together with the translating frame. This way, once the needle cooperating member has been brought in a desired position relative to the cross guide, it may be moved in the advancing and retracting directions of the needle or needles so as to advance or retract the needle or needles. Preferably the arrangement is such that a single needle is advanced or retracted upon movement of the translating frame.

[018] Where the at least one infusion needle comprises an array of infusion needles, the needle cooperating member is preferably arranged to cooperate with a respective one infusion needle of the array of infusion needles at a time.

[019] More specifically, the needle cooperating member may be arranged for acting on the array of infusion needles so as to advance or retract, depending on its position relative to the cross guide, the respective one infusion needle. To this end, the needle cooperating member may be separate from the array of infusion needles. That is, in a rest position, the needle cooperating member may be disengaged from the infusion needles and, upon movement of the translating frame, it may engage the respective one of the infusion needles. In one embodiment, the infusion needles of the array of infusion needles may be mounted in a mounting block so as to be slidable in the advancing and retracting directions, wherein the needle cooperating member is preferably arranged to advance the respective one infusion needle by pushing it in the advancing direction.

[020] In a particular embodiment, the needle cooperating member may comprise a needle driver part and a positioning part, wherein the needle driver part and the positioning part are arranged to disengage from each other when the translating frame moves in the advancing direction. In this case, a secondary cross guide member may be arranged in parallel to the cross guide, wherein the positioning part is movably, preferably slidably, mounted on the main secondary cross guide member and the needle driver part is movably, preferably slidably, mounted on the (main) cross guide.

[021] Preferably, the arrangement is such that, when the positioning part and the needle driver part are engaged, the positioning part may be moved along the secondary cross guide member in the displacement direction, thereby moving the needle driver part along the main cross guide also in the displacement direction into a desired position, and, when the needle driver part has been positioned, the aforementioned translating frame may be moved in the advancing or retracting direction so that the needle driver part and the positioning part disengage from each other and so that the needle driver part may cooperate with the respective one infusion needle of the array of infusion needles.

[022] A displacement cable, which will be described in further detail hereinafter, may be provided for pulling the needle cooperating member along the cross guide in the displacement direction and may be connected to the positioning part of the needle cooperating member.

[023] Where the at least one infusion needle comprises only a single infusion needle, the single infusion needle may be attached to the needle cooperating member so as to be movable in the displacement direction together with the needle cooperating member. The single infusion needle may be welded or potted to the needle cooperating member so as to securely hold the infusion needle in place.

[024] The single infusion needle may have a curved section by which it is attached to the needle cooperating member. This may facilitate mounting of the infusion needle at a correct position of the needle cooperating member when the system is being assembled. More specifically, the curved section may be fixedly held in a correspondingly curved recess of the needle cooperating member. The curved recess provides a counter-force to forces acting on the needle when the needle is advanced to pierce with its front end through the penetration area in the wall of the housing. [025] Also, a needle-reinforcing tube may be placed around the single infusion needle to help minimize any deflection of the infusion needle when penetrating the penetration area of the housing’s wall.

[026] Finally, a tubing for supplying the substance to be injected through the single infusion needle may be connected to an end of the single infusion needle and looped inside the housing to allow the tubing a required range of motion.

[027] At least one motor may be provided, such as a first motor for advancing and/or retracting the needle or needles in opposite advancing and retracting directions and a second motor for displacing the needle or needles or the needle cooperating member in a different lateral displacement direction. Alternatively, two motors may be provided for, in cooperation, advancing and/or retracting the needle or needles in the opposite advancing and retracting directions and for displacing the needle or needles or the needle cooperating member in the different lateral displacement direction.

[028] The motor or motors may be arranged within the housing in which the needle or needles are arranged. However, depending on the space that is available for implanting the housing within the patient’s body, it may be desirable to keep the housing small. In that case, one or more pull cables may be provided to extend from one or more motors, which are remotely arranged inside or even outside the patient’s body, into the housing in order to transfer kinetic energy into the housing for moving the needles or needles that are arranged in the housing. Also, one or more cables or belts may be provided inside the housing to transmit energy between components that are arranged inside the housing.

[029] In all embodiments where a motor or cable is arranged to advance the infusion needle or needles in the advancing direction and, e.g., resilient means, such as a spring element, are provided for urging the needle or needles back into a rest position, the arrangement may likewise be opposite such that the motor or cable is arranged to retract the infusion needle or needles into the rest position and, e.g., resilient means, such as a spring element, are provided for advancing the needle or needles into an operating position.

[030] In all embodiments where a cable is employed, the cable is preferably a Bowden cable so that it can transmit pulling forces while being bendable. This is particularly advantageous in situations where a part of the drive unit is remote from the housing and where the cable extends into the housing from a remotely arranged motor.

[031] While a cable is typically understood as comprising a coated set of wires, a cable in the sense of the present disclosure may comprise one or more wires, uncoated or preferably coated, such as a single uncoated wire, a single coated wire, a set of uncoated wires, a set of coated wires, or a coated set of wires. The wires are preferably made of metal, but may alternatively be made or comprise one or more polymer wires.

[032] As mentioned before, the system may comprise a displacement cable or a displacement belt for pulling the needle cooperating member along the cross guide in the displacement direction.

[033] In a first embodiment, a tensioning spring may be arranged to provide a counter-force counteracting the pulling force of the displacement cable that may be acting on the needle cooperating member. The tensioning spring thus helps to hold the needle positioning member in position relative to the cross guide. Preferably, the counter-force provided by the tensioning spring is strong enough to move the needle cooperating member in a direction opposite the displacement direction when there is no pulling force of the displacement cable acting on the needle cooperating member. That is, when, after a certain number of injections, the needle cooperating member has been displaced step by step relative to the cross guide so that it has reached a final position, the pulling force of the displacement cable may be released so that the counter-force of the tensioning spring causes the needle cooperating member to return to a starting position.

[034] It is advantageous when the tensioning spring is designed as a constant-force tensioning spring. This way, the pulling force required to move the needle cooperating member along the cross guide, and thus the power provided by an associated motor, is constant independent of the position of the needle cooperating member relative to the cross guide. For instance, the tensioning spring may comprise a metal band which winds on itself when it is not tensioned. One end of the metal band may be attached to a reel and the other end may be connected to the needle cooperating member. Then, when the needle cooperating member is pulled step by step along the cross guide with the aid of the displacement cable, the tensioning spring creates a constant counter-force. When the pulling force of the displacement cable is released, the tensioning spring winds automatically back onto the reel, thereby pulling the needle cooperating member back into its starting position. Preferably, the tensioning spring provides a tensioning force of between 0.5 N and 2 N, preferably between 0.8 N and 1.2 N, most preferably about 1 N.

[035] In a second embodiment, the displacement cable or displacement belt may be arranged for pulling the needle cooperating member along the cross guide in opposite first and second displacement directions. A tensioning spring as described above is not required in this case because the needle cooperating member may be returned to its starting position by means of the displacement cable. In this case, a first wheel and a second wheel may be provided, the first wheel having a first axis of rotation and the second wheel having a second axis of rotation in parallel to and spaced apart from the first axis, wherein the displacement cable or displacement belt winds around the first and second wheels. [036] Preferably, the displacement cable or displacement belt is endless. For instance, it may be provided in the form of a loop extending from the first wheel to the second wheel, winding around the second wheel by 180° or preferably - in order to prevent sliding of the cable or belt - by 180° and a number of additional complete revolutions, extending back from the second wheel to the first wheel, and winding around the first wheel by 180° or - again - preferably by 180° and a number of additional complete revolutions. Then, the needle cooperating member moves in the first and second displacement direction depending on the direction of rotation of the first and second wheels.

[037] A tensioning element may be provided to create a tensioning force on the displacement cable or displacement belt in a direction transverse to a longitudinal axis of the displacement cable or displacement belt so as to reduce any slack in the displacement cable or displacement belt.

[038] A motor may be arranged inside or even outside the housing to provide power for rotating the first or second wheel. However, as mentioned, when the space for implantation is limited and, therefore, the housing must be kept small so that a motor cannot be fitted into the housing, it may be preferable to arrange a drive cable to rotate the first or second wheel, the drive cable accordingly extending out of the housing to a remote motor. In this context, the drive cable may connect to one of the first and second wheels and wind on and off the first or second wheel or around the first or second wheel.

[039] Alternatively, at least one of the first and second wheels may be mounted on a drive shaft so as to rotate by rotation of the drive shaft and the drive cable may connect to the drive shaft in order to drive the drive shaft. In this case, a third wheel may be mounted on the drive shaft and the drive cable may wind on and off the third wheel or around the third wheel.

[040] In the case where the drive cable is arranged to wind on and off the first or second wheel or on and off the third wheel, the drive cable may be attached to the respective wheel with one end of the drive cable so that the drive cable unwinds and a section of the drive cable moves out of the housing when the cable is being pulled in a first direction, wherein a tensioning spring is arranged so as to pull the drive cable into an opposite second direction back into the housing onto the respective wheel. In the alternative case where the drive cable is arranged to wind around the first or second wheel or around the third wheel, the drive cable may be arranged so that, when the drive cable is being pulled, one section of the drive cable moves into the housing while another section of the drive cable moves out of the housing.

[041] In all embodiments, a first alignment structure may be arranged on the needle cooperating member and a second alignment structure may be arranged stationary so that the first and second alignment structures engage with each other and define different rest positions for the needle cooperating member when the needle cooperating member is moved along the cross guide into different positions. This arrangement supports exact positioning of the needle cooperating member.

[042] In a preferred embodiment, the first alignment structure may be a leaf spring and the second alignment structure may comprise a plurality of stationary detents or protrusions arranged to cooperate with the leaf spring or, alternatively, the first alignment structure may comprise the plurality of detents or protrusions and the second alignment structure comprises one or more stationary leaf springs arranged to cooperate with the detents or protrusions. Thus, when the needle cooperating member is moved relative to the cross guide in the displacement direction from one position to the next position, the leaf spring is urged backwards to disengage from the detents or protrusions and then snaps forward again in order to reengage with one or more neighboring detents or protrusions.

SECOND ASPECT - Translating frame

[043] According to a second aspect of the present disclosure, the system comprises at least one linear bearing, preferably two parallel linear bearings, and a translating frame arranged to move along the linear bearing or bearings in the advancing and retracting directions of the at least one infusion needle so as to advance or retract or both advance and retract the infusion needle or needles by respective movement of the translating frame. Most preferably, the cross guide described above to which the needle cooperating member is coupled may be fixed to the translating frame so that it can be moved together with the translating frame in the needle advancing and retracting directions. Providing two parallel linear bearings increases the stability and accuracy of the system. The two linear bearings preferably take the form of two parallel shafts to which the translating frame is slidably mounted.

[044] Further at least one return spring may be arranged to urge the translating frame into a rest position. For instance, the at least one return spring may comprise a coil spring arranged around one linear bearing or, more preferably, two coil springs arranged around respective ones of two parallel linear bearings.

[045] The drive unit may comprise an advancement cable which is arranged so that pulling the advancement cable causes the advancing or retracting of the at least one infusion needle. For example, the advancement cable may be arranged to move the translating frame along the at least one linear bearing in the advancing and retracting directions, thereby advancing and/or retracting the infusion needle or needles. The advancement cable may be guided through the wall of the housing towards a motor which is arranged remote from the housing at a location outside the patient or more preferably at a location somewhere inside the patient.

THIRD ASPECT - Cable with block-and-tackle setup [046] According to a third aspect of the present disclosure, the advancement cable may form part of a block-and-tackle setup. This reduces the amount of power that is needed to advance the needle or needles through the penetration area in the wall of the housing. Accordingly, the motor for driving the advancement cable may be relatively small.

[047] In the case that the advancement cable is arranged to move the above-mentioned translating frame along the above-mentioned linear bearing or bearings in the advancing and retracting directions, the block-and-tackle setup may comprise at least one first pulley, preferably two first pulleys, fixed to the translating frame so as to move together with the translating frame and at least one second pulley, preferably two second pulleys, fixed to the housing so as to be stationary. In addition, one end of the advancement cable is either fixed to the housing or to the translating frame. Thus, when the advancement cable is fixed with one of its ends to the housing and the advancement cable is being pulled so as to move the translating frame, it winds along the first pulley which moves along with the translating frame, thereby dividing the pulling force necessary for moving the translating frame by 2. By providing two first and two second pulleys, the pulling force may be further divided in half once again.

FOURTH ASPECT - Combined advancement and displacement cable

[048] According to a fourth aspect of the present disclosure, the drive unit may comprise a combined advancement and displacement cable which is arranged so that pulling the advancement and displacement cable allows for causing both the advancing or retracting of the at least one infusion needle and the displacement of the at least one infusion needle in a displacement direction which is different to the advancing and retracting directions. For example, a first actuator may be attached to a first end of the advancement and displacement cable and a second actuator may be attached to a second end of the advancement and displacement cable, wherein the first actuator is arranged so as to allow pulling and moving the advancement and displacement cable in a first pulling direction and the second actuator is arranged so as to allow pulling and moving the advancement and displacement cable in a second pulling direction opposite to the first pulling direction.

[049] The arrangement may be such that simultaneous actuation of the first and second actuators so as to move the advancement and displacement cable in opposite first and second pulling directions causes the advancing or retracting of the at least one infusion needle.

[050] In this case, when the advancement and displacement cable is arranged to move the above- mentioned translating frame along the above-mentioned linear bearing or bearings in the advancing and retracting directions, movement of the advancement and displacement cable in opposite first and second pulling directions may cause the translating frame to move along the linear bearing or bearings. This may be achieved, for example, by means of at least two first pulleys fixed to the housing so as to be stationary, wherein the advancement and displacement cable is guided over one of the two first pulleys fixed to the housing, further to the translating frame and further over the other one of the two first pulleys fixed to the housing. Thus, when the opposite ends of the advancement and displacement cable are pulled in opposite first and second pulling directions over the same distance, the translating frame is pulled along the linear bearing or bearings in a direction towards the two first pulleys, such as in the advancing direction of the infusion needle or needles. While the aforementioned block -and - tackle setup may likewise be provided for the advancement and displacement cable, this is not so important in this case, because here two motors instead of only one motor may be used, one at each end of the advancement and displacement cable, so that twice the amount of power is available. Again, the aforementioned return spring may be arranged to urge the translating frame towards a rest position so that, when the pulling force on the advancement and displacement cable is reduced, the return spring will cause automatic movement of the translating frame back into the rest position.

[051] The arrangement may further be such that actuation of any one of the first and second actuators so as to move the advancement and displacement cable in the first or second pulling direction, while the respective other one of the first and second actuators is not caused to move the advancement and displacement cable, causes the displacement of the at least one infusion needle in the displacement direction.

[052] In this case, when the system comprises the above-mentioned needle cooperating member to which the at least one infusion needle is attached and the above-mentioned cross guide to which the needle cooperating member is coupled, the advancement and displacement cable may be connected to the needle cooperating member so as to pull and move the needle cooperating member along the cross guide into different positions in the displacement direction. This may be achieved, for example, by means of at least two second pulleys fixed to the translating frame on opposed sides of the needle cooperating member, wherein the advancement and displacement cable is guided over the two second pulleys. Thus, when the advancement and displacement cable is pulled in the one or in the other pulling direction, the needle cooperating member is accordingly pulled along the cross guide towards a respective one of the two second pulleys, namely in a displacement direction of the infusion needle or needles.

[053] In one embodiment, the advancement and displacement cable may comprise two separate cable sections, each cable section having one end thereof connected to the needle cooperating member. However, the advancement and displacement cable may alternatively be continuous with a central portion thereof being fixedly connected to the needle cooperating member.

[054] As becomes clear from the foregoing, in this fourth aspect, two motors may be arranged for, in cooperation, advancing or retracting the at least one infusion needle in the advancing or retracting direction and, individually, displacing the needle cooperating member in respectively opposite displacement directions.

[055] In particular, also in this fourth aspect, the at least one infusion needle may comprise only a single infusion needle attached to the needle cooperating member so as to be movable in the displacement direction together with the needle cooperating member. Again, the single infusion needle may be welded or potted to the needle cooperating member and may have a curved section by which it is attached to the needle cooperating member, wherein the curved section may be fixedly held in a correspondingly curved recess of the needle cooperating member. Also, a needle-reinforcing tube may be placed around the single infusion needle to help minimize any deflection of the infusion needle when penetrating the penetration area of the housing’s wall, and a tubing for supplying the substance to be injected through the single infusion needle may be connected to an end of the single infusion needle and looped inside the housing to allow the tubing a required range of motion.

FIFTH ASPECT - Infusion needle with lateral feeding port

[056] According to a fifth aspect of the present disclosure, the at least one infusion needle may have a tubular needle body with a tip end, an injection port arranged at the tip end so as to allow for injecting the substance via the at least one infusion needle, a feeding port arranged distant from the tip end so as to allow for receiving the substance to be injected and a needle lumen inside the tubular needle body connecting the injection port with the feeding port, wherein the feeding port is a side port which is arranged on a side of the tubular needle body. Thus, according to this aspect, the substance to be injected is fed sideways into the needle body. This way, the supply lumen is not in conflict with the rear end of the needle, which end may be used and specifically adapted for moving the infusion needle in the advancing or retracting direction. While this aspect is certainly applicable in cases where only a single infusion needle is present so that only a single supply lumen is required, this aspect may advantageously be employed also in a system which comprises a plurality of infusion needles. In general, in cases where a plurality of needles is provided, the infusion needles may be spaced apart from each other by a distance of between 1 mm and 2 mm, preferably by a distance of 1.5 mm.

[057] In either case, the system may comprise an internal reservoir inside the housing which is arranged for holding the substance to be injected, wherein, when the infusion needle is in an advanced position in which it penetrates the penetration area, the feeding port is positioned inside the internal reservoir and the injection port is positioned outside the housing. Accordingly, in this position the substance, such as an infusion liquid, may enter the infusion needle through the feeding port arranged on the side of the tubular needle body and, when an appropriate pressure is applied on the substance in the internal reservoir, the substance will flow from the internal reservoir through the feeding port, needle lumen and injection port into the patient. In the case of a plurality of infusion needles, they may be arranged so that each of the infusion needles may be advanced individually into a position in which it penetrates the penetration area with its respective feeding port positioned inside the internal reservoir and its respective injection port positioned outside the housing.

[058] Preferably, the penetration area may comprise a septum and the internal reservoir may be arranged within the septum such that, when the infusion needle is in a retracted position, the feeding port is outside the internal reservoir and inside the septum. This way, the feeding port is hermetically closed by the material of the septum when the infusion needle is not in use and retracted.

Alternatively, the dimension of the internal reservoir inside the septum may be such that the feeding port is positioned inside the internal reservoir when the infusion needle is in the retracted position. This may be advantageous in order to ensure that the needle lumen is filled with substance from the internal reservoir before the infusion needle is moved from its retracted position to its advanced position. Again, in the case of a plurality of infusion needles, each of the infusion needles is arranged in this way, preferably in a side-by-side arrangement.

[059] Further preferably, also the injection port at the tip end of the infusion needle or needles may be arranged inside the septum when the infusion needle is in the retracted position. This way, the injection port is safely protected. In this retracted position, the injection port may be arranged inside the septum and outside the internal reservoir. This way, again, also the injection port is hermetically closed by the material of the septum when the infusion needle is not in use and retracted. Furthermore, such arrangement increases the stability of the infusion needle and gives some guidance to the needle movement. Alternatively, the injection port may be arranged inside the septum and inside the internal reservoir when the infusion needle is in the retracted position. Again, this may be advantageous in order to ensure that the needle lumen is already filled with substance from the internal reservoir before the infusion needle is moved from its retracted position to its advanced position.

[060] As regards a supply lumen for supplying the substance to be injected to the internal reservoir, in the cases where the system comprises the above-mentioned one or more linear bearings and translating frame arranged to move along the linear bearings in the advancing and retracting directions so as to advance and/or retract the infusion needle by respective movement of the translating frame, the supply lumen may be arranged so as to run along an inner lumen of the linear bearing. This way the overall size of the housing may be kept small. The inner lumen preferably connects directly to the aforementioned internal reservoir.

[061] Preferably, in this embodiment as well as in all other embodiments described so far, (also) the injection port of the infusion needle is designed as a side port arranged on a side of the tubular needle body, as will be explained in more detail hereinafter. Thus, the infusion needle may be closed at its tip end and the laterally arranged injection port is used for delivery of the drug into the particular body part. Therefore, the infusion needle will not cut out any material but will simply divide it during penetration. Thus, when the infusion needle penetrates any material, such as fibrosis and/or the septum, which may be in the form of a self-sealing penetration membrane, there will be no material entering and blocking the drug delivery passageway.

[062] In all embodiments, the maximum size of the housing is preferably 30 mm x 40 mm x 6 mm.

[063] COMMUNICATION ASPECTAccording to a further aspect of the present disclosure, security of the system against fraudulent third-party intervention may be increased. This is particularly important in the context of wireless communication, which can easily be intercepted and then misused by third parties. Accordingly, the system is preferably configured such that at least one of: wireless communication from or to, or both from and to, a controller of the system is encrypted, data transmitted by a controller via wireless communication is signed, and authentication of a user of the system involves input of authentication data of the patient.

[064] Preferably, the encrypted wireless communication includes encryption with a public key and decryption with a private key, such as the well-known RSA encryption. Other encryption methods may likewise be implemented. Preferably, the security level is further increased in that the private key may be a combined key derived by combining at least a first key and a second key.

[065] Similarly, as regards the signing of the data transmitted wirelessly by a controller, such as by the aforementioned external controller or remote controller to the internal controller, the signing may involve a private key, whereas subsequent verification of the signed data may involve a corresponding public key.

[066] Preferably, data communication involves both an encryption and a signature. The RSA encryption technology allows for both, encrypting the data and adding a digital signature to the data. For the encryption/decryption process, the sender uses a public key of the recipient for encrypting the data and the recipient uses his private key for subsequently decrypting the data, whereas for the signing/authentication process, the sender uses his private key to sign the (encrypted) data and the recipient uses the sender’s public key to authenticate the signature.

[067] As regards the authentication of a user which involves input of authentication data of the patient, the system may comprise a verification unit which is configured to obtain the authentication data of the patient. For instance, the verification unit may comprise at least one of a fingerprint reader, a retina scanner, a camera, a graphical user interface for inputting a code, and a microphone. Only after a positive verification by the verification unit will certain functions of the system be enabled. For instance, the positive verification may enable the controller to process certain data or may open a communication channel between two controllers of the system, such as a wireless communication channel.

[068] Alternatively or in addition, the system may comprise a sensation generator for generating a sensation which is detectable by a sense of the patient. In this course, the patient may input into the system authentication data which relate to what the patient has sensed. Then, the authentication of the user may involve a verification by the verification unit that the authentication data input by the user matches data from the sensation generator which relate to the sensation generated by the sensation generator. Again, only after a positive verification by the verification unit will certain functions of the system be enabled. For instance, the positive verification may enable the controller to process certain data or may open a communication channel between two controllers of the system, such as a wireless communication channel.

[069] In this context, the sensation generator may be configured to generate as the sensation detectable by the sense of the patient at least one of: a vibration, which may include e.g. a fixed-frequency mechanical vibration, a sound, which may include e.g. a superposition of fixed-frequency mechanical vibrations, a photonic signal, which may include e.g. a non-visible light pulse, such as an infrared pulse, a light signal, which may include e.g. a visual light pulse, an electrical signal, which may include e.g. an electrical current pulse, and a heat signal, which may include e.g. a thermal pulse.

General Communication Housing

[070] Further, an external device configured for the communication with the implantable medical device when implanted in a patient is provided, the external device comprising: a display device and a housing unit configured to mechanically and disconnectably connect to the display device, wherein the housing comprises a first communication unit for receiving communication from the display device and a second communication unit for wirelessly transmitting communication to the implantable medical device.

[071] According to one embodiment, the external device comprises a handheld electronic device. [072] According to one embodiment, the external device is configured for communicating with the implantable medical device for changing the operational state of an implantable medical device. The advantage of the embodiment is that the operational state of the implantable medical device can be changed remotely.

[073] According to one embodiment, the first communication unit is a wireless communication unit for wireless communication with the display device. The advantage of the embodiment is that the display device can be communicated without the need of electric wires.

[074] According to one embodiment, the first communication unit is configured to communicate wirelessly with the display device using a first communication frequency and the second communication unit is configured to communicate wirelessly with the implantable medical device using a second communication frequency, wherein the first and second communication frequencies are different. The advantage of the embodiment is that the likelihood of interferences is reduced.

[075] According to one embodiment, the second communication unit is configured to communicate wirelessly with the implantable medical device using electromagnetic waves at a frequency below 100 kHz.

[076] According to one embodiment, the second communication unit is configured to communicate wirelessly with the implantable medical device using electromagnetic waves at a frequency below 40 kHz. The advantage of the embodiment is that titanium, which is commonly used for medical devices, is transparent for electromagnetic waves below 40 kHz.

[077] According to one embodiment, the first communication unit is configured to communicate wirelessly with the display device using electromagnetic waves at a frequency above 100 kHz. The advantage of the embodiment is that the frequency spectrum below 100 kHz remains noise free for the communication with the medical implantable device.

[078] According to one embodiment, the first communication unit is configured to communicate wirelessly with the display device using a first communication protocol and the second communication unit is configured to communicate wirelessly with the implantable medical device using a second communication protocol, wherein the first and second communication protocols are different. The advantage of the embodiment is that the protocol can be independently chosen for the communication of the first and second communication units, depending on which protocol suits the needs of the communication units better.

[079] According to one embodiment, the housing unit comprises a first antenna configured for wireless communication with the display device and a second antenna configured for wireless communication with the implantable medical device. The advantage of the embodiment is that the antenna can be independently chosen for the communication of the first and second communication units, depending on which antenna suits the needs of the communication units better.

[080] According to one embodiment, the first communication unit is a wire-based communication unit for wire-based communication with the display device. The advantage of the embodiment is that the communication of the first communication unit is reliable and secure.

[081] According to one embodiment, the display device comprises a first communication unit for communication with the housing unit and a second communication unit for wireless communication with a second external device. The advantage of the embodiment is that communication with an additional external device becomes possible, thereby introducing redundancy and reliability.

[082] According to one embodiment, the second communication unit of the display device is configured for communicating with the second external device over the internet. The advantage of the embodiment is that the display device can communicate with devices far away.

[083] According to one embodiment, the first communication unit of the display device is a wireless communication unit for wireless communication with the housing unit. The advantage of the embodiment is that the communication unit can be connected to the housing unit without the use of wires.

[084] According to one embodiment, the first communication unit of the display device is configured to communicate wirelessly with the housing unit using a first communication frequency and the second communication unit of the display device is configured to communicate wirelessly with the second external device using a second communication frequency, wherein the first and second communication frequencies are different. The advantage of the embodiment is that the likelihood of interferences is reduced and the signal to interference and noise ratio is increased.

[085] According to one embodiment, the first communication unit of the display device is configured to communicate wirelessly with the housing unit using a first communication protocol and the second communication unit of the display device is configured to communicate wirelessly with the second external device using a second communication protocol, wherein the first and second communication protocols are different. The advantage of the embodiment is that the protocol can be independently chosen for the communication of the first and second communication units, depending on which protocol suits the needs of the communication units better.

[086] According to one embodiment, the display device comprises a first antenna configured for wireless communication with the housing and a second antenna configured for wireless communication with the second external device. The advantage of the embodiment is that the antenna can be independently chosen for the communication of the first and second communication units, depending on which antenna suits the needs of the communication units better.

[087] According to one embodiment, the first communication unit is a wire-based communication unit for wire-based communication with the housing unit. The advantage of the embodiment is that the communication of the first communication unit is reliable and secure.

[088] According to one embodiment, the display device is configured to display a user interface to the patient. The advantage of the embodiment is that the patient can use his familiar display device to communicate with the housing unit.

[089] According to one embodiment, the housing unit is configured to transmit information pertaining to the display of the user interface to the display device. The advantage of the embodiment is that the patient can receive information using his familiar display device.

[090] According to one embodiment, the display device is configured to receive from the patient input pertaining to communication to or from the implantable medical device and transmit signals based on the received input to the housing unit. The advantage of the embodiment is that the patient can use his familiar display device to communicate with the housing unit.

[091] According to one embodiment, the display device comprises a touch screen configured to display the user interface and receive the input from the patient. The advantage of the embodiment is that the patient can use a familiar way of handling the information.

[092] According to one embodiment, the housing unit is configured to display a user interface to the patient. The advantage of the embodiment is that the housing unit can receive user input.

[093] According to one embodiment, the first communication unit of the housing unit is configured to receive communication from the implantable medical device pertaining to input from the patient and wirelessly transmit signals based on the received input to the implantable medical device, using the second communication unit. The advantage of the embodiment is that the housing unit acts as an extra node in the communication between the display device and the medical implantable device, thereby enabling it to monitor the communication.

[094] According to one embodiment, the second communication unit of the housing unit is configured for wireless communication with the implantable medical device using a standard network protocol. The advantage of the embodiment is that the implementation of the communication units is cheap and the protocols are reliable. [095] According to one embodiment, the standard network protocol is one of the list of: Radio Frequency type protocol, RFID-type protocol, WLAN-type protocol, Bluetooth-type protocol, BLE- type protocol, NFC-type protocol, 3G/4G/5G-type protocol, and GSM-type protocol.

[096] According to one embodiment, the second communication unit of the housing unit comprises a Bluetooth transceiver.

[097] According to one embodiment, the second communication unit of the housing unit is configured for wireless communication with the implantable medical device using a proprietary network protocol. The advantage of the embodiment is that the housing unit is compatible with implantable medical devices that use proprietary network protocols.

[098] According to one embodiment, the second communication unit of the housing unit comprises a UWB transceiver. The advantage is that high data rates can be communicated via the second communication unit.

[099] According to one embodiment, the first communication unit of the housing unit is configured for wireless communication with the display device using a standard network protocol. The advantage of the embodiment is that the implementation of the communication units is cheap and the protocols are reliable.

[0100] According to one embodiment, the standard network protocol is an NFC-type protocol. The advantage of the embodiment is that the distance between the communicating devices is limited, thereby protecting against eavesdropping attacks.

[0101] According to one embodiment, the first communication unit of the housing unit is configured for wireless communication with the display device using a proprietary network protocol. The advantage of the embodiment is that the housing unit is compatible with implantable medical devices that use proprietary network protocols.

[0102] According to one embodiment, a communication range of the first communication unit of the housing unit is less than a communication range of the second communication unit of the housing unit. The advantage of the embodiment is that energy is saved by selecting the first communication unit when its range suffices.

[0103] According to one embodiment, a communication range of the first communication unit of the display device is less than a communication range of the second communication unit of the display device. The advantage of the embodiment is that energy is saved by selecting the first communication unit when its range suffices. [0104] According to one embodiment, at least one of the housing unit and the display device is configured to allow communication between the housing unit and the display device on the basis of a distance between the housing unit and the display device. The advantage of the embodiment is that the distance is used as a safety and authorization factor.

[0105] According to one embodiment, at least one of the housing unit and the display device is configured to allow communication between the housing unit and the display device on the basis of the housing unit being mechanically connected to the display device. The advantage of the embodiment is that the safety against a man-in-the-middle attacks is increased.

[0106] According to one embodiment, the housing unit is configured to allow communication between the housing unit and the implantable medical device on the basis of a distance between the housing unit and the implantable medical device. The advantage of the embodiment is that the distance is used as a safety and authorization factor.

[0107] According to one embodiment, the housing unit further comprises an encryption unit configured to encrypt communication received from the display device. The advantage of the embodiment is that the encrypted communication is protected against unwanted third party access.

[0108] According to one embodiment, the housing unit is further adapted to transmit the encrypted communication to the implantable medical device using the second communication unit. The advantage of the embodiment is that the encrypted communication is protected against unwanted third party access.

[0109] According to one embodiment, the second communication unit of the display device is configured to be disabled to enable at least one of: communication between the display device and the housing unit, and communication between the housing unit and the implantable medical device.

[0110] The display device in any of the embodiments described herein may be a wearable device or a handset. The advantage of the embodiment is that the device is mobile and can be used where needed.

[0111] According to one embodiment, the housing unit comprises a case for the wearable device or handset. The advantage of the embodiment is that the wearable device or handset can be protected from mechanical damage.

[0112] Further, a housing unit configured for communication with the implantable medical device when implanted in a patient is provided, the housing unit being configured to mechanically connect to a display device and comprising a first communication unit for communication with the display device and a second communication unit for wireless communication with the implantable medical device. [0113] According to one embodiment, the display device is a wearable device or a handset and the housing unit comprises a case for the wearable device or handset.

[0114] According to one embodiment, the first communication unit is a wireless communication unit for wireless communication with the display device.

[0115] According to one embodiment, the first communication unit is configured to communicate wirelessly with the display device using a first communication frequency and the second communication unit is configured to communicate wirelessly with the implantable medical device using a second communication frequency, wherein the first and second communication frequencies are different.

[0116] According to one embodiment, the housing unit is configured to transmit information pertaining to the display of a user interface to the display device.

[0117] According to one embodiment, the housing unit is configured to receive patient input from the display device.

[0118] According to one embodiment, the housing unit is configured to display a user interface to the patient.

[0119] According to one embodiment, the housing unit is configured to allow communication between the housing unit and the display device on the basis of a distance between the housing unit and the display device.

[0120] According to one embodiment, the housing unit is configured to allow communication between the housing unit and the display device on the basis of the housing unit being mechanically connected to the display device.

[0121] According to one embodiment, the housing unit is configured to allow communication between the housing unit and the implantable medical device on the basis of a distance between the housing unit and the implantable medical device.

[0122] According to one embodiment, the housing unit further comprises an encryption unit configured to encrypt communication received from the display device.

[0123] According to one embodiment, the housing unit is further adapted to transmit the encrypted communication to the implantable medical device using the second communication unit. [0124] According to one embodiment, the minimum bounding box of the housing unit and the display device, when the housing is mechanically connected to the display device, is no more than 10 % wider, 10 % longer or 100 % higher than the minimum bounding box of the display device.

[0125] According to one embodiment, the housing unit comprises one or more switches configured to be used by the patient when the housing is not mechanically connected to the display device.

[0126] According to one embodiment, the switches are at least partly covered by the display device, when the display device is mechanically connected to the housing unit.

[0127] According to one embodiment, at least a part of the housing bends in order to mechanically connect to the display device.

[0128] According to one embodiment, at least a part of the housing is configured to clasp the display device.

[0129] According to one embodiment, the housing is configured to cover at least one side of the display device when it is mechanically connected to the display device.

[0130] According to one embodiment, the housing is configured to be mechanically connected to the display device by a device which is mechanically connected to the housing and the display device.

General Security Module

[0131] Further, an implantable controller for the implantable medical device is provided. The implantable controller comprises a wireless transceiver for communicating wirelessly with an external device, a security module, and a central unit configured to be in communication with the wireless transceiver, the security module and the implantable medical device. The wireless transceiver is configured to receive communication from the external device including at least one instruction to the implantable medical device and transmit the received communication to the central unit. The central unit is configured to send secure communication to the security module derived from the communication received from the external device, and the security module is configured to decrypt at least a portion of the secure communication and/or verify the authenticity of the secure communication. The security module is configured to transmit a response communication to the central unit and the central unit is configured to communicate the at least one instruction to the implantable medical device, the at least one instruction being based on the response communication or on a combination of the response communication and the communication received from the external device. [0132] According to one embodiment, the security module comprises a set of rules for accepting communication from the central unit.

[0133] According to one embodiment, the wireless transceiver is configured to be placed in an off- mode, in which no wireless communication can be transmitted or received by the wireless transceiver, and wherein the set of rules comprises a rule stipulating that communication from the central unit is only accepted when the wireless transceiver is placed in the off-mode.

[0134] According to one embodiment, the set of rules comprises a rule stipulating that communication from the central unit is only accepted when the wireless transceiver has been placed in the off-mode for a specific time period.

[0135] According to one embodiment, the central unit is configured to verify a digital signature of the received communication from the external device.

[0136] According to one embodiment, the set of rules comprises a rule stipulating that communication from the central unit is only accepted when the digital signature of the received communication has been verified by the central unit.

[0137] According to one embodiment, the central unit is configured to verify the size of the received communication from the external device.

[0138] According to one embodiment, the set of rules comprises a rule stipulating that communication from the central unit is only accepted when the size of the received communication has been verified by the central unit.

[0139] The wireless transceiver of any of the preceding embodiments may be configured to receive a message from the external device being encrypted with at least a first and second layer of encryption and the central unit may be configured to decrypt a first layer of decryption and transmit at least a portion of the message comprising the second layer of encryption to the security model. The security module may be configured to decrypt the second layer of encryption and transmit a response communication to the central unit based on the portion of the message decrypted by the security module.

[0140] According to one embodiment, the central unit may be configured to decrypt a portion of the message comprising a digital signature such that the digital signature can be verified by the central unit. [0141] According to one embodiment, the central unit is configured to decrypt a portion of the message comprising message size information such that the message size can be verified by the central unit.

[0142] According to one embodiment, the central unit is configured to decrypt a first and second portion of the message, and the first portion comprises a checksum for verifying the authenticity of the second portion.

[0143] According to one embodiment, the response communication transmitted from the security module comprises a checksum, and the central unit may be configured to verify the authenticity of at least a portion of the message decrypted by the central unit using the received checksum.

[0144] According to one embodiment, the set of rules comprises a rule related to the rate of data transfer between the central unit and the security module.

[0145] The security module in any of the embodiments herein may be configured to decrypt a portion of the message comprising a digital signature, encrypted with the second layer of encryption, such that the digital signature can be verified by the security module.

[0146] The central unit may be configured such that it is only capable of decrypting a portion of the communication received from the external device when the wireless transceiver is placed in the off- mode.

[0147] According to one embodiment, the central unit is only capable of communicating the at least one instruction to the implantable medical device when the wireless transceiver is placed in the off- mode.

[0148] According to one embodiment, the implantable controller is configured to receive, using the wireless transceiver, a message from the external device comprising a first non-encrypted portion and a second encrypted portion, decrypt the encrypted portion, and use the decrypted portion to verify the authenticity of the non-encrypted portion.

[0149] According to one embodiment, the central unit is configured to transmit the encrypted portion to the security module, receive a response communication from the security module based on information contained in the encrypted portion being decrypted by the security module, and use the response communication to verify the authenticity of the non-encrypted portion.

[0150] According to one embodiment, the non-encrypted portion comprises at least a portion of the at least one instruction to the implantable medical device. [0151] The implantable controller may be configured to receive, using the wireless transceiver, a message from the external device comprising information related to at least one of a physiological parameter of the patient and a physical parameter of the implanted medical device and use the received information to verify the authenticity of the message.

[0152] The physiological parameter of the patient may comprise at least one of: a temperature, a heart rate and a saturation value.

[0153] The physical or functional parameter of the implanted medical device may comprise at least one of: a current setting or value of the implanted medical device, a prior instruction sent to the implanted medical device and an ID of the implanted medical device.

[0154] According to one embodiment, the portion of the message comprising the information is encrypted, and the central unit is configured to transmit the encrypted portion to the security module and receive a response communication from the security module based on the information having been decrypted by the security module.

[0155] According to one embodiment, the security module comprises a hardware security module comprising at least one hardware -based key. The hardware-based key may correspond to a hardwarebased key in the external device, which may be a hardware -based key on a key-card connectable to the external device.

[0156] According to one embodiment, the security module comprises a software security module comprising at least one software-based key. The software-based key may correspond to a softwarebased key in the external device. The software-based key may correspond to a software -based key on a key-card connectable to the external device. The security module may in any of the embodiments comprise a combination of a software-based key and a hardware-based key.

[0157] In any of the preceding embodiments, the implantable controller may comprise at least one crypto-processor.

[0158] The wireless transceiver may in any of the embodiments be configured to receive communication from a handheld external device.

[0159] According to one embodiment, the at least one instruction to the implantable medical device may comprise an instruction for changing an operational state of the implantable medical device.

[0160] The wireless transceiver may be configured to communicate wirelessly with the external device using electromagnetic waves at a frequency below 100 kHz or at a frequency below 40 kHz. [0161] According to one embodiment, the wireless transceiver is configured to communicate wirelessly with the external device using a first communication protocol, and the central unit is configured to communicate with the security module using a second different communication protocol.

[0162] In any of the embodiments , the wireless transceiver may be configured to communicate wirelessly with the external device using a standard network protocol. The standard network protocol may be selected from a list comprising RFID-type protocols, WLAN-type protocols, Bluetooth type protocols, BLE-type protocols, NFC-type protocols, 3G/4G/5G-type protocols, and GSM-type protocols.

[0163] The wireless transceiver may in some embodiments be configured to communicate wirelessly with the external device using a proprietary network protocol.

[0164] According to one embodiment, the wireless transceiver comprises a UWB transceiver.

[0165] According to one embodiment, the security module and/or the central unit and/or the wireless transceiver are comprised in the controller.

[0166] The external unit in any of the embodiments herein may be a wearable device or a handset. The advantage of the embodiment is that the device is mobile and can be used where needed.

[0167] Further, the implantable medical device may comprise a receiving unit. The implantable medical device comprises at least one coil configured for receiving transcutaneously transferred energy, a measurement unit configured to measure a parameter related to the energy received by the coil, a variable impedance electrically connected to the coil, a switch placed between the variable impedance and the coil for switching off the electrical connection between the variable impedance and the coil. The implantable medical device further comprises a controller configured to control at least one of the variable impedance for varying the impedance and thereby tune the coil based on the measured parameter, and the switch for switching off the electrical connection between the variable impedance and the coil in response to when the measured parameter exceeds a threshold value.

[0168] According to one embodiment, the controller is configured to vary the variable impedance in response to when the measured parameter exceeds a threshold value.

[0169] According to one embodiment, the measurement unit is configured to measure a parameter related to the energy received by the coil over a time period.

[0170] According to one embodiment, the measurement unit is configured to measure a parameter related to a change in energy received by the coil. [0171] According to one embodiment, the first switch is placed at a first end portion of the coil, and the implantable medical device further comprises a second switch placed at a second end portion of the coil such that the coil can be completely disconnected from other portions of the implantable medical device.

[0172] According to one embodiment, the receiving unit is configured to receive transcutaneously transferred energy in pulses according to a pulse pattern, and the measurement unit is configured to measure a parameter related to the pulse pattern.

[0173] According to one embodiment, the controller is configured to control the variable impedance in response to when the pulse pattern deviates from a predefined pulse pattern.

[0174] According to one embodiment, the controller is configured to control the switch for switching off the electrical connection between the variable impedance and the coil in response to the pulse pattern deviating from a predefined pulse pattern.

[0175] According to one embodiment, the measurement unit is configured to measure a temperature in the implantable medical device or in the body of the patient, and the controller is configured to control the first and second switch in response to the measured temperature.

[0176] According to one embodiment, the variable impedance comprises a resistor and a capacitor, a resistor and an inductor and/or an inductor and a capacitor.

[0177] The variable impedance may comprise a digitally tuned capacitor. The variable impedance may comprise a digital potentiometer. The variable impedance may comprise a variable inductor.

[0178] According to one embodiment, the variation of the impedance is configured to lower the active power that is received by the receiving unit.

[0179] According to one embodiment, the variable impedance is placed in series with the coil.

[0180] According to one embodiment, the variable impedance is placed parallel to the coil.

[0181] According to one embodiment, the implantable medical device further comprises an energy storage unit connected to the receiving unit. The energy storage unit is configured to store energy received by the receiving unit.

ANOTHER ASPECT - SURFACE COATING

[0182] Another aspect of the present disclosure relates to the mitigation of fibrin creation caused by contact between a medical implant, such as the above-discussed implantable system, and the tissue or flowing blood of a patient. As is well known, the body tends to react to a medical implant, partly because the implant is a foreign object, and partly because the implant interacts mechanically with tissue of the body and/or blood flowing within the body. Implantation of medical devices and/or biomaterial in the tissue of a patient may trigger the body’s foreign body reaction leading to the formation of foreign body giant cells and the development of a fibrous capsule enveloping the implant. The formation of a dense fibrous capsule that isolates the implant from the host is the common underlying cause of implant failure. Implantation of medical devices and/or biomaterial in a blood flow may also cause the formation of fibrous capsules due to the attraction of certain cells within the blood stream. Implants may, due to the fibrin formation, cause blood clotting leading to complications for the patient. Implants in contact with flowing blood and/or placed in the body may also lead to bacterial infection. One common way of counteracting the creation of blood clots is by using blood thinners of different sorts. One commonly used blood thinner is called heparin. However, heparin has certain side effects that are undesirable.

[0183] In general, fibrin is an insoluble protein that is partly produced in response to bleeding and is the major component of blood clots. Fibrin is formed by fibrinogen, a soluble protein that is produced by the liver and found in blood plasma. When tissue damage results in bleeding, fibrinogen is converted at the wound into fibrin by the action of thrombin, a clotting enzyme. The fibrin then forms, together with platelets, a hemostatic plug or clot over a wound site. The process of forming fibrin from fibrinogen starts with the attraction of platelets. Platelets have thrombin receptors on their surfaces that bind serum thrombin molecules. These molecules can in turn convert soluble fibrinogen into fibrin. The fibrin then forms long strands of tough and insoluble protein bound to the platelets. The strands of fibrin are then cross-linked so that it hardens and contracts. This is enabled by Factor XIII which is a zymogen found in the blood of humans. Fibrin may also be created due to the foreign body reaction. When a foreign body is detected in the body, the immune system will become attracted to the foreign material and attempt to degrade it. If this degradation fails, an envelope of fibroblasts may be created to form a physical barrier to isolate the body from the foreign body. This may further evolve into a fibrin sheath. In case the foreign body is an implant, this may hinder the function of the implant.

[0184] Thus, implants can, when implanted in the body, be in contact with flowing blood. This may cause platelet adhesion on the surface of the implants. The platelets may then cause the fibrinogen in the blood to convert into fibrin creating a sheath on and/or around the implant. This may prevent the implant from working properly and may also create blood clots that are perilous for the patient. However, implants not in contact with flowing blood can still malfunction due to fibrin creation. Here the foreign body reaction may be the underlying factor for the malfunction. Further, the implantation of a foreign body into the human body may cause an inflammatory response. The response generally persists until the foreign body has been encapsulated in a relatively dense layer of fibrotic connective tissue which protects the human body from the foreign body. The process may start with the implant immediately and spontaneously acquiring a layer of host proteins. The blood protein-modified surface enables cells to attach to the surface, enabling monocytes and macrophages to interact on the surface of the implant. The macrophages secrete proteins that modulate fibrosis and in turn develop the fibrosis capsule around the foreign body, i.e., the implant. In practice, a fibrosis capsule may be formed of a dense layer of excess fibrous connective tissue. The inelastic properties of the fibrotic capsule may lead to hardening, tightness, deformity, and distortion of the implant, which in severe cases may result in revision surgery.

[0185] Implants may also cause infections of different sorts. Bacterial colonization that leads to implant-associated infections are a known issue for many types of implants. For example, the commensal skin bacteria, Staphylococci, and the Staphylococcus aureus tend to colonize foreign bodies such as implants and may cause infections. A problem with the Staphylococci is that it may also produce a biofilm around the implant encapsulating the bacterial niche from the outside environment. This makes it harder for the host defense systems to take care of the bacteria. There are other examples of bacteria and processes that creates bacteria causing infection due to implants.

[0186] Thus, according to this further aspect of the present disclosure, in order to mitigate fibrin creation caused by contact between components of the above-discussed implantable system, and the tissue or flowing blood of a patient, the implantable components of the system may comprise a specific coating arranged on the respective outer surface of the component. The coating may comprise at least one layer of a biomaterial. The biomaterial is preferably fibrin -based. The coating may comprise at least one drug or substance with antithrombotic and/or antibacterial and/or antiplatelet characteristics. The drug or substance may be encapsulated in a porous material.

[0187] There may be provided a second coating arranged on the first coating. The second coating may be a different biomaterial than said first coating. In particular, the first coating may comprise a layer of perfluorocarbon chemically attached to the surface and the second coating may comprise a liquid perfluorocarbon layer.

[0188] Further preferably, the surface may comprise a metal, such as at least one of titanium, cobalt, nickel, copper, zinc, zirconium, molybdenum, tin or lead.

[0189] Finally, the surface may comprise a micro pattern, wherein the micro pattern may be etched into the surface prior to insertion into the body. The layer of a biomaterial may be coated on the micro pattern.

FURTHER ASPECT - SECURE INJECTION OF DRUGS [0190] A further aspect of the present disclosure relates to the manner of securely injecting drugs into a vessel of the patient, in particular into a blood vessel, for instance into an artery or a vein, using a system according to any one of the embodiments disclosed herein, i.e. involving an infusion needle which is advanced into and retracted from the vessel.

FIRST SUB-ASPECT - Short distance of needle injection port

[0191] According to a first sub-aspect of this further aspect, as already mentioned previously, the infusion needle may comprise an injection port on a side surface thereof. Preferably, said injection port is spaced apart from the tip end of the at least one infusion needle by less than 2 mm, more preferably less than 1 mm, even more preferably between 0.5 and 1 mm. This is particularly helpful in situations where the vessel to be pierced has a small diameter. Namely, due to the injection port being a side port and being arranged very close to the tip end of the infusion needle, the infusion needle needs to be advanced into the vessel only over a very short distance in order for placing the injection port inside the vessel, thereby preventing that the tip end of the infusion needle extends through and out of the vessel wall on the opposite side of the vessel. The above-mentioned spacing relates to the distance between the tip end of the infusion needle and the end of the injection port closest to the tip end. In this context, the injection port preferably has an extension of not more than 0.5 mm in a longitudinal direction of the infusion needle, more preferably not more than 0.3 mm, even more preferably not more than 0.2 mm.

[0192] Further preferably, the injection port may have an extension in a direction transverse to the longitudinal direction of the infusion needle which is greater than an extension of the injection port in the longitudinal direction of the infusion needle. This way, the cross-sectional area of the injection port can be kept large while reducing the longitudianl extension of the injection port, thereby ensuring that, upon advancement of the infusion needle into the vessel, the injection port is fully contained in the lumen of the vessel due to the injection port’s short longitudinal extension.

[0193] Accordingly, the at least partly implantable system for injecting a substance into a patient’s body may comprise: a housing adapted for implantation inside the patient’s body, the housing having an outer wall with a penetration area, at least one infusion needle disposed in the housing, and a drive unit arranged for advancing and retracting the at least one infusion needle in opposite advancing and retracting directions so that a tip end of the at least one infusion needle penetrates, upon advancement of the at least one infusion needle, said penetration area so as to allow for injecting the substance through said penetration area via the at least one infusion needle, wherein the infusion needle is designed as stated above, i.e. being provided with an injection port on a side surface of the at least one infusion needle, said injection port being spaced apart from the tip end of the at least one infusion needle by less than 2 mm preferably less than 1 mm, more preferably between 0.5 and 1 mm, and preferably having an extension of not more than 0.5 mm in a longitudinal direction of the infusion needle, more preferably not more than 0.3 mm, even more preferably not more than 0.2 mm, and further preferably having an extension in a direction transverse to a longitudinal direction of the infusion needle which is greater than an extension of the injection port in the longitudinal direction of the infusion needle.

SECOND SUB-ASPECT - Inclined needle

[0194] According to a second sub-aspect of this further aspect, the injection needle may be arranged so that it enters, upon advancement, into the vessel in an inclined manner, i.e. non -vertically. This can be achieved by arranging the infusion needle such that it does not extend from the housing vertically, when advanced, but extends at an inclined angle relative to an outer surface of the housing. To this end, the outer wall of the housing of the implantable system may have an outer surface which extends in a first direction and which is configured so that a longitudinal vessel, such as a vein or an artery, is placeable adjacent said outer surface in such a manner that a central axis of the longitudinal vessel extends in parallel to said first direction. Then, when the advancing and retraction directions of the at least one infusion needle are arranged in a plane defined by said first direction of the outer surface of the housing’s outer wall and said central axis of the longitudinal vessel and at an inclination angle relative to said first direction, the infusion needle enters, upon advancement, the vessel at such an inclination angle. In other words, the infusion needle is arranged inside the housing angularly with respect to the housing’s outer wall, more specifically with respect to the outer surface of the housing’s outer wall. In any case, the infusion needle is preferably inclined relative to the outer wall of the housing by an inclination angle which is smaller than 90° and preferably in a range of 10° and 80°, more preferably in a range of 20° to 40°.

[0195] It is further preferred to provide a holder that is configured to hold, when the at least one infusion needle is being advanced, the longitudinal vessel in position relative to the housing such that the central axis of the vessel extends in parallel to said first direction of the outer surface of the housing’s outer wall. The holder ensures, on the one hand, that the vessel is correctly positioned and, on the other hand, that the vessel cannot move away, when it is being pierced by the infusion needle.

[0196] Preferably, the holder is configured to enclose a section of the longitudinal vessel either partly or preferably about its entire circumference, namely in manner so that the vessel cannot escape from the holder. In this regard, the holder may comprise a movable lid configured to open and close the holder for placing and holding said section of the longitudinal vessel inside the holder.

[0197] More preferably, the first direction may change in a curve. That is, as mentioned above, the outer surface of the housing may extend in a first direction and may be configured so that a longitudinal vessel can be placed adjacent said outer surface. If the first direction changes in a curve, i.e. if the surface along which the vessel is placed is curved in an appropriate direction, then the tip end of the infusion needle being advanced through a vessel wall into the vessel is less likely to pierce through an opposing vessel wall upon further advancement.

[0198] Accordingly, the at least partly implantable system for injecting a substance into a patient’s body may comprise: a housing (or casing) adapted for implantation inside the patient’s body, the housing having an outer wall with a penetration area, at least one infusion needle disposed in the housing so as to penetrate the penetration area and configured for being advanced and retracted in opposite advancing and retraction directions between an advanced position and a retracted position, wherein the system is adapted to inject the substance into the patient’s body via the at least one infusion needle when the infusion needle is in the advanced position, and wherein injection of the substance into the patient’s body via the at least one infusion needle is not possible when the infusion needle is in the retracted position, and a drive unit may be arranged for advancing and retracting the at least one infusion needle in the opposite advancing and retracting directions so that a tip end of the at least one infusion needle penetrates, upon advancement of the at least one infusion needle, said penetration area so as to allow for injecting the substance through said penetration area via the at least one infusion needle, wherein the outer wall of the housing may have an outer surface extending in a first direction and configured so that a longitudinal vessel is placeable adjacent said outer surface such that a central axis of the vessel extends in parallel to the first direction, and wherein the advancing and retraction directions of the at least one infusion needle are arranged in a plane defined by said first direction and said longitudinal axis of the vessel and at an inclination angle relative to said first direction, wherein said inclination angle is preferably in a range of 10° and 80°, more preferably in a range of 20° to 40°, wherein the system may further comprise the above-mentioned holder.

Curved needle

[0199] According to a further preferred aspect, the inclined needle is a curved needle. More specifically, at least a tip end section of the infusion needle, which is a section including the tip end of the infusion needle, is curved in a plane of curvature. This provides certain advantages. First, the effect of a curved needle is similar to the effect of the curved surface along which the vessel is placed, as described above. Namely, if the curved needle is advanced into the vessel by rotating the infusion needle about an axis which may substantially correspond with an axis about which the tip end section of the infusion needle is curved, then the tip end of the infusion needle being advanced through a vessel wall into the vessel is less likely to pierce through an opposing vessel wall upon further advancement. Accordingly, advancement and retraction of the infusion needle in the advancing and retraction directions preferably comprises rotation of the tip end section of the infusion needle about an axis of rotation which is vertical to the plane of curvature. It is further preferred to combine the curved surface along which the vessel is placed with the curved needle.

[0200] A second effect is that the housing in which the rotatable curved needle is housed may be designed smaller as compared to a housing in which one or more straight infusion needles are accommodated which are longitudinally displaceable in the infusion needle’s advancing and retraction directions.

[0201] Accordingly, the at least partly implantable system for injecting a substance into a patient’s body may comprise an at least partly implantable system for injecting a substance into a patient’s body, comprising: a housing or casing adapted for implantation inside the patient’s body, the housing or casing having an outer wall with a penetration area, at least one infusion needle disposed in the housing or casing so as to penetrate the penetration area and configured for being advanced and retracted in opposite advancing and retraction directions between an advanced position and a retracted position, wherein the system is adapted to inject the substance into the patient’s body via the at least one infusion needle when the infusion needle is in the advanced position, and wherein injection of the substance into the patient’s body via the at least one infusion needle is not possible when the infusion needle is in the retracted position, wherein the infusion needle is inclined relative to the outer wall by an inclination angle in a range of 10° and 80° and wherein at least a tip end section of the at least one infusion needle, which is a section including a tip end of the at least one infusion needle, is curved in a plane of curvature, wherein preferably advancement and retraction of the at least one infusion needle in the advancing and retraction directions comprises rotation of the tip end section of the at least one infusion needle about an axis of rotation which is vertical to the plane of curvature.

EVEN FURTHER ASPECT - Needle passing diaphragm [0202] An even further aspect of the present disclosure relates to a problem which may arise when an infusion needle has an injection port on a side surface thereof. In this case, when the infusion needle passes through a diaphragm which separates the interior of the housing from the exterior, the injection needle creates a hole in the diaphragm and the injection port on the side surface of the infusion needle moves along the material from which the diaphragm is made, such as silicon material or any other polymeric material. This may cause some scratching and, consequently, abrasion of the diaphragm material and transport thereof into the patient’s body.

FIRST SUB-ASPECT - Needle in tube

[0203] According to a first sub-aspect of this even further aspect, the system may be configured such that, when the at least one infusion needle is in a retracted position, the tip end of the infusion needle is arranged in a tube, wherein an inner surface of the tube and an outer surface of the infusion needle are liquid-tightly sealed against each other. This results in a sealing of the injection port, namely in a manner such that fluid ingress, such as blood ingress, through the tube and further into the injection port is securely prevented. Preferably, an inner diameter of the inner surface of the tube and an outer diameter of the outer surface of the at least one infusion needle match each other so as to liquid-tightly seal against each other in order to prevent fluid ingress through the tube and into the injection port. That is, the sealing surfaces are constituted by these two surfaces. Preferably, the injection port is arranged in this sealing section of the infusion needle. In a preferred embodiment, one or preferably both of the inner surface of the tube and the outer surface of the infusion needle - preferably comprising the section where the injection port is arranged - is made of ceramic material. Ceramics can be manufactured with high precision so as to provide mutually opposing sliding surfaces with small tolerances, thereby allowing to produce a liquid-tight fit between said inner and outer surfaces. Then, when the infusion needle and its injection port are advanced from the tube so as to extend from the housing, the needle does not need to pinch a hole into the housing’s wall in order to penetrate it. Rather, the hole is already provided in the wall by the tube within which the tip end of the infusion needle resides. This reduces the risk that material is scraped off of the wall by means of an edge of the injection port’s opening when the infusion needle is being advanced. While the tube has one end which is open to the exterior of the housing at the time when the infusion needle is in its retracted position, there is no danger that any kind of body fluid or fibrosis can get into the needle or block the needle, because of the inner surface of the tube and outer surface of the infusion needle being liquid-tightly sealed against each other or liquid tightly sealing against each other. Rather, when the needle is advanced to extend out of the tube, any fibrosis inside the tube will be pushed out and any fibrosis in front of the tube will be penetrated by means of the infusion needle.

[0204] Accordingly, the at least partly implantable system for injecting a substance into a patient’s body may comprise: a housing adapted for implantation inside the patient’s body, the housing having an outer wall with a penetration area, at least one infusion needle disposed in the housing, and a drive unit arranged for advancing and retracting the at least one infusion needle in opposite advancing and retracting directions so that a tip end of the at least one infusion needle penetrates, upon advancement of the at least one infusion needle, said penetration area so as to allow for injecting the substance through said penetration area via the at least one infusion needle, wherein an injection port is provided on a side surface of the at least one infusion needle and wherein, when the at least one infusion needle is in a retracted position, the tip end of the infusion needle is arranged in a tube, wherein an inner surface of the tube and an outer surface of the at least one infusion needle are liquid-tightly sealed against each other so as to prevent fluid ingress, e.g. blood ingress, through the tube and into the injection port, wherein preferably an inner diameter of the inner surface of the tube and an outer diameter of the outer surface of the at least one infusion needle match each other so as to liquid-tightly seal against each other in order to prevent fluid ingress through the tube and further into the injection port, wherein more preferably one or both of the inner surface of the tube and the outer surface of the at least one infusion needle, preferably including a section of the infusion needle comprising the injection port, is made of ceramic material.

SECOND SUB-ASPECT - Pre-configured elastic opening

[0205] According to a second sub-aspect of this even further aspect, the penetration area of the housing’s outer wall to be penetrated by the infusion needle may be made at least partly of an elastic material in which a passage is pre-configured for the at least one infusion needle to pass through, said passage being normally closed by resilient forces that are generated by the elasticity of the elastic material, such as silicone or any other elastic polymeric material. Thus, external forces are not required to keep the passage closed against ingress of body fluids or ingrowth of fibrosis. Then, when the infusion needle and its injection port are advanced through said pre-configured passage, the needle does not need to pinch a hole into the housing’s wall in order to penetrate it. Rather, the passage is already provided in the wall and needs only to be opened. For instance, the passage may automatially open by the tip end of the infusion needle diving into the passage, thereby expanding it to open. This reduces the risk that material is scraped off of the wall by means of an edge of the injection port’s opening when the infusion needle is being advanced.

[0206] In a preferred embodiment, the passage has a widened entrance section facing towards the housing. Thus, in the entrance section the passage is normally open for the at least one infusion needle to enter into the passage when it is being advanced. This facilitates the insertion of the infusion needle into and further through the passage.

[0207] In other embodiments, the tip end of the infusion needle may reside inside the passage when the infusion needle is in its retracted position. This avoids the need to properly feed the infusion needle into the passage when it is being advanced. This is, however, only an option forthose embodiments where the tip end of the infusion needle is moved forward and backward but not laterally between successive infusions.

[0208] Preferably, the passage is configured as a slit having a lengthwise extension through the wall and a widthwise extension. Such slit may be compressed by acting upon opposite sides of the elastic material in opposite directions of the slit’s widthwise extension so that the slit opens up, thereby opening the passage for the at least one infusion needle when the infusion needle is being advanced. In one embodiment, a compressor is operatively connected with the infusion needle and is arranged to compress the slit along its widthwise extension when the needle is beeing advanced.

[0209] Accordingly, the at least partly implantable system for injecting a substance into a patient’s body may comprise: a housing adapted for implantation inside the patient’s body, the housing having an outer wall with a penetration area, at least one infusion needle disposed in the housing, and a drive unit arranged for advancing and retracting the at least one infusion needle in opposite advancing and retracting directions so that a tip end of the at least one infusion needle penetrates, upon advancement of the at least one infusion needle, said penetration area so as to allow for injecting the substance through said penetration area via the at least one infusion needle, wherein said penetration area is at least partly made of an elastic material in which a passage is preconfigured for the at least one infusion needle to pass through, said passage being normally closed by resilient forces that are generated by the elasticity of the elastic material, wherein preferably the passage has a widened entrance section where the passage is normally open for the at least one infusion needle to enter into the passage and/or the passage opens automatically for the at least one infusion needle to pass through when the infusion needle is being advanced, the passage preferably being configured as a slit having a lengthwise extension and a widthwise extension, wherein a compressor may be provided to act upon opposite sides of the elastic material in opposite directions of the slit’s widthwise extension so as to open the passage for the at least one infusion needle when the infusion needle is being advanced. THIRD SUB-ASPECT - Needle injection port with rounded or beveled edge

[0210] According to a third sub-aspect of this even further aspect, there may be provided an infusion needle, the injection port of which being again provided on a side surface thereof and, here, having a rounded or beveled edge at a transition between the injection port and the side surface. In other words, the edge surrounding the injection port on the outer surface of the injection needle may be rounded or beveled. This way, sharpness of the edge is reduced, thereby reducing the risk that material is scraped off by means of an edge of the injection port’s opening when the infusion needle is being advanced. Prefereably, the rounded or beveled edge is provided at least on opposite sides of the injection port, wherein a hypothetical connecting line between said opposite sides of the injection port extends along the advancing and retracting directions of the infusion needle. These are the areas of the injection port where scraping off of material by means of the injection port’s outer edge occurs most.

[0211] Accordingly, an at least partly implantable system for injecting a substance into a patient’s body may comprise: a housing adapted for implantation inside the patient’s body, the housing having an outer wall with a penetration area, at least one infusion needle disposed in the housing, and a drive unit arranged for advancing and retracting the at least one infusion needle in opposite advancing and retracting directions so that a tip end of the at least one infusion needle penetrates, upon advancement of the at least one infusion needle, said penetration area so as to allow for injecting the substance through said penetration area via the at least one infusion needle, wherein an injection port is provided on a side surface of the at least one infusion needle, said injection port having a rounded or beveled edge at a transition between the injection port and the side surface, wherein preferably the rounded or beveled edge is provided at least on opposite sides of the injection port, wherein a hypothetical connecting line between said opposite sides of the injection port extends along the advancing and retracting directions of the infusion needle.

[0212] FOURTH SUB-ASPECT - Needle with stylet According to a third sub-aspect of this even further aspect, an injection port on the side of the infusion needle is obviated. Instead, the injection port is provided in a front side of the tip end of the infusion needle, in the usual way, through which the substance is dispensable to the outside of the infusion needle. A stylet is provided which is movable within the hollow body of the infusion needle between an advanced position, in which the stylet is so far advanced inside the hollow body that it closes the injection port so as to prevent fibrosis from growing into the infusion needle when the infusion needle is implanted in a patient, and a retracted position, in which the stylet is - at least - so far retracted inside the hollow body that a pathway is open for the substance to flow through the hollow body out of the injection port.

[0213] A main advantage of the stylet closing the injection port is not only that it prevents fibrosis from growing into the infusion needle but also that the infusion needle cannot cut out any material from the penetration area, i.e. a diaphragm or septum or membrane, through which the infusion needle passes with its tip end upon advancement of the infusion needle from its retracted position to it advanced position.

[0214] In the advanced position of the stylet, the stylet may even extend from the tip end of the at least one infusion needle. In other words, the tip end of the stylet is the part which cuts through the penetration area, so that only the tip end of the stylet needs to be sharp, whereas the tip end of the needle body may be blunt. This may reduce the risk of tissue damage in cases where the needle stays advanced into the patient’s body over a longer time period.

[0215] In a general manner, in its retracted position, the stylet may even be retracted out of the hollow body of the infusion needle so that it disengages from the infusion needle, but it is preferable when the tip end of the stylet remains in the hollow body when the stylet is in its fully retracted position in order to facilitate its re-insertion into the infusion needle and in order to provide a seal against leakage of drugs from the infusion needle when the drugs are injected through the infusion needle into the patient’s body. For this purpose, a feeding port may be provided in a side wall of the hollow body so as to allow for the substance to be fed through the feeding port into the hollow.

[0216] In the embodiments described so far, the tip end of the infusion needle penetrates, upon advancement of the infusion needle, said penetration area, i.e. membrane, septum, diaphragm, etc. However, the infusion needle having the injection port in the front side of the tip end of the infusion needle and a stylet within the hollow body of the infusion needle which closes the injection port so as to prevent fibrosis from growing into the infusion needle when the infusion needle is implanted in a patient, offers further possibilities in that the needle need not be retracted entirely back into the housing. For instance, the tip end of the infusion needle may extend from the penetration area when the infusion needle is in its retracted position. In either case, when the infusion needle is advanced from such retracted position into the patient, its tip end will pierce through any fibrosis that may have formed on or in front of the infusion needle. This has the advantage that forces required to pierce through the penetration area are avoided and thus, any drive for advancing the infusion needle may be dimensioned accordingly smaller.

[0217] For the case where the tip end of the infusion needle extends from the penetration area when the infusion needle is in its retracted position, protection walls may be provided on the housing, preferably on opposite sides of the tip end of the infusion needle, so as to prevent the tip end to get into contact with tissue of the patient when the at least one infusion needle is in its retracted position. In the case of a plurality of needles arranged side by side for multiple piercing of the patient, the tip ends of the infusion needles may be provided between two longitudinal walls, e.g. in a groove provided on the outer surface of the housing.

[0218] Alternatively, where the infusion needle (with its tip end extending from the penetration area in the retracted position) is laterally displaceable for multiple piercing of the patient and wherein the penetration area in the housing’s outer wall comprises a septum through which infusion needle extends, the septum may be configured such that it is movable in a lateral direction along with the at least one infusion needle when the at least one infusion needle is displaced laterally. This way, any fibrosis forming on both the infusion needle and the septum would move along with the infusion needle and septum when the infusion needle and septum are moved laterally for variation of the injection site. The above-mentioned protection walls protecting the tip end of the infusion needle may be provided also in this situation.

[0219] Accordingly, an at least partly implantable system for injecting a substance into a patient’s body may comprise: a housing adapted for implantation inside the patient’s body, the housing having an outer wall with a penetration area, at least one infusion needle disposed in the housing so as to penetrate the penetration area, and a drive unit may be arranged for advancing and retracting the at least one infusion needle in opposite advancing and retraction directions between an advanced position and a retracted position, wherein the system is adapted to inject the substance into the patient’s body via the at least one infusion needle when the infusion needle is in the advanced position, and wherein injection of the substance into the patient’s body via the at least one infusion needle is not possible when the infusion needle is in the retracted position, wherein the infusion needle comprises: a tip end and a hollow body, wherein - preferably - a feeding port is provided in a side wall of the hollow body so as to allow for the substance to be fed through the feeding port into the hollow body and wherein an injection port is provided in a front side of the tip end through which the substance is dispensable to the outside of the infusion needle, and a stylet which is movable within the hollow body between an advanced position, in which the stylet is so far advanced inside the hollow body that it closes the injection port so as to prevent fibrosis from growing into the infusion needle when the infusion needle is implanted in a patient, and a retracted position, in which the stylet is so far retracted inside the hollow body that a pathway is open for the substance to flow - preferably from the feeding port and - through the hollow body out of the injection port.

[0220] The present disclosure also relates to the infusion needle with stylet as such, i.e. independent of the system, because the principle of the infusion needle with stylet can also be used in the other embodiments of the present disclosure if those embodiments are adapted accordingly. Thus, such an infusion needle comprises a tip end and a hollow body, wherein a feeding port is provided in a side wall of the hollow body so as to allow a substance to be fed through the feeding port into the hollow body and wherein an injection port is provided in a front side of the tip end through which the substance is dispensable to the outside of the infusion needle, and a stylet which is movable within the hollow body between an advanced position, in which the stylet is so far advanced inside the hollow body that it closes the injection port so as to prevent fibrosis from growing into the infusion needle when the infusion needle is implanted in a patient, and a retracted position, in which the stylet is so far retracted inside the hollow body that a pathway is open for the substance to travel from the feeding port and through the hollow body out of the injection port, wherein, in the advanced position of the stylet, the stylet may extend from the tip end of the infusion needle, in which case the stylet may be sharp for piercing through tissue of the patient when the infusion needle is advanced, whereas the tip end of the infusion needle may be blunt.

Embodiments comprising curved needle with stylet

[0221] In a preferred embodiment, at least a tip end section of the infusion needle, i.e. a section of the infusion needle comprising the tip end of the infusion needle, may be curved in a plane of curvature, i.e. the infusion needle is a curved needle. A curved needle is particularly advantageous in connection with systems for injecting a substance into a patient’s having an inclined injection needle, as described further above. Some preferred embodiments of the present disclosure relating to an at least partly implantable system for injecting a substance into a patient’s body comprise such a curved needle with further comprises stylet.

[0222] Those systems which employ a curved needle with a stylet may comprise a needle arm to which the infusion needle is mounted and a stylet arm to which the stylet is mounted, wherein the needle arm and the stylet arm are rotatable about a common axis of rotation. This way, the infusion needle and its stylet can be rotated together and/or individually, i.e. they can be advanced and retracted between respective advanced and retracted positions. A conduit may be connected to the needle arm for supplying the substance to the needle. Preferably, the conduit is flexible so as to enable the conduit to follow movement of the needle arm. [0223] Furthermore, the system may comprise a drive unit for carrying out at least the following steps, in sequence: advancing the infusion needle and stylet by rotating the needle arm jointly with the stylet arm about the common axis of rotation in the advancing direction, retracting the stylet inside the infusion needle towards its retracted position by rotating the stylet arm about the common axis of rotation in the retraction direction, retracting the infusion needle by rotating the needle arm about the common axis of rotation in the retraction direction.

When in this sequence of steps the infusion needle is retracted back into the housing without reinserting the stylet into the needle body beforehand, there may be a risk that some body fluid or blood drops from the retracted needle into the housing. This is, of course, not a problem in those embodiments where the infusion needle is not retracted entirely back into the housing, namely where at least the tip end of the infusion needle is not retracted into the interior of the housing. However, at least for those embodiments where also the tip end of the infusion needle is retracted into the housing when the infusion needle returns to its retracted position, the drive is preferably further configured to advance, before retraction of the infusion needle, the stylet inside the infusion needle by rotating the stylet arm about the common axis of rotation in the advancing direction.

[0224] The drive unit may comprise a first drive shaft which extends from the housing (or casing), the first drive shaft being configured to rotate the needle arm and the stylet arm about the common axis of rotation. Certain mechanism may be provided in order to ensure that the above sequence of steps is realized, i.e. that the needle arm and the stylet arm are at some times rotated together and at other times rotated individually, such as a releasable holder, a clutch, a cam drive and the like, as will be described hereinafter,

[0225] Preferably, the needle arm and stylet arm are mounted on a carriage which is movable inside the housing (or casing) so as to laterally move the tip end of the at least one infusion needle between different lateral positions. This way, variations of the injection site can be achieved with a single infusion needle. A second drive shaft extending from the housing or casing may be provided to move the carriage inside the housing or casing so as to laterally move the at least one infusion needle between the different lateral positions.

[0226] Accordingly, an at least partly implantable system for injecting a substance into a patient’s body, which system comprises a curved needle with stylet, may comprise: a housing or casing adapted for implantation inside the patient’s body, the housing or casing having an outer wall with a penetration area, at least one infusion needle disposed in the housing or casing so as to penetrate the penetration area and configured for being advanced and retracted in opposite advancing and retraction directions between an advanced position and a retracted position, wherein the system is adapted to inject the substance into the patient’s body via the at least one infusion needle when the infusion needle is in the advanced position, and wherein injection of the substance into the patient’s body via the at least one infusion needle is not possible when the infusion needle is in the retracted position, wherein at least a tip end section of the at least one infusion needle, which is a section including a tip end of the at least one infusion needle, is curved in a plane of curvature, with the tip end inclined relative to the outer wall by an inclination angle in a range of 10° and 80°, wherein the infusion needle comprises: the tip end and a hollow body, wherein - preferably - a feeding port is provided in a side wall of the hollow body so as to allow for the substance to be fed through the feeding port into the hollow body and wherein an injection port is provided in a front side of the tip end through which the substance is dispensable to the outside of the infusion needle, and a stylet which is movable within the hollow body between an advanced position, in which the stylet is so far advanced inside the hollow body that it closes the injection port so as to prevent fibrosis from growing into the infusion needle when the infusion needle is implanted in a patient, and a retracted position, in which the stylet is so far retracted inside the hollow body that a pathway is open for the substance to flow - preferably from the feeding port and - through the hollow body out of the injection port, wherein the system further comprises a needle arm to which the infusion needle is mounted and a stylet arm to which the stylet is mounted, the needle arm and the stylet arm being rotatable about a common axis of rotation.

RELEASABLE HOLDER

[0227] One mechanism to ensure that the needle arm and the stylet arm are at some times rotated together and at other times rotated individually may involve a drive unit with a biasing element and releasable holder, as described hereinafter.

[0228] The biasing element provides a biasing force which urges the needle arm and the stylet arm apart from each other, whereas the releasable holder is configured to hold the needle arm and stylet arm close to each other against the biasing force of the biasing element. In addition, a release is arranged to release the releasable holder, when the infusion needle reaches or has reached its advanced position, such that the stylet arm is moved apart from the needle arm due to the biasing force of the biasing element.

[0229] The biasing element may be a torque spring. But other biasing elements are also possible, such springs of other type or biasing elements providing magnetic and/or electro-magnetic forces, to name only a few. However, torque springs are preferred fortheir simplicity. Preferably, the torque spring has a square or rectangular cross-section so as to provide maximum force on a minimum of space.

[0230] One end of the torque spring may be attached to the stylet arm and another end of the torque spring may be attached to the needle arm so as to urge the two arms apart from each other. Alternatively, one end of the torque spring may be attached to the stylet arm and another end of the torque spring may be attached to the housing or casing or, where the needle arm and stylet arm are mounted on a carriage which is movable inside the housing or casing so as to laterally move the tip end of the at least one infusion needle between different lateral positions, to the carriage. This way, when stylet arm is connected to the needle arm and the needle arm is moved (rotated) so as to advance the infusion needle into the patient’s body by means of the drive unit, and then the stylet arm is released from the needle arm, the needle arm can return to its retracted position, i.e. the stylet moves out of the infusion needle, due to the biasing force of the torsion spring.

[0231] For this purpose, the releasable holder may comprise a flexible hook by which the needle arm and stylet arm are hooked together when the stylet arm rotates jointly with the needle arm about the common axis of rotation in the advancing direction, whereas the release is a deflector configured to deflect the flexible hook sideways so as to unhook the flexible hook when the infusion needle reaches or has reached its advanced position.

[0232] In this embodiment in which the drive unit comprises a biasing element and releasable holder, the infusion needle is retracted back into the housing without reinserting the stylet into the needle body beforehand. As mentioned before, this may create the risk that some body fluid or blood drops from the retracted needle into the housing. While this is not a problem in those embodiments where the infusion needle is not retracted entirely back into the housing, namely where at least the tip end of the infusion needle is not retracted into the interior of the housing, at least for those embodiments where also the tip end of the infusion needle is retracted into the housing when the infusion needle returns to its retracted position, the drive should preferably be configured to advance the stylet inside the infusion needle, by rotating the stylet arm about the common axis of rotation in the advancing direction, before retraction of the infusion needle. This is achieved with the embodiments described next (clutch; cam drive). CLUTCH

[0233] Another mechanism to ensure that the needle arm and the stylet arm are at some times rotated together and at other times rotated individually may involve a drive unit with at least one biasing element and a clutch, as described hereinafter.

[0234] The at least one biasing element may provide a biasing force which urges the stylet arm jointly with the needle arm about the common axis of rotation either in the advancing direction or in the retraction direction, whereas the clutch may be configured for selectively connecting the drive unit with at least one of: the stylet arm, the needle arm, and both the stylet arm and needle arm. This way, both the needle arm and the stylet arm are always urged in the same direction by means of the biasing element, i.e. toward their retracted positions or toward their advanced positions. The drive unit may support such movement (rotation) if this is needed or at least helpful to overcome certain counteracting forces, such as when the tip end of the infusion needle pierces the penetration area. Once the two arms have reached their end position, the drive unit may rotate the two arms in the opposite direction. Depending on the state of the clutch, the drive unit engages either the stylet arm (or the needle arm) or both the stylet arm and the needle arm and, therefore, moves one or both of the two arms in the opposite direction against the biasing force.

[0235] In a preferred embodiment, the at least one biasing element provides a biasing force which urges the stylet arm jointly with the needle arm about the common axis of rotation in the advancing direction. In this case, the clutch may be configured for selectively connecting the drive unit either with the stylet arm, for retracting the stylet inside the infusion needle towards its retracted position by rotating the stylet arm about the common axis of rotation in the retraction direction, or with either the needle arm or both needle arm and the stylet arm, for retracting the infusion needle by rotating the needle arm about the common axis of rotation in the retraction direction.

[0236] The at least one biasing element may comprise a torque spring. But other biasing elements are also possible, such springs of other type or biasing elements providing magnetic and/or electromagnetic forces, to name only a few. However, torque springs are preferred for their simplicity. Preferably, the torque spring has a square or rectangular cross-section so as to provide maximum force on a minimum of space.

[0237] Preferably, one biasing element may be provided for each of the needle arm and stylet arm. For instance, when the construction is such that rotation of the stylet arm due to the biasing force causes the stylet arm to abut against the needle arm and, consequently, the stylet arm carries the needle arm toward the advanced position, a single biasing element acting on the stylet arm might be sufficient. But a separate biasing element may be provided to urge the needle arm toward its advanced position, namely in order to securely hold the needle arm in the advanced position at the time when the stylet arm retracts the stylet backwards inside the hollow body of the infusion needle.

[0238] In this embodiment in which the drive unit comprises a biasing element and a clutch, the infusion needle can be retracted back into the housing after the stylet has been re -inserted into the needle body, by rotating the stylet arm about the common axis of rotation in the advancing direction, before retraction of the infusion needle. Thus, there is no danger in this case that residual body fluid drops out from the retracted infusion needle into the inside of the housing, because any such fluid is pushed out of the infusion needle by the stylet before the tip end of the infusion needle reaches the interior of the housing.

[0239] CAM DRIVE

[0240] An even further mechanism to ensure that the needle arm and the stylet arm are at some times rotated together and at other times rotated individually may involve a drive unit with a needle crank arm and a stylet crank arm, as described hereinafter.

[0241] The needle crank arm may be connected with one end thereof to the needle arm and with another end thereof to a needle guide pathway such that movement of the needle crank arm along the needle guide pathway and rotation of the needle arm about the common axis of rotation are interdependent, whereas the stylet crank arm may be connected with one end thereof to the stylet arm and with another end thereof to a stylet guide pathway such that movement of the stylet crank arm along the stylet guide pathway and rotation of the stylet arm about the common axis of rotation are interdependent. This way, by individually moving the needle crank arm and stylet crank arm, respectively, the positions of the infusion needle and its stylet, respectively, can be determined precisely at any point of time. That is, when the needle crank arm is moved along the needle guide pathway, the needle arm has to follow by rotating about the common axis of rotation. In a similar way, when the stylet crank arm is moved along the stylet guide pathway, the stylet arm has to follow by rotating about the common axis of rotation.

[0242] Now, such movement of the needle crank arm and stylet crank arm, respectively, may be controlled individually in a timely manner. For this purpose, the drive unit may further include at least one cam which comprises a needle cam pathway and a stylet cam pathway. Then, the needle crank arm may be connected, e.g. by means of a first cam follower, to the needle cam pathway in such a way that movement of the cam causes the needle arm to rotate about the common axis of rotation, whereas the stylet crank arm may be connected, e.g. by a second cam follower, to the stylet cam pathway in such a way that rotation of the cam causes the stylet arm to rotate about the common axis of rotation. The needle cam pathway and the stylet cam pathways may be in the form of a groove or a ridge along which the cam followers are forced to move. [0243] Preferably, the at least one cam is in the form of a cam disk which is rotatable about a central axis. Thus, the needle arm and the stylet arm, respectively, may be urged to rotate about the common axis of rotation by simply rotating the at least one cam disk. That is, because the needle and stylet crank arms engage the needle and stylet cam pathways and are forced to move along these cam pathways, respectively, in particular by means of their cam followers, rotation of the cam disk or disks causes movement of the crank arms and, consequently, movement (rotation) of the needle arm and stylet arm, respectively, to which the crank arms are connected. Preferably, a single cam disk is provided exhibiting both the needle cam pathway and the stylet cam pathway, so that only one cam needs to be driven in order to move advance and retract the infusion needle and its stylet, respectively.

[0244] Preferably, the needle arm and stylet arm are mounted on a carriage which is movable inside the housing or casing so as to laterally move the tip end of the at least one infusion needle between different lateral positions. In this case, the carriage may be rotatably mounted inside the housing or casing, i.e. such lateral movement of the tip end of the infusion needle is in fact a movement about the common axis of rotation.

OTHER ASPECT - POP RIVET

[0245] A further aspect of the present disclosure relates to an implantable energized medical device, which may advantageously be combined with the disclosed implantable drug delivery system and which is configured to be held in position by a tissue portion of a patient, the medical device comprising: a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, and a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross-sectional area in a third plane and being configured to connect the first portion to the second portion, wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the first and second cross-sectional areas, such that the first portion and second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes, the connecting portion and second portion are configured to form a connecting interface between the connecting portion and the second portion, and the second portion extends along a first direction being parallel to the second plane, wherein the second portion has a lengthwise cross-sectional area along the first direction, wherein a second lengthwise cross-sectional area is smaller than a first lengthwise cross-sectional area and wherein the first lengthwise cross-sectional area is located closer to said connecting interface with regard to the first direction.

[0246] In some embodiments, the second portion has a first end and a second end opposing the first end along the first direction, wherein the second portion has a length between the first and second end, and wherein the second portion has an intermediate region and a distal region, wherein the intermediate region is defined by the connecting interface between the connecting portion and the second portion, and the distal region extends from the connecting interface between the connecting portion and the second portion to the second end.

[0247] In some embodiments, the lengthwise cross-sectional area of the second portion decreases continuously from an end of the intermediate region towards the second end.

[0248] In some embodiments, the lengthwise cross-sectional area of the second portion decreases linearly from an end of the intermediate region towards the second end.

[0249] In some embodiments, the lengthwise cross-sectional area of the second portion decreases stepwise from an end of the intermediate region towards the second end.

[0250] In some embodiments, the distal region of the second portion is conically shaped.

[0251] In some embodiments, the second portion has rotational symmetry along the first direction.

[0252] In some embodiments, the second surface of the second portion is substantially perpendicular to a central extension of the connecting portion.

[0253] In some embodiments, the second surface of the second portion is substantially parallel to the second plane.

[0254] In some embodiments, the second surface of the second portion is substantially flat and configured to form a contact area to the second tissue surface, and wherein the second portion further comprises a lower surface facing away from the first portion configured to taper towards the second end.

[0255] In some embodiments, the second portion has a proximal region, wherein the proximal region extends from the first end to the connecting interface between the connecting portion and the second portion.

[0256] In some embodiments, the lengthwise cross-sectional area of the second portion decreases continuously from an end of the intermediate region towards the first end. [0257] In some embodiments, the lengthwise cross-sectional area of the second portion decreases linearly from an end of the intermediate region towards the first end.

[0258] In some embodiments, the lengthwise cross-sectional area of the second portion decreases stepwise from an end of the intermediate region towards the first end.

[0259] In some embodiments, the proximal region of the second portion is conically shaped.

[0260] In some embodiments, the first and second ends comprise an elliptical point respectively.

[0261] In some embodiments, the first and second ends comprise a hemispherical end cap respectively.

[0262] In some embodiments, the second portion has at least one circular cross-section along the length between the first and second end.

[0263] In some embodiments, the second portion has at least one oval cross-section along the length between the first and second end.

[0264] In some embodiments, the second portion has at least one elliptical cross-section along the length between the first and second end.

[0265] In some embodiments, the second portion has said length in a direction being different to a central extension of the connecting portion.

[0266] In some embodiments, the connecting interface between the connecting portion and the second portion is eccentric with respect to the second portion.

[0267] In some embodiments, the connecting interface between the connecting portion and the second portion is eccentric, with respect to the second portion, in the first direction, but not in a second direction being perpendicular to the first direction.

[0268] In some embodiments, the connecting interface between the connecting portion and the second portion is eccentric, with respect to the second portion, in the first direction and in a second direction being perpendicular to the first direction.

[0269] In some embodiments, the second direction is parallel to the second plane.

[0270] In some embodiments, the proximal region and the distal region comprises the second surface configured to engage the second surface of the second side of the tissue portion.

[0271] In some embodiments, the second portion is tapered from the first end to the second end. [0272] In some embodiments, the second portion is tapered from the intermediate region of the second portion to each of the first end and second end.

[0273] In some embodiments, the first portion has a maximum dimension being in the range of 10 to 40 mm, such as in the range of 10 to 30 mm, such as in the range of 15 to 25 mm.

[0274] In some embodiments, the first portion has a diameter being in the range of 10 to 40 mm, such as in the range of 10 to 30 mm, such as in the range of 15 to 25 mm.

[0275] In some embodiments, the connecting portion has a maximum dimension in the third plane in the range of 2 to 20 mm, such as in the range of 2 to 15 mm, such as in the range of 5 to 10 mm.

[0276] In some embodiments, the second portion has a maximum dimension being in the range of 30 to 90 mm, such as in the range of 30 to 70 mm, such as in the range of 35 to 60 mm.

[0277] In some embodiments, the first portion has one or more of a spherical shape, an ellipsoidal shape, a polyhedral shape, an elongated shape, and a flat disk shape.

[0278] In some embodiments, the connecting portion has one of an oval cross-section, an elongated cross-section, and a circular cross-section, in a plane parallel to the third plane.

[0279] In some embodiments, the distal region is configured to be directed downwards in a standing patient.

[0280] In some embodiments, the first portion has a first height, and the second portion has a second height, both heights being in a direction perpendicular to the first and second planes, wherein the first height is smaller than the second height.

[0281] In some embodiments, the first height is less than 2/3 of the second height, such as less than 1/2 of the second height, such as less than 1/3 of the second height.

[0282] In some embodiments, the second end of the second portion comprises connections for connecting to an implant being located in a caudal direction from a location of the implantable energized medical device in the patient.

[0283] In some embodiments, the first end of the second portion comprises connections for connecting to an implant being located in a cranial direction from a location of the implantable energized medical device in the patient. [0284] In some embodiments, the connecting portion further comprises a fourth cross-sectional area in a fourth plane, wherein the fourth plane is parallel to the first, second and third planes, and wherein the third cross-sectional area is smaller than the fourth cross-sectional area.

[0285] In some embodiments, the connecting portion comprises a protruding element comprising the fourth cross-sectional area.

[0286] In some embodiments, the first surface is configured to engage the first tissue surface of the first side of the tissue portion.

[0287] In some embodiments, the first portion comprises a first wireless energy receiver configured to receive energy transmitted wirelessly from an external wireless energy transmitter.

[0288] In some embodiments, the first portion comprises an internal wireless energy transmitter.

[0289] In some embodiments, the second portion comprises a second wireless energy receiver.

[0290] In some embodiments, the first portion comprises a first energy storage unit.

[0291] In some embodiments, the second portion comprises a second energy storage unit.

[0292] In some embodiments, at least one of the first and second energy storage unit is a solid- state battery.

[0293] In some embodiments, the solid-state battery is a thionyl -chloride battery.

[0294] In some embodiments, the first wireless energy receiver is configured to receive energy transmitted wirelessly by the external wireless energy transmitter, and store the received energy in the first energy storage unit, the internal wireless energy transmitter is configured to wirelessly transmit energy stored in the first energy storage unit to the second wireless energy receiver, and the second wireless energy receiver is configured to receive energy transmitted wirelessly by the internal wireless energy transmitter and store the received energy in the second energy storage unit.

[0295] In some embodiments, the first portion comprises a first controller comprising at least one processing unit.

[0296] In some embodiments, the second portion comprises a second controller comprising at least one processing unit.

[0297] In some embodiments, at least one of the first and second controller is connected to a wireless transceiver for communicating wirelessly with an external device. [0298] In some embodiments, the first controller is connected to a first wireless communication receiver in the first portion for receiving wireless communication from an external device, the first controller is connected to a first wireless communication transmitter in the first portion for transmitting wireless communication to a second wireless communication receiver in the second portion.

[0299] In some embodiments, the second controller is connected to the second wireless communication receiver for receiving wireless communication from the first portion.

[0300] In some embodiments, the first wireless energy receiver comprises a first coil and the internal wireless energy transmitter comprises a second coil.

[0301] In some embodiments, the first portion comprises a combined coil, wherein the combined coil is configured to receive energy wirelessly from an external wireless energy transmitter, and transmit energy wirelessly to the second wireless receiver of the second portion.

[0302] In some embodiments, at least one of the coils are embedded in a ceramic material.

[0303] In some embodiments, the implantable energized medical device further comprises a housing configured to enclose at least the first portion, and wherein a first portion of the housing is made from titanium and a second portion of the housing is made from a ceramic material.

[0304] In some embodiments, the portion of the housing made from a ceramic material comprises at least one coil embedded in the ceramic material.

[0305] In some embodiments, the implantable energized medical device further comprises a housing configured to enclose at least the second portion, and wherein a first portion of the housing is made from titanium and a second portion of the housing is made from a ceramic material.

[0306] In some embodiments, the portion of the housing made from a ceramic material comprises at least one coil embedded in the ceramic material.

[0307] In some embodiments, the second portion comprises at least a portion of an operation device for operating an implantable body engaging portion.

[0308] In some embodiments, the second portion comprises at least one electrical motor.

[0309] In some embodiments, the second portion comprises a transmission configured to reduce the velocity and increase the force of the movement generated by the electrical motor. [0310] In some embodiments, the transmission is configured to transfer a week force with a high velocity into a stronger force with lower velocity.

[0311] In some embodiments, the transmission is configured to transfer a rotating force into a linear force.

[0312] In some embodiments, the transmission comprises a gear system.

[0313] In some embodiments, the second portion comprises a magnetic coupling for transferring mechanical work from the electrical motor through one of: a barrier separating a first chamber of the second portion from a second chamber of the second portion, a housing enclosing at least the second portion.

[0314] In some embodiments, the second portion comprises at least one hydraulic pump.

[0315] In some embodiments, the hydraulic pump comprises a pump comprising at least one compressible hydraulic reservoir.

[0316] In some embodiments, the implantable energized medical device further comprises a capacitor connected to at least one of the first and second energy storage unit and connected to the electrical motor, wherein the capacitor is configured to: be charged by at least one of the first and second energy storage units, and provide the electrical motor with electrical power.

[0317] In some embodiments, at least one of the first and second portion comprises a sensation generator adapted to generate a sensation detectable by a sense of the patient.

[0318] In some embodiments, the second portion comprises a force transferring element configured to mechanically transfer force from the second portion to an implanted body engaging portion.

[0319] In some embodiments, the second portion comprises a force transferring element configured to hydraulically transfer force from the second portion to an implanted body engaging portion.

[0320] In some embodiments, the second portion comprises at least one lead for transferring electrical energy and/or information from the second portion to an implanted body engaging portion.

[0321] In some embodiments, the first portion comprises an injection port for injecting fluid into the first portion. [0322] In some embodiments, the connecting portion comprises a conduit for transferring a fluid from the first portion to the second portion.

[0323] In some embodiments, the conduit is arranged to extend through the hollow portion of the connecting portion.

[0324] In some embodiments, the second portion comprises a first and a second chamber separated from each other, wherein the first chamber comprises a first liquid and the second chamber comprises a second liquid, and wherein the second liquid is a hydraulic liquid configured to transfer force to an implantable element configured to exert force on the body portion of the patient.

[0325] In some embodiments, a wall portion of the first chamber is resilient to allow an expansion of the first chamber.

[0326] In some embodiments, the second portion comprises a first hydraulic system in fluid connection with a first hydraulically operable implantable element configured to exert force on the body portion of the patient, and a second hydraulic system in fluid connection with a second hydraulically operable implantable element configured to exert force on the body portion of the patient, wherein the first and second hydraulically operable implantable elements are adjustable independently from each other.

[0327] In some embodiments, the first hydraulic system comprises a first hydraulic pump and the second hydraulic systems comprises a second hydraulic pump.

[0328] In some embodiments, each of the first and second hydraulic systems comprises a reservoir for holding hydraulic fluid.

[0329] In some embodiments, the implantable energized medical device further comprises a first pressure sensor configured to sense a pressure in the first hydraulic system, and a second pressure sensor configured to sense a pressure in the second hydraulic system.

[0330] In some embodiments, the first surface is configured to engage the first tissue surface of the first side of the tissue portion.

[0331] In some embodiments, the first, second and third planes are parallel to a major extension plane of the tissue.

[0332] In some embodiments, the fourth plane is parallel to a major extension plane of the tissue.

[0333] A further aspect of the present disclosure relates to an implantable energized medical device, which may advantageously be combined with the disclosed implantable drug delivery system and which is configured to be held in position by a tissue portion of a patient, the medical device comprising: a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, and a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross-sectional area in a third plane and a third surface configured to engage the first tissue surface of the first side of the tissue portion, wherein the connecting portion is configured to connect the first portion to the second portion, wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the second cross-sectional area, such that the first portion, second portion and connecting portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes, the first portion is configured to receive electromagnetic waves at a frequency above a frequency level, and/or to transmit electromagnetic waves at a frequency below the frequency level, wherein the second portion is configured to receive and/or transmit electromagnetic waves at a frequency below the frequency level, and wherein the frequency level is 100 kHz.

[0334] In some embodiments, wherein the first portion is configured to transmit electromagnetic waves at the frequency below the frequency level to the second portion.

[0335] In some embodiments, the first portion is configured to transmit electromagnetic waves at the frequency above the frequency level to an external device.

[0336] In some embodiments, the frequency level is 40 kHz or 20 kHz.

[0337] In some embodiments, the electromagnetic waves comprise wireless energy and/or wireless communication.

[0338] In some embodiments, the first portion comprises a first wireless energy receiver for receiving energy transmitted wirelessly by an external wireless energy transmitter above the frequency level, and an internal wireless energy transmitter configured to transmit energy wirelessly to the second portion below the frequency level, and the second portion comprises a second wireless energy receiver configured to receive energy transmitted wirelessly by the internal wireless energy transmitter below the frequency level.

[0339] In some embodiments, the first portion comprises a first controller comprising at least one processing unit. [0340] In some embodiments, the second portion comprises a second controller comprising at least one processing unit.

[0341] In some embodiments, the first controller is connected to a first wireless communication receiver in the first portion for receiving wireless communication from an external device above the frequency level, the first controller is connected to a first wireless communication transmitter in the first portion for transmitting wireless communication to a second wireless communication receiver in the second portion below the frequency level.

[0342] In some embodiments, the second controller is connected to the second wireless communication receiver for receiving wireless communication from the first portion below the frequency level.

[0343] In some embodiments, the first portion comprises an outer casing made from a polymer material.

[0344] In some embodiments, the outer casing forms a complete enclosure, such that electromagnetic waves received and transmitted by the first portion must travel through the casing.

[0345] In some embodiments, the second portion comprises an outer casing made from titanium.

[0346] In some embodiments, the outer casing forms a complete enclosure, such that electromagnetic waves received and transmitted by the second portion must travel through the casing.

[0347] A further aspect of the present disclosure relates to an implantable energized medical device, which may advantageously be combined with the disclosed implantable drug delivery system and which is configured to be held in position by a tissue portion of a patient, the medical device comprising: a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, and a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross-sectional area in a third plane and a third surface configured to engage the first tissue surface of the first side of the tissue portion, wherein the connecting portion is configured to connect the first portion to the second portion, wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the second cross-sectional area, such that the first portion, second portion and connecting portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes, the first portion is configured to receive and/or transmit electromagnetic waves at a frequency below the frequency level, and wherein the frequency level is 100 kHz.

[0348] In some embodiments, the second portion is configured to receive and/or transmit electromagnetic waves at a frequency below the frequency level.

[0349] In some embodiments, the first portion is configured to transmit electromagnetic waves at the frequency below the frequency level to the second portion.

[0350] In some embodiments, the first portion is configured to transmit electromagnetic waves at the frequency below the frequency level to an external device.

[0351] In some embodiments, the frequency level is 40 kHz or 20 kHz.

[0352] In some embodiments, the electromagnetic waves comprise wireless energy and/or wireless communication.

[0353] In some embodiments, the first portion comprises a first wireless energy receiver for receiving energy transmitted wirelessly by an external wireless energy transmitter below the frequency level, and an internal wireless energy transmitter configured to transmit energy wirelessly to the second portion below the frequency level, and the second portion comprises a second wireless energy receiver configured to receive energy transmitted wirelessly by the internal wireless energy transmitter below the frequency level.

[0354] In some embodiments, the first portion comprises a first controller comprising at least one processing unit.

[0355] In some embodiments, the second portion comprises a second controller comprising at least one processing unit.

[0356] In some embodiments, the first controller is connected to a first wireless communication receiver in the first portion for receiving wireless communication from an external device below the frequency level, the first controller is connected to a first wireless communication transmitter in the first portion for transmitting wireless communication to a second wireless communication receiver in the second portion below the frequency level.

[0357] In some embodiments, the second controller is connected to the second wireless communication receiver for receiving wireless communication from the first portion below the frequency level. [0358] In some embodiments, the first portion comprises an outer casing made from a polymer material.

[0359] In some embodiments, the first portion comprises an outer casing made from titanium.

[0360] In some embodiments, the outer casing forms a complete enclosure, such that electromagnetic waves received and transmitted by the first portion must travel through the casing.

[0361] In some embodiments, the second portion comprises an outer casing made from titanium.

[0362] In some embodiments, the outer casing forms a complete enclosure, such that electromagnetic waves received and transmitted by the second portion must travel through the casing.

[0363] A further aspect of the present disclosure relates to an implantable energized medical device, which may advantageously be combined with the disclosed implantable drug delivery system and which is configured to be held in position by a tissue portion of a patient, the medical device comprising: a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, and a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross-sectional area in a third plane and a third surface configured to engage the first tissue surface of the first side of the tissue portion, wherein the connecting portion is configured to connect the first portion to the second portion, wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the second cross-sectional area, such that the first portion, second portion and connecting portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes, the first portion is made from a polymer material, the second portion comprises a casing made from titanium, wherein the casing forms a complete enclosure.

[0364] In some embodiments, the casing of the second portion forms a complete enclosure such that the entirety of the outer surface of the second portion is covered by the casing, when the second portion is connected to the connecting portion.

[0365] In some embodiments, the first portion comprises a casing made from the polymer material.

[0366] In some embodiments, the casing of the first portion forms a complete enclosure such that the entirety of the outer surface of the first portion is covered by the casing. [0367] In some embodiments, the connecting portion comprises a connection arranged to connect to the first and second portion respectively and carry electrical signals and/or energy.

[0368] In some embodiments, the connection is arranged in a core of the connecting portion such that it is encapsulated by outer material of the connecting portion.

[0369] In some embodiments, the connecting portion comprises a ceramic material.

[0370] In some embodiments, the connection is encapsulated within the ceramic material.

[0371] In some embodiments, the first portion comprises a first connection configured to connect to the connection of the connecting portion.

[0372] In some embodiments, the second portion comprises a second connection configured to connect to the connection of the connection portion.

[0373] In some embodiments, the casing of the second portion is hermetically sealed.

[0374] In some embodiments, the second connection is arranged such that the hermetical seal of the second portion is kept intact.

[0375] In some embodiments, the casing of the first portion is hermetically sealed.

[0376] A further aspect of the present disclosure relates to an implantable energized medical device, which may advantageously be combined with the disclosed implantable drug delivery system and which is configured to be held in position by a tissue portion of a patient, the medical device comprising: a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, and a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross-sectional area in a third plane and a third surface configured to engage the first tissue surface of the first side of the tissue portion, wherein the connecting portion is configured to connect the first portion to the second portion, wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the second cross-sectional area, such that the first portion, second portion and connecting portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes, and wherein the connecting portion is configured to extend between the first portion and the second portion along a central extension axis, and wherein the second portion is configured to extend in a length direction being divergent with the central extension axis, and wherein the connecting portion has a substantially constant cross-sectional area along the central extension axis, or wherein the connecting portion has a decreasing cross-sectional area in a direction from the first portion towards the second portion along the central extension axis, and/or wherein the second portion has a substantially constant cross-sectional area along the length direction, or wherein the second portion has a decreasing cross-sectional area in the length direction.

[0377] In some embodiments, the third cross-sectional area is smaller than the first cross-sectional area.

[0378] In some embodiments, the connecting portion is tapered in the direction from the first portion towards the second portion along the central extension axis.

[0379] In some embodiments, the connecting portion has a circular or oval cross -section along the central extension axis with a decreasing diameter in the direction from the first portion towards the second portion.

[0380] In some embodiments, the second portion is tapered in the length direction.

[0381] In some embodiments, the connecting portion has a circular or oval cross-section in the length direction with a decreasing diameter in the length direction.

[0382] In some embodiments, the length direction extends from an interface between the connecting portion and the second portion towards an end of the second portion.

[0383] In some embodiments, the length direction extends in a direction substantially perpendicular to the central extension axis.

[0384] A further aspect of the present disclosure relates to an implantable energized medical device, which may advantageously be combined with the disclosed implantable drug delivery system, configured to be held in position by a tissue portion of a patient is provided, the medical device comprising: a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross-sectional area in a third plane and being configured to connect the first portion to the second portion, and a hermetic seal arrangement configured to enclose the connecting portion so as to prevent fluid from the patient to enter the connecting portion, wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the first and second cross-sectional areas, such that the first portion and second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes, and the connecting portion comprises a flexible structure enabling the connecting portion to flex.

[0385] In some embodiments, the flexible structure is configured to allow the connecting portion to flex in more than one direction.

[0386] In some embodiments, the flexible structure is configured to allow the connecting portion to flex in all directions.

[0387] In some embodiments, the flexible structure comprises a bellows.

[0388] In some embodiments, the bellows is a metallic bellows.

[0389] In some embodiments, the metallic bellows is welded.

[0390] In some embodiments, the bellows is a titanium bellows.

[0391] In some embodiments, the bellows form part of the hermetic seal arrangement.

[0392] In some embodiments, the flexible structure comprises elevated and lowered portions enabling said flexing of the connecting portion.

[0393] In some embodiments, the elevated and lowered portions are configured to enable the connecting portion to be compressed and/or expanded.

[0394] In some embodiments, the flexible structure has a substantially cylindrical shape.

[0395] In some embodiments, the flexible structure is configured to seal against the first portion and/or the second portion.

[0396] In some embodiments, the connecting portion and the second portion are hermetically sealed from the first portion.

[0397] In some embodiments, the hermetic seal arrangement encloses the connecting portion and the second portion so as to hermetically seal the connecting portion and the second portion from the first portion. [0398] In some embodiments, the first portion comprises a first wireless energy receiver for receiving energy transmitted wirelessly by an external wireless energy transmitter, and an internal wireless energy transmitter configured to transmit energy wirelessly to the second portion, and the second portion comprises a second wireless energy receiver configured to receive energy transmitted wirelessly by the internal wireless energy transmitter.

[0399] In some embodiments, the first portion comprises a first energy storage unit connected to the first wireless energy receiver.

[0400] In some embodiments, the second portion comprises a second energy storage unit connected to the second wireless energy receiver.

[0401] In some embodiments, at least one of the first and second energy storage unit is a solid-state battery.

[0402] In some embodiments, the solid-state battery is a thionyl -chloride battery.

[0403] In some embodiments, the first wireless energy receiver is configured to receive energy transmitted wirelessly by the external wireless energy transmitter and store the received energy in the first energy storage unit, the internal wireless energy transmitter is configured to wirelessly transmit energy stored in the first energy storage unit to the second wireless energy receiver, and the second wireless energy receiver is configured to receive energy transmitted wirelessly by the internal wireless energy transmitter and store the received energy in the second energy storage unit.

[0404] In some embodiments, the first portion comprises a first controller comprising at least one processing unit.

[0405] In some embodiments, the second portion comprises a second controller comprising at least one processing unit.

[0406] In some embodiments, at least one of the first and second controller is connected to a wireless transceiver for communicating wirelessly with an external device.

[0407] In some embodiments, the first controller is connected to a first wireless communication receiver in the first portion for receiving wireless communication from an external device,

[0408] the first controller is connected to a first wireless communication transmitter in the first portion for transmitting wireless communication to a second wireless communication receiver in the second portion. [0409] In some embodiments, the second controller is connected to the second wireless communication receiver for receiving wireless communication from the first portion.

[0410] In some embodiments, the first wireless energy receiver comprises a first coil and the wireless energy transmitter comprises a second coil.

[0411] In some embodiments, the first portion comprises a combined coil, wherein the combined coil is configured to receive energy wirelessly from an external wireless energy transmitter, and transmit energy wirelessly to the second wireless receiver of the second portion.

[0412] In some embodiments, at least one of the coils are embedded in a ceramic material.

[0413] In some embodiments, the implantable energized medical device further comprises a housing configured to enclose at least the first portion, and wherein a first portion of the housing is made from titanium and a second portion of the housing is made from a ceramic material.

[0414] In some embodiments, the portion of the housing made from a ceramic material comprises at least one coil embedded in the ceramic material.

[0415] In some embodiments, the implantable energized medical device further comprises a housing configured to enclose at least the second portion, and wherein a first portion of the housing is made from titanium and a second portion of the housing is made from a ceramic material.

[0416] In some embodiments, the portion of the housing made from a ceramic material comprises at least one coil embedded in the ceramic material.

[0417] In some embodiments, the first portion is detachably connected to at least one of the second portion and the connecting portion.

[0418] In some embodiments, the connecting portion comprising a flange having a flange area being larger than a cross-section area of the hole in the tissue portion, such that the flange is hindered from travelling through the hole in the tissue portion, such that the second portion and the connecting portion can be held in position by the tissue portion of the patient also when the first portion is disconnected from the connecting portion.

[0419] In some embodiments, a connecting interface between the connecting portion and the second portion is eccentric with respect to the second portion.

[0420] In some embodiments, a connecting interface between the connecting portion and the first portion is eccentric with respect to the first portion. [0421] In some embodiments, the second portion has a first end and a second end opposing the first end, wherein the second portion has a length between the first and second end.

[0422] In some embodiments, the first end and second end are separated in a direction parallel to the second plane.

[0423] In some embodiments, the first and second ends comprise an elliptical point respectively.

[0424] In some embodiments, the first and second ends comprise a hemispherical end cap respectively.

[0425] In some embodiments, the second portion has at least one circular cross-section along the length between the first and second end.

[0426] In some embodiments, the second portion has at least one oval cross-section along the length between the first and second end.

[0427] In some embodiments, the second portion has at least one elliptical cross-section along the length between the first and second end.

[0428] In some embodiments, the implantable energized medical device further comprises a gear arrangement and an electric motor, wherein the gear arrangement is configured to reduce the velocity and increase the force of the movement generated by the electric motor.

[0429] In some embodiments, the gear arrangement is configured to transfer a force with a high velocity into a stronger force with lower velocity.

[0430] In some embodiments, the gear arrangement is configured to transfer a rotating force into a linear force.

[0431] In some embodiments, the gear arrangement comprises a gear system.

[0432] In some embodiments, the second portion comprises a magnetic coupling for transferring mechanical work from the electric motor through one of: a barrier separating a first chamber of the second portion from a second chamber of the second portion, a housing enclosing at least the second portion.

[0433] In some embodiments, the second portion comprises at least one hydraulic pump.

[0434] In some embodiments, the hydraulic pump comprises a pump comprising at least one compressible hydraulic reservoir. [0435] According to an embodiment of the inventive concept, an implantable energized medical device configured to be held in position by a tissue portion of a patient is provided, the medical device comprising: a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, and a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross-sectional area in a third plane and being configured to connect the first portion to the second portion, wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the first and second cross-sectional areas, such that the first portion and second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes, wherein the connecting portion and the second portion are configured to form a unit having a central axis extending from a first end of said unit to a second end of said unit, the first end being proximal to the first portion and the second end being distal to the first portion, wherein a physical footprint of said unit perpendicular to the central axis decreases continuously or stepwise from the first end to the second end of said unit.

[0436] In some embodiments, said physical footprint comprises a cross-sectional area perpendicular to the central axis.

[0437] In some embodiments, the connecting portion and the second portion are one of: configured to reversibly connect to each other to form said unit; or configured to irreversibly connect to each other to form said unit; or configured as a single body forming said unit.

[0438] In some embodiments, said unit comprises an angled section forming a bend in said unit.

[0439] In some embodiments, the bend is between 15° and 165°, such as between 30° and 150°, such as between 45° and 135°, such as substantially 90°.

[0440] In some embodiments, the first portion comprises a first wireless energy receiver for receiving energy transmitted wirelessly by an external wireless energy transmitter, and an internal wireless energy transmitter configured to transmit energy wirelessly to the second portion, and the second portion comprises a second wireless energy receiver configured to receive energy transmitted wirelessly by the internal wireless energy transmitter. [0441] In some embodiments, the first portion comprises a first energy storage unit connected to the first wireless energy receiver.

[0442] In some embodiments, the second portion comprises a second energy storage unit connected to the second wireless energy receiver.

[0443] In some embodiments, at least one of the first and second energy storage unit is a solid-state battery.

[0444] In some embodiments, the solid-state battery is a thionyl -chloride battery.

[0445] In some embodiments, the first wireless energy receiver is configured to receive energy transmitted wirelessly by the external wireless energy transmitter and store the received energy in the first energy storage unit, the internal wireless energy transmitter is configured to wirelessly transmit energy stored in the first energy storage unit to the second wireless energy receiver, and the second wireless energy receiver is configured to receive energy transmitted wirelessly by the internal wireless energy transmitter and store the received energy in the second energy storage unit.

[0446] In some embodiments, the first portion comprises a first controller comprising at least one processing unit.

[0447] In some embodiments, the second portion comprises a second controller comprising at least one processing unit.

[0448] In some embodiments, at least one of the first and second controller is connected to a wireless transceiver for communicating wirelessly with an external device.

[0449] In some embodiments, the first controller is connected to a first wireless communication receiver in the first portion for receiving wireless communication from an external device, the first controller is connected to a first wireless communication transmitter in the first portion for transmitting wireless communication to a second wireless communication receiver in the second portion.

[0450] In some embodiments, the second controller is connected to the second wireless communication receiver for receiving wireless communication from the first portion.

[0451] In some embodiments, the first wireless energy receiver comprises a first coil and the wireless energy transmitter comprises a second coil. [0452] In some embodiments, the first portion comprises a combined coil, wherein the combined coil is configured to receive energy wirelessly from an external wireless energy transmitter, and transmit energy wirelessly to the second wireless receiver of the second portion.

[0453] In some embodiments, at least one of the coils are embedded in a ceramic material.

[0454] In some embodiments, the implantable energized medical device further comprises a housing configured to enclose at least the first portion, and wherein a first portion of the housing is made from titanium and a second portion of the housing is made from a ceramic material.

[0455] In some embodiments, the portion of the housing made from a ceramic material comprises at least one coil embedded in the ceramic material.

[0456] In some embodiments, the implantable energized medical further comprises a housing configured to enclose at least the second portion, and wherein a first portion of the housing is made from titanium and a second portion of the housing is made from a ceramic material.

[0457] In some embodiments, the portion of the housing made from a ceramic material comprises at least one coil embedded in the ceramic material.

[0458] In some embodiments, the first portion is detachably connected to at least one of the second portion and the connecting portion.

[0459] In some embodiments, the connecting portion comprising a flange having a flange area being larger than a cross-section area of the hole in the tissue portion, such that the flange is hindered from travelling through the hole in the tissue portion, such that the second portion and the connecting portion can be held in position by the tissue portion of the patient also when the first portion is disconnected from the connecting portion.

[0460] In some embodiments, a connecting interface between the connecting portion and the second portion is eccentric with respect to the second portion.

[0461] In some embodiments, a connecting interface between the connecting portion and the first portion is eccentric with respect to the first portion.

[0462] In some embodiments, the second portion has a first end and a second end opposing the first end, wherein the second portion has a length between the first and second end.

[0463] In some embodiments, the first end and second end are separated in a direction parallel to the second plane. [0464] In some embodiments, the first and second ends comprise an elliptical point respectively.

[0465] In some embodiments, the first and second ends comprise a hemispherical end cap respectively.

[0466] In some embodiments, the second portion has at least one circular cross-section along the length between the first and second end.

[0467] In some embodiments, the second portion has at least one oval cross-section along the length between the first and second end.

[0468] In some embodiments, the second portion has at least one elliptical cross-section along the length between the first and second end.

[0469] In some embodiments, the implantable energized medical device further comprises a gear arrangement and an electric motor, wherein the gear arrangement is configured to reduce the velocity and increase the force of the movement generated by the electric motor.

[0470] In some embodiments, the gear arrangement is configured to transfer a force with a high velocity into a stronger force with lower velocity.

[0471] In some embodiments, the gear arrangement is configured to transfer a rotating force into a linear force.

[0472] In some embodiments, the gear arrangement comprises a gear system.

[0473] In some embodiments, the second portion comprises a magnetic coupling for transferring mechanical work from the electric motor through one of: a barrier separating a first chamber of the second portion from a second chamber of the second portion, a housing enclosing at least the second portion.

[0474] In some embodiments, the second portion comprises at least one hydraulic pump.

[0475] In some embodiments, the hydraulic pump comprises a pump comprising at least one compressible hydraulic reservoir.

[0476] According to an embodiment of the inventive concept, an implantable energized medical device configured to be held in position by a tissue portion of a patient is provided, the medical device comprising: a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, and a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross-sectional area in a third plane and being configured to connect the first portion to the second portion, wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the first and second cross-sectional areas, such that the first portion and second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes, wherein the connecting portion is configured to extend between the first portion and the second portion along a central extension axis, and wherein the second portion is configured to extend in a length direction being divergent with the central extension axis, and wherein the connecting portion has a decreasing cross-sectional area in a direction from the first portion towards the second portion along the central extension axis, wherein a largest cross-sectional area of the second portion in the length direction is smaller than a smallest cross-sectional area of the connecting portion in said direction from the first portion towards the second portion along the central extension axis, and wherein the second portion further has a decreasing cross-sectional area in the length direction from a first end of the second portion proximal to the connecting portion to a second end of the second portion distal to the connecting portion.

[0477] According to an embodiment of the inventive concept, an implantable energized medical device configured to be held in position by a tissue portion of a patient is provided, the medical device comprising: a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross-sectional area in a third plane and being configured to connect the first portion to the second portion, and an electric motor, wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the first and second cross-sectional areas, such that the first portion and second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes, at least part of the electric motor is arranged within the connecting portion. [0478] In some embodiments, the electric motor is arranged within the connecting portion within an imaginary boundary defined by the first surface of the first portion extending through the connecting portion.

[0479] In some embodiments, the electric motor is arranged within the connecting portion within an imaginary boundary defined by the second surface of the second portion extending through the connecting portion.

[0480] In some embodiments, the electric motor is fully arranged in the connecting portion within imaginary boundaries defined by the first surface of the first portion extending through the connecting portion and the second surface of the second portion extending through the connecting portion respectively.

[0481] In some embodiments, the electric motor is arranged such that its longest dimension extends in a direction substantially perpendicular to the first, second and third cross-sectional areas.

[0482] In some embodiments, the electric motor is arranged such that its longest dimension extends in a direction between the first portion and the second portion.

[0483] In some embodiments, the worm drive is configured to transfer mechanical force from the electric motor to an implantable body engaging portion being external to the implantable energized medical device.

[0484] In some embodiments, the electric motor extends through the connecting portion into the first portion and/or the second portion.

[0485] In some embodiments, the electric motor extends through an imaginary boundary defined by the first surface of the first portion extending through the connecting portion.

[0486] In some embodiments, the electric motor extends through an imaginary boundary defined by the second surface of the second portion extending through the connecting portion.

[0487] In some embodiments, the electric motor extends through imaginary boundaries defined by the first surface of the first portion extending through the connecting portion and the second surface of the second portion extending through the connecting portion respectively.

[0488] In some embodiments, the implantable energized medical device further comprises a gear arrangement operatively connected to the electric motor wherein the gear arrangement is partly or fully arranged in one of the first portion and the second portion. [0489] In some embodiments, the gear arrangement is arranged within the connecting portion within an imaginary boundary defined by the first surface of the first portion extending through the connecting portion.

[0490] In some embodiments, the gear arrangement is arranged within the connecting portion within an imaginary boundary defined by the second surface of the second portion extending through the connecting portion.

[0491] In some embodiments, the gear arrangement is fully arranged in the connecting portion within imaginary boundaries defined by the first surface of the first portion extending through the connecting portion and the second surface of the second portion extending through the connecting portion respectively.

[0492] In some embodiments, the gear arrangement extends through the connecting portion into the first portion and/or the second portion.

[0493] In some embodiments, the gear arrangement extends through an imaginary boundary defined by the first surface of the first portion extending through the connecting portion.

[0494] In some embodiments, the gear arrangement extends through an imaginary boundary defined by the second surface of the second portion extending through the connecting portion.

[0495] In some embodiments, the gear arrangement extends through imaginary boundaries defined by the first surface of the first portion extending through the connecting portion and the second surface of the second portion extending through the connecting portion respectively.

[0496] In some embodiments, the gear arrangement is configured to transfer mechanical force from the electric motor to an implantable body engaging portion being external to the implantable energized medical device.

[0497] In some embodiments, the gear arrangement is a worm drive or comprises a worm drive.

[0498] In some embodiments, the first portion comprises a first wireless energy receiver for receiving energy transmitted wirelessly by an external wireless energy transmitter, and an internal wireless energy transmitter configured to transmit energy wirelessly to the second portion, and the second portion comprises a second wireless energy receiver configured to receive energy transmitted wirelessly by the internal wireless energy transmitter.

[0499] In some embodiments, the first portion comprises a first energy storage unit connected to the first wireless energy receiver. [0500] In some embodiments, the second portion comprises a second energy storage unit connected to the second wireless energy receiver.

[0501] In some embodiments, at least one of the first and second energy storage unit is a solid-state battery.

[0502] In some embodiments, the solid-state battery is a thionyl -chloride battery.

[0503] In some embodiments, the first wireless energy receiver is configured to receive energy transmitted wirelessly by the external wireless energy transmitter and store the received energy in the first energy storage unit, the internal wireless energy transmitter is configured to wirelessly transmit energy stored in the first energy storage unit to the second wireless energy receiver, and the second wireless energy receiver is configured to receive energy transmitted wirelessly by the internal wireless energy transmitter and store the received energy in the second energy storage unit.

[0504] In some embodiments, the first portion comprises a first controller comprising at least one processing unit.

[0505] In some embodiments, the second portion comprises a second controller comprising at least one processing unit.

[0506] In some embodiments, at least one of the first and second controller is connected to a wireless transceiver for communicating wirelessly with an external device.

[0507] In some embodiments, the first controller is connected to a first wireless communication receiver in the first portion for receiving wireless communication from an external device, the first controller is connected to a first wireless communication transmitter in the first portion for transmitting wireless communication to a second wireless communication receiver in the second portion.

[0508] In some embodiments, the second controller is connected to the second wireless communication receiver for receiving wireless communication from the first portion.

[0509] In some embodiments, the first wireless energy receiver comprises a first coil and the wireless energy transmitter comprises a second coil.

[0510] In some embodiments, the first portion comprises a combined coil, wherein the combined coil is configured to receive energy wirelessly from an external wireless energy transmitter, and transmit energy wirelessly to the second wireless receiver of the second portion.

[0511] In some embodiments, at least one of the coils are embedded in a ceramic material. [0512] In some embodiments, the implantable energized medical device further comprises a housing configured to enclose at least the first portion, and wherein a first portion of the housing is made from titanium and a second portion of the housing is made from a ceramic material.

[0513] In some embodiments, the portion of the housing made from a ceramic material comprises at least one coil embedded in the ceramic material.

[0514] In some embodiments, the implantable energized medical device further comprises a housing configured to enclose at least the second portion, and wherein a first portion of the housing is made from titanium and a second portion of the housing is made from a ceramic material.

[0515] In some embodiments, the portion of the housing made from a ceramic material comprises at least one coil embedded in the ceramic material.

[0516] In some embodiments, the first portion is detachably connected to at least one of the second portion and the connecting portion.

[0517] In some embodiments, the connecting portion comprising a flange having a flange area being larger than a cross-section area of the hole in the tissue portion, such that the flange is hindered from travelling through the hole in the tissue portion, such that the second portion and the connecting portion can be held in position by the tissue portion of the patient also when the first portion is disconnected from the connecting portion.

[0518] In some embodiments, a connecting interface between the connecting portion and the second portion is eccentric with respect to the second portion.

[0519] In some embodiments, a connecting interface between the connecting portion and the first portion is eccentric with respect to the first portion.

[0520] In some embodiments, the second portion has a first end and a second end opposing the first end, wherein the second portion has a length between the first and second end.

[0521] In some embodiments, the first end and second end are separated in a direction parallel to the second plane.

[0522] In some embodiments, the first and second ends comprise an elliptical point respectively.

[0523] In some embodiments, the first and second ends comprise a hemispherical end cap respectively. [0524] In some embodiments, the second portion has at least one circular cross-section along the length between the first and second end.

[0525] In some embodiments, the second portion has at least one oval cross-section along the length between the first and second end.

[0526] In some embodiments, the second portion has at least one elliptical cross-section along the length between the first and second end.

[0527] In some embodiments, the gear arrangement is configured to reduce the velocity and increase the force of the movement generated by the electric motor.

[0528] In some embodiments, the gear arrangement is configured to transfer a force with a high velocity into a stronger force with lower velocity.

[0529] In some embodiments, the gear arrangement is configured to transfer a rotating force into a linear force.

[0530] In some embodiments, the gear arrangement comprises a gear system.

[0531] In some embodiments, the second portion comprises a magnetic coupling for transferring mechanical work from the electric motor through one of: a barrier separating a first chamber of the second portion from a second chamber of the second portion, a housing enclosing at least the second portion.

[0532] In some embodiments, the second portion comprises at least one hydraulic pump.

[0533] In some embodiments, the hydraulic pump comprises a pump comprising at least one compressible hydraulic reservoir.

[0534] According to an embodiment of the inventive concept, an implantable energized medical device configured to be held in position by a tissue portion of a patient is provided, the medical device comprising: a first portion configured to be placed on a first side of the tissue portion, the first portion comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, the first portion being further configured to connect, directly or indirectly, to a second portion placed on a second side of the tissue portion opposing the first side, wherein the first portion comprises an internal wireless energy transmitter configured to transmit energy wirelessly to the second portion.

[0535] In some embodiments, the first portion is configured to connect, directly or indirectly, to the second portion, via a connecting portion configured to extend through a hole in the tissue portion, the hole extending between the first side of the tissue portion and the second side of the tissue portion. [0536] In some embodiments, the implantable energized medical device further comprises the connecting portion.

[0537] In some embodiments, the connecting portion is integrally formed with the first portion.

[0538] In some embodiments, the connecting portion is a separate component with regard to the first portion, the connecting portion being configured to be connected to the first portion.

[0539] In some embodiments, the first portion has a first cross-sectional area in a first plane and the connecting portion has a second cross-sectional area in a second plane, wherein the first and second planes are parallel to each other, wherein the second cross-sectional area is smaller than the first cross- sectional area, such that the first portion and the second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first and second planes.

[0540] In some embodiments, the first portion is configured to detachably connect, directly or indirectly, to the second portion.

[0541] In some embodiments, the first portion comprises a first wireless energy receiver for receiving energy transmitted wirelessly by an external wireless energy transmitter.

[0542] In some embodiments, the first portion comprises a first energy storage unit connected to the first wireless energy receiver.

[0543] In some embodiments, the first energy storage unit is a solid-state battery.

[0544] In some embodiments, the solid-state battery is a thionyl -chloride battery.

[0545] In some embodiments, the first wireless energy receiver is configured to receive energy transmitted wirelessly by the external wireless energy transmitter and store the received energy in the first energy storage unit, the internal wireless energy transmitter is configured to wirelessly transmit energy stored in the first energy storage unit to a second wireless energy receiver in the second portion.

[0546] In some embodiments, the first portion comprises a first controller comprising at least one processing unit.

[0547] In some embodiments, the first controller is connected to a wireless transceiver for communicating wirelessly with an external device.

[0548] In some embodiments, the first controller is connected to a first wireless communication receiver in the first portion for receiving wireless communication from an external device, the first controller is connected to a first wireless communication transmitter in the first portion for transmitting wireless communication to a second wireless communication receiver in the second portion.

[0549] In some embodiments, the first wireless energy receiver comprises a first coil and the wireless energy transmitter comprises a second coil.

[0550] In some embodiments, the first portion comprises a combined coil, wherein the combined coil is configured to receive energy wirelessly from an external wireless energy transmitter, and transmit energy wirelessly to the second wireless receiver of the second portion.

[0551] In some embodiments, at least one of the coils are embedded in a ceramic material.

[0552] In some embodiments, the connecting portion comprises a flange having a flange area being larger than a cross-section area of the hole in the tissue portion, such that the flange is hindered from travelling through the hole in the tissue portion, such that the second portion and the connecting portion can be held in position by the tissue portion of the patient also when the first portion is disconnected from the connecting portion.

[0553] In some embodiments, a connecting interface between the connecting portion and the first portion is eccentric with respect to the first portion.

[0554] A system is provided, the system comprising an implantable energized medical device configured to be held in position by a tissue portion of a patient, the medical device comprising: - a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, - a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, and - a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross-sectional area in a third plane and being configured to connect the first portion to the second portion, wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the first and second cross-sectional areas, such that the first portion and second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes; a body engaging implant configured to at least one of stretch, contract, expand, stimulate, and exert a force on body tissue or a body organ; an implantable energy storage unit; an implantable reservoir configured to hold a fluid; an implantable pump configured to transfer fluid to and from the implantable reservoir and the body engaging implant respectively via a conduit; and an implantable electric motor connected to the implantable energy storage unit, the implantable electric motor being configured to operate the implantable pump; wherein the implantable energy storage unit, the implantable reservoir, the implantable pump and the implantable electric motor are arranged externally to the implantable energized medical device.

[0555] A system is provided, the system comprising an implantable energized medical device configured to be held in position by a tissue portion of a patient, the medical device comprising: - a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, - a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, - a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross-sectional area in a third plane and being configured to connect the first portion to the second portion, and - an implantable energy storage unit arranged in the first portion, the connecting portion or the second portion; wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the first and second cross- sectional areas, such that the first portion and second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes; a body engaging implant configured to at least one of stretch, contract, expand, stimulate, and exert a force on body tissue or a body organ; an implantable reservoir configured to hold a fluid; an implantable pump configured to transfer fluid to and from the implantable reservoir and the body engaging implant respectively via a conduit; and an implantable electric motor connected to the implantable energy storage unit, the implantable electric motor being configured to operate the implantable pump; wherein the implantable reservoir, the implantable pump and the implantable electric motor are arranged externally to the implantable energized medical device.

[0556] A system is provided, the system comprising an implantable energized medical device configured to be held in position by a tissue portion of a patient, the medical device comprising: - a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, - a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, - a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross- sectional area in a third plane and being configured to connect the first portion to the second portion, and - an implantable electric motor arranged in the first portion, the connecting portion or the second portion; wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the first and second cross-sectional areas, such that the first portion and second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes; a body engaging implant configured to at least one of stretch, contract, expand, stimulate, and exert a force on body tissue or a body organ; an implantable energy storage unit; an implantable reservoir configured to hold a fluid; an implantable pump configured to transfer fluid to and from the implantable reservoir and the body engaging implant respectively via a conduit; wherein the implantable electric motor is connected to the implantable energy storage unit, and the implantable electric motor is configured to operate the implantable pump; wherein the implantable energy storage unit, the implantable reservoir and the implantable pump are arranged externally to the implantable energized medical device.

[0557] A system is provided, the system comprising an implantable energized medical device configured to be held in position by a tissue portion of a patient, the medical device comprising: - a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, - a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, - a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross- sectional area in a third plane and being configured to connect the first portion to the second portion, and - an implantable reservoir configured to hold a fluid, the implantable reservoir being arranged in the first portion, the connecting portion or the second portion wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the first and second cross-sectional areas, such that the first portion and second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes a body engaging implant configured to at least one of stretch, contract, expand, stimulate, and exert a force on body tissue or a body organ; an implantable energy storage unit; an implantable pump configured to transfer fluid to and from the reservoir and the body engaging implant respectively via a conduit; and an implantable electric motor connected to the implantable energy storage unit, the implantable electric motor being configured to operate the implantable pump; wherein the implantable energy storage unit, the implantable pump and the implantable electric motor are arranged externally to the implantable energized medical device. [0558] A system is provided, the system comprising an implantable energized medical device configured to be held in position by a tissue portion of a patient, the medical device comprising: - a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, - a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, - a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross- sectional area in a third plane and being configured to connect the first portion to the second portion, and - an implantable pump arranged in the first portion, the connecting portion or the second portion, wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the first and second cross-sectional areas, such that the first portion and second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes; a body engaging implant configured to at least one of stretch, contract, expand, stimulate, and exert a force on body tissue or a body organ; an implantable energy storage unit; an implantable reservoir configured to hold a fluid; and an implantable electric motor connected to the implantable energy storage unit, the implantable electric motor being configured to operate the implantable pump; wherein the implantable pump is configured to transfer fluid to and from the implantable reservoir and the body engaging implant respectively via a conduit; wherein the implantable energy storage unit, the implantable reservoir, and the implantable electric motor are arranged externally to the implantable energized medical device .

[0559] A system is provided, the system comprising an implantable energized medical device configured to be held in position by a tissue portion of a patient, the medical device comprising: - a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, - a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, and - a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross- sectional area in a third plane and being configured to connect the first portion to the second portion, wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the first and second cross-sectional areas, such that the first portion and second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes; a body engaging implant configured to at least one of stretch, contract, expand, stimulate, and exert a force on body tissue or a body organ; an implantable energy storage unit; and an implantable electric motor connected to the implantable energy storage unit, the implantable electric motor being configured to operate the body engaging implant; wherein the implantable energy storage unit and the implantable electric motor are arranged externally to the implantable energized medical device.

[0560] A system is provided, the system comprising an implantable energized medical device configured to be held in position by a tissue portion of a patient, the medical device comprising: - a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, - a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, - a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross- sectional area in a third plane and being configured to connect the first portion to the second portion, - an implantable energy storage unit arranged in the first portion, the connecting portion or the second portion, and - an implantable electric motor arranged in the first portion, the connecting portion or the second portion, the implantable electric motor being connected to the implantable energy storage unit, wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the first and second cross-sectional areas, such that the first portion and second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes; a body engaging implant configured to at least one of stretch, contract, expand, stimulate, and exert a force on body tissue or a body organ; an implantable reservoir configured to hold a fluid; and an implantable pump configured to transfer fluid to and from the implantable reservoir and the body engaging implant respectively via a conduit; wherein the implantable electric motor is configured to operate the implantable pump; wherein the implantable reservoir and the implantable pump are arranged externally to the implantable energized medical device.

[0561] A system is provided, the system comprising an implantable energized medical device configured to be held in position by a tissue portion of a patient, the medical device comprising: - a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, - a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, - a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross- sectional area in a third plane and being configured to connect the first portion to the second portion, - an implantable reservoir configured to hold a fluid arranged in the first portion, the connecting portion or the second portion, and - an implantable electric motor arranged in the first portion, the connecting portion or the second portion, wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the first and second cross-sectional areas, such that the first portion and second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes; a body engaging implant configured to at least one of stretch, contract, expand, stimulate, and exert a force on body tissue or a body organ; an implantable energy storage unit, and an implantable pump configured to transfer fluid to and from the implantable reservoir and the body engaging implant respectively via a conduit; wherein the implantable electric motor is connected to the implantable energy storage unit and configured to operate the implantable pump; wherein the implantable energy storage unit and the implantable pump are arranged externally to the implantable energized medical device.

[0562] A system is provided, the system comprising an implantable energized medical device configured to be held in position by a tissue portion of a patient, the medical device comprising: - a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, - a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, - a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross- sectional area in a third plane and being configured to connect the first portion to the second portion, - an implantable reservoir configured to hold a fluid, the implantable reservoir being arranged in the first portion, the connecting portion or the second portion, and - an implantable pump arranged in the first portion, the connecting portion or the second portion, wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the first and second cross-sectional areas, such that the first portion and second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes; a body engaging implant configured to at least one of stretch, contract, expand, stimulate, and exert a force on body tissue or a body organ; an implantable energy storage unit; and an implantable electric motor connected to the implantable energy storage unit, the implantable electric motor being configured to operate the implantable pump; wherein the implantable pump is configured to transfer fluid to and from the implantable reservoir and the body engaging implant respectively via a conduit; and wherein the implantable energy storage unit and the implantable electric motor are arranged externally to the implantable energized medical device.

[0563] A system is provided, the system comprising an implantable energized medical device configured to be held in position by a tissue portion of a patient, the medical device comprising: - a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, - a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, - a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross- sectional area in a third plane and being configured to connect the first portion to the second portion, - an implantable pump arranged in the first portion, the connecting portion or the second portion, and - an implantable energy storage unit arranged in the first portion, the connecting portion or the second portion, wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the first and second cross-sectional areas, such that the first portion and second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes; a body engaging implant configured to at least one of stretch, contract, expand, stimulate, and exert a force on body tissue or a body organ; an implantable reservoir configured to hold a fluid; an implantable electric motor connected to the implantable energy storage unit, the implantable electric motor being configured to operate the implantable pump; wherein the implantable pump is configured to transfer fluid to and from the implantable reservoir and the body engaging implant respectively via a conduit wherein the implantable reservoir and the implantable electric motor are arranged externally to the implantable energized medical device.

[0564] A system is provided, the system comprising an implantable energized medical device configured to be held in position by a tissue portion of a patient, the medical device comprising: - a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, - a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, - a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross- sectional area in a third plane and being configured to connect the first portion to the second portion, and - an implantable electric motor arranged in the first portion, the connecting portion or the second portion, wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the first and second cross-sectional areas, such that the first portion and second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes; a body engaging implant configured to at least one of stretch, contract, expand, stimulate, and exert a force on body tissue or a body organ; an implantable energy storage unit; wherein the implantable electric motor is connected to the implantable energy storage unit, the implantable electric motor being configured to operate the body engaging implant; wherein the implantable energy storage unit is arranged externally to the implantable energized medical device.

[0565] A system is provided, the system comprising an implantable energized medical device configured to be held in position by a tissue portion of a patient, the medical device comprising: - a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, - a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, - a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross- sectional area in a third plane and being configured to connect the first portion to the second portion, - an implantable energy storage unit arranged in the first portion, the connecting portion or the second portion, - an implantable electric motor arranged in the first portion, the connecting portion or the second portion, the implantable electric motor being connected to the implantable energy storage unit, and - an implantable reservoir configured to hold a fluid, the implantable reservoir being arranged in the first portion, the connecting portion or the second portion, wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the first and second cross-sectional areas, such that the first portion and second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes; a body engaging implant configured to at least one of stretch, contract, expand, stimulate, and exert a force on body tissue or a body organ; an implantable pump configured to transfer fluid to and from the implantable reservoir and the body engaging implant respectively via a conduit; wherein the implantable electric motor is configured to operate the implantable pump; wherein the implantable pump is arranged externally to the implantable energized medical device. [0566] A system is provided, the system comprising an implantable energized medical device configured to be held in position by a tissue portion of a patient, the medical device comprising: - a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, - a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, - a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross- sectional area in a third plane and being configured to connect the first portion to the second portion, - an implantable reservoir configured to hold a fluid arranged in the first portion, the connecting portion or the second portion, - an implantable electric motor arranged in the first portion, the connecting portion or the second portion, and - an implantable pump arranged in the first portion, the connecting portion or the second portion, wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the first and second cross-sectional areas, such that the first portion and second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes; a body engaging implant configured to at least one of stretch, contract, expand, stimulate, and exert a force on body tissue or a body organ; an implantable energy storage unit, and wherein the implantable pump is configured to transfer fluid to and from the implantable reservoir and the body engaging implant respectively via a conduit; wherein the implantable electric motor is connected to the implantable energy storage unit and configured to operate the implantable pump; wherein the implantable energy storage unit is arranged externally to the implantable energized medical device.

[0567] A system is provided, the system comprising an implantable energized medical device configured to be held in position by a tissue portion of a patient, the medical device comprising: - a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, - a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, - a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross- sectional area in a third plane and being configured to connect the first portion to the second portion, - an implantable reservoir configured to hold a fluid, the implantable reservoir being arranged in the first portion, the connecting portion or the second portion, - an implantable pump arranged in the first portion, the connecting portion or the second portion, and - an implantable energy storage unit arranged in the first portion, the connecting portion or the second portion, wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the first and second cross-sectional areas, such that the first portion and second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes; a body engaging implant configured to at least one of stretch, contract, expand, stimulate, and exert a force on body tissue or a body organ; an implantable electric motor connected to the implantable energy storage unit, the implantable electric motor being configured to operate the implantable pump; wherein the implantable pump is configured to transfer fluid to and from the implantable reservoir and the body engaging implant respectively via a conduit; and wherein the implantable electric motor is arranged externally to the implantable energized medical device.

[0568] A system is provided, the system comprising an implantable energized medical device configured to be held in position by a tissue portion of a patient, the medical device comprising: - a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, - a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, - a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross- sectional area in a third plane and being configured to connect the first portion to the second portion, - an implantable pump arranged in the first portion, the connecting portion or the second portion, - an implantable energy storage unit arranged in the first portion, the connecting portion or the second portion, and - an electric motor arranged in the first portion, the connecting portion or the second portion, wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the first and second cross-sectional areas, such that the first portion and second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes; a body engaging implant configured to at least one of stretch, contract, expand, stimulate, and exert a force on body tissue or a body organ; an implantable reservoir configured to hold a fluid; wherein the implantable electric motor is connected to the implantable energy storage unit, the implantable electric motor being configured to operate the implantable pump; wherein the implantable pump is configured to transfer fluid to and from the implantable reservoir and the body engaging implant respectively via a conduit wherein the implantable reservoir is arranged externally to the implantable energized medical device. [0569] A system is provided, the system comprising an implantable energized medical device configured to be held in position by a tissue portion of a patient, the medical device comprising: - a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, - a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, - a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross- sectional area in a third plane and being configured to connect the first portion to the second portion, and - an implantable energy storage unit arranged in the first portion, the connecting portion or the second portion, wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the first and second cross- sectional areas, such that the first portion and second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes; a body engaging implant configured to at least one of stretch, contract, expand, stimulate, and exert a force on body tissue or a body organ; an implantable electric motor connected to the implantable energy storage unit, the implantable electric motor being configured to operate the body engaging implant; wherein the implantable electric motor is arranged externally to the implantable energized medical device.

[0570] In some embodiments, the implantable energized medical device further comprises a first wireless communication receiver configured to receive communication signals from outside the patient’s body.

[0571] In some embodiments, the implantable energized medical device further comprises a second wireless communication transmitter arranged in the second portion, wherein the second wireless communication transmitter is configured to transmit communication signals to the first wireless communication receiver.

[0572] In some embodiments, the implantable energized medical device further comprises a first wireless communication transmitter arranged in the first portion, the first wireless communication transmitter being configured to transmit communication signals outside of the patient’s body.

[0573] In some embodiments, the implantable energized medical device further comprises a second wireless communication receiver arranged in the second portion, wherein the first wireless communication transmitter is configured to transmit communication signals to the second wireless communication receiver. [0574] In some embodiments, the implantable energized medical device further comprises a wireless energy receiver configured to receive energy transmitted wirelessly from outside the patient’s body and deliver the received energy to the implantable energy storage unit.

[0575] In some embodiments, the implantable energized medical device further comprises a control unit configured to control at least one of the body engaging implant, the implantable energy storage unit, the implantable pump, and the implantable electric motor.

[0576] In some embodiments, the implantable electric motor is operatively connected to the implantable pump via a rotatable shaft.

[0577] In some embodiments, the implantable electric motor is operatively connected to the implantable pump via a magnetic coupling.

[0578] In some embodiments, the system further comprises a gear arrangement arranged in the implantable energized medical device and operatively connected to the electric motor, the gear arrangement being configured to reduce the velocity and increase the force of movement generated by the electric motor.

[0579] In some embodiments, the system further comprises a gear arrangement arranged externally to the implantable energized medical device and operatively connected to the electric motor, the gear arrangement being configured to reduce the velocity and increase the force of movement generated by the electric motor.

[0580] In some embodiments, the system further comprises a housing configured to enclose at least the first portion, and wherein a first portion of the housing is made from titanium and a second portion of the housing is made from a ceramic material.

[0581] In some embodiments, the portion of the housing made from a ceramic material comprises at least one coil embedded in the ceramic material.

[0582] In some embodiments, the system further comprises a housing configured to enclose at least the second portion, and wherein a first portion of the housing is made from titanium and a second portion of the housing is made from a ceramic material.

[0583] In some embodiments, the portion of the housing made from a ceramic material comprises at least one coil embedded in the ceramic material.

[0584] In some embodiments, the first portion is detachably connected to at least one of the second portion and the connecting portion. [0585] In some embodiments, the connecting portion comprising a flange having a flange area being larger than a cross-section area of the hole in the tissue portion, such that the flange is hindered from travelling through the hole in the tissue portion, such that the second portion and the connecting portion can be held in position by the tissue portion of the patient also when the first portion is disconnected from the connecting portion.

[0586] In some embodiments, a connecting interface between the connecting portion and the second portion is eccentric with respect to the second portion.

[0587] In some embodiments, a connecting interface between the connecting portion and the first portion is eccentric with respect to the first portion.

[0588] In some embodiments, the second portion has a first end and a second end opposing the first end, wherein the second portion has a length between the first and second end.

[0589] In some embodiments, the first end and second end are separated in a direction parallel to the second plane.

[0590] In some embodiments, the first and second ends comprise an elliptical point respectively.

[0591] In some embodiments, the first and second ends comprise a hemispherical end cap respectively.

[0592] In some embodiments, the second portion has at least one circular cross-section along the length between the first and second end.

[0593] In some embodiments, the second portion has at least one oval cross-section along the length between the first and second end.

[0594] In some embodiments, the second portion has at least one elliptical cross-section along the length between the first and second end.

[0595] In some embodiments, the system further comprises a gear arrangement, wherein the gear arrangement is configured to reduce the velocity and increase the force of the movement generated by the electric motor.

[0596] In some embodiments, the gear arrangement is configured to transfer a force with a high velocity into a stronger force with lower velocity.

[0597] In some embodiments, the gear arrangement is configured to transfer a rotating force into a linear force. [0598] In some embodiments, the gear arrangement comprises a gear system.

[0599] In some embodiments, the second portion comprises a magnetic coupling for transferring mechanical work from the electric motor through one of: a barrier separating a first chamber of the second portion from a second chamber of the second portion, a housing enclosing at least the second portion.

[0600] In some embodiments, the pump is a hydraulic pump.

[0601] In some embodiments, the hydraulic pump comprises a pump comprising at least one compressible hydraulic reservoir.

[0602] According to an embodiment of the inventive concept, an implantable energized medical device configured to be held in position by a tissue portion of a patient is provided, the medical device comprising: a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, and a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross-sectional area in a third plane and being configured to connect the first portion to the second portion, wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the first and second cross-sectional areas, such that the first portion and second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes, the first portion is configured to be placed subcutaneously in the patient, and wherein the first portion comprises a connecting interface arrangement for transferring wired energy and/or wired communication signals and/or fluid to an additional implant in the patient.

[0603] In some embodiments, a height of the first portion measured in a plane perpendicular to the first plane is 15 mm or less, such as 10 mm or less, such as 7 mm or less, such as 5 mm or less.

[0604] In some embodiments, the connecting interface arrangement comprises a port for transferring fluid from the first portion to said additional implant.

[0605] In some embodiments, the implantable energized medical device further comprises at least one conduit or tube for transferring said fluid, wherein the at least one conduit or tube is connected to the port. [0606] In some embodiments, the implantable energized medical device further comprises at least one wire for energy and/or communication signals connected to the connecting interface arrangement.

[0607] In some embodiments, the height of the first portion is a maximum height.

[0608] In some embodiments, the first portion comprises a first wireless energy receiver for receiving energy transmitted wirelessly by an external wireless energy transmitter, and an internal wireless energy transmitter configured to transmit energy wirelessly to the second portion, and the second portion comprises a second wireless energy receiver configured to receive energy transmitted wirelessly by the internal wireless energy transmitter.

[0609] In some embodiments, the first portion comprises a first energy storage unit connected to the first wireless energy receiver.

[0610] In some embodiments, the second portion comprises a second energy storage unit connected to the second wireless energy receiver.

[0611] In some embodiments, at least one of the first and second energy storage unit is a solid-state battery.

[0612] In some embodiments, the solid-state battery is a thionyl -chloride battery.

[0613] In some embodiments, the first wireless energy receiver is configured to receive energy transmitted wirelessly by the external wireless energy transmitter and store the received energy in the first energy storage unit, the internal wireless energy transmitter is configured to wirelessly transmit energy stored in the first energy storage unit to the second wireless energy receiver, and the second wireless energy receiver is configured to receive energy transmitted wirelessly by the internal wireless energy transmitter and store the received energy in the second energy storage unit.

[0614] In some embodiments, the first portion comprises a first controller comprising at least one processing unit.

[0615] In some embodiments, the second portion comprises a second controller comprising at least one processing unit.

[0616] In some embodiments, at least one of the first and second controller is connected to a wireless transceiver for communicating wirelessly with an external device.

[0617] In some embodiments, the first controller is connected to a first wireless communication receiver in the first portion for receiving wireless communication from an external device, the first controller is connected to a first wireless communication transmitter in the first portion for transmitting wireless communication to a second wireless communication receiver in the second portion.

[0618] In some embodiments, the second controller is connected to the second wireless communication receiver for receiving wireless communication from the first portion.

[0619] In some embodiments, the first wireless energy receiver comprises a first coil and the wireless energy transmitter comprises a second coil.

[0620] In some embodiments, the first portion comprises a combined coil, wherein the combined coil is configured to receive energy wirelessly from an external wireless energy transmitter, and transmit energy wirelessly to the second wireless receiver of the second portion.

[0621] In some embodiments, at least one of the coils are embedded in a ceramic material.

[0622] In some embodiments, the implantable energized medical device further comprises a housing configured to enclose at least the first portion, and wherein a first portion of the housing is made from titanium and a second portion of the housing is made from a ceramic material.

[0623] In some embodiments, the portion of the housing made from a ceramic material comprises at least one coil embedded in the ceramic material.

[0624] In some embodiments, the implantable energized medical device further comprises a housing configured to enclose at least the second portion, and wherein a first portion of the housing is made from titanium and a second portion of the housing is made from a ceramic material.

[0625] In some embodiments, the portion of the housing made from a ceramic material comprises at least one coil embedded in the ceramic material.

[0626] In some embodiments, the first portion is detachably connected to at least one of the second portion and the connecting portion.

[0627] In some embodiments, the connecting portion comprising a flange having a flange area being larger than a cross-section area of the hole in the tissue portion, such that the flange is hindered from travelling through the hole in the tissue portion, such that the second portion and the connecting portion can be held in position by the tissue portion of the patient also when the first portion is disconnected from the connecting portion.

[0628] In some embodiments, a connecting interface between the connecting portion and the second portion is eccentric with respect to the second portion. [0629] In some embodiments, a connecting interface between the connecting portion and the first portion is eccentric with respect to the first portion.

[0630] In some embodiments, the second portion has a first end and a second end opposing the first end, wherein the second portion has a length between the first and second end.

[0631] In some embodiments, the first end and second end are separated in a direction parallel to the second plane.

[0632] In some embodiments, the first and second ends comprise an elliptical point respectively.

[0633] In some embodiments, the first and second ends comprise a hemispherical end cap respectively.

[0634] In some embodiments, the second portion has at least one circular cross-section along the length between the first and second end.

[0635] In some embodiments, the second portion has at least one oval cross-section along the length between the first and second end.

[0636] In some embodiments, the second portion has at least one elliptical cross-section along the length between the first and second end.

[0637] In some embodiments, the implantable energized medical further comprises a gear arrangement and an electric motor, wherein the gear arrangement is configured to reduce the velocity and increase the force of the movement generated by the electric motor.

[0638] In some embodiments, the gear arrangement is configured to transfer a force with a high velocity into a stronger force with lower velocity.

[0639] In some embodiments, the gear arrangement is configured to transfer a rotating force into a linear force.

[0640] In some embodiments, the gear arrangement comprises a gear system.

[0641] In some embodiments, the second portion comprises a magnetic coupling for transferring mechanical work from the electric motor through one of: a barrier separating a first chamber of the second portion from a second chamber of the second portion, a housing enclosing at least the second portion.

[0642] In some embodiments, the second portion comprises at least one hydraulic pump. [0643] In some embodiments, the hydraulic pump comprises a pump comprising at least one compressible hydraulic reservoir.

[0644] According to an embodiment of the inventive concept, an implantable energized medical device configured to be held in position by a tissue portion of a patient is provided, the medical device comprising: a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, and a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross-sectional area in a third plane and being configured to connect the first portion to the second portion, wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the first and second cross-sectional areas, such that the first portion and second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes, the first portion and the second portion are configured to be placed subcutaneously in the patient, such that the implantable energized medical device can be placed with either of the first portion and the second portion on the first side of the tissue portion.

[0645] In some embodiments, a height of the second portion measured in a plane perpendicular to the second plane is 15 mm or less, such as 10 mm or less, such as 7 mm or less, such as 5 mm or less.

[0646] In some embodiments, the first portion has a length in a plane parallel to the first plane, wherein the second portion has a length in a plane parallel to the second plane, and wherein the length of the first portion differ no more than 30% with regard to the length of the second portion, such as wherein the length of the first portion differ no more than 15% with regard to the length of the second portion, such as wherein the length of the first portion differ no more than 5% with regard to the length of the second portion, such as wherein the length of the first portion differ no more than 1% with regard to the length of the second portion.

[0647] In some embodiments, the first portion has a width in a plane parallel to the first plane, wherein the second portion has a width in a plane parallel to the second plane, and wherein the width of the first portion differ no more than 30% with regard to the width of the second portion, such as wherein the width of the first portion differ no more than 15% with regard to the width of the second portion, such as wherein the width of the first portion differ no more than 5% with regard to the width of the second portion, such as wherein the width of the first portion differ no more than 1% with regard to the width of the second portion.

[0648] In some embodiments, the first portion has a height in a plane perpendicular to the first plane, and wherein the height of the first portion differ no more than 30% with regard to the height of the second portion, such as wherein the height of the first portion differ no more than 15% with regard to the height of the second portion, such as wherein the height of the first portion differ no more than 5% with regard to the height of the second portion, such as wherein the height of the first portion differ no more than 1% with regard to the height of the second portion.

[0649] In some embodiments, a height of the first portion measured in a plane perpendicular to the first plane is 15 mm or less, such as 10 mm or less, such as 7 mm or less, such as 5 mm or less.

[0650] In some embodiments, the first portion comprises a first wireless energy receiver for receiving energy transmitted wirelessly by an external wireless energy transmitter, and an internal wireless energy transmitter configured to transmit energy wirelessly to the second portion, and the second portion comprises a second wireless energy receiver configured to receive energy transmitted wirelessly by the internal wireless energy transmitter.

[0651] In some embodiments, the first portion comprises a first energy storage unit connected to the first wireless energy receiver.

[0652] In some embodiments, the second portion comprises a second energy storage unit connected to the second wireless energy receiver.

[0653] In some embodiments, at least one of the first and second energy storage unit is a solid-state battery.

[0654] In some embodiments, the solid-state battery is a thionyl -chloride battery.

[0655] In some embodiments, the first wireless energy receiver is configured to receive energy transmitted wirelessly by the external wireless energy transmitter and store the received energy in the first energy storage unit, the internal wireless energy transmitter is configured to wirelessly transmit energy stored in the first energy storage unit to the second wireless energy receiver, and the second wireless energy receiver is configured to receive energy transmitted wirelessly by the internal wireless energy transmitter and store the received energy in the second energy storage unit.

[0656] In some embodiments, the first portion comprises a first controller comprising at least one processing unit. [0657] In some embodiments, the second portion comprises a second controller comprising at least one processing unit.

[0658] In some embodiments, at least one of the first and second controller is connected to a wireless transceiver for communicating wirelessly with an external device.

[0659] In some embodiments, the first controller is connected to a first wireless communication receiver in the first portion for receiving wireless communication from an external device, the first controller is connected to a first wireless communication transmitter in the first portion for transmitting wireless communication to a second wireless communication receiver in the second portion.

[0660] In some embodiments, the second controller is connected to the second wireless communication receiver for receiving wireless communication from the first portion.

[0661] In some embodiments, the first wireless energy receiver comprises a first coil and the wireless energy transmitter comprises a second coil.

[0662] In some embodiments, the first portion comprises a combined coil, wherein the combined coil is configured to receive energy wirelessly from an external wireless energy transmitter, and transmit energy wirelessly to the second wireless receiver of the second portion.

[0663] In some embodiments, at least one of the coils are embedded in a ceramic material.

[0664] In some embodiments, the implantable energized medical device further comprises a housing configured to enclose at least the first portion, and wherein a first portion of the housing is made from titanium and a second portion of the housing is made from a ceramic material.

[0665] In some embodiments, the portion of the housing made from a ceramic material comprises at least one coil embedded in the ceramic material.

[0666] In some embodiments, the implantable energized medical device further comprises a housing configured to enclose at least the second portion, and wherein a first portion of the housing is made from titanium and a second portion of the housing is made from a ceramic material.

[0667] In some embodiments, the portion of the housing made from a ceramic material comprises at least one coil embedded in the ceramic material.

[0668] In some embodiments, the first portion is detachably connected to at least one of the second portion and the connecting portion. [0669] In some embodiments, the connecting portion comprising a flange having a flange area being larger than a cross-section area of the hole in the tissue portion, such that the flange is hindered from travelling through the hole in the tissue portion, such that the second portion and the connecting portion can be held in position by the tissue portion of the patient also when the first portion is disconnected from the connecting portion.

[0670] In some embodiments, a connecting interface between the connecting portion and the second portion is eccentric with respect to the second portion.

[0671] In some embodiments, a connecting interface between the connecting portion and the first portion is eccentric with respect to the first portion.

[0672] In some embodiments, the second portion has a first end and a second end opposing the first end, wherein the second portion has a length between the first and second end.

[0673] In some embodiments, the first end and second end are separated in a direction parallel to the second plane.

[0674] In some embodiments, the first and second ends comprise an elliptical point respectively.

[0675] In some embodiments, the first and second ends comprise a hemispherical end cap respectively.

[0676] In some embodiments, the second portion has at least one circular cross-section along the length between the first and second end.

[0677] In some embodiments, the second portion has at least one oval cross-section along the length between the first and second end.

[0678] In some embodiments, the second portion has at least one elliptical cross-section along the length between the first and second end.

[0679] In some embodiments, the implantable energized medical device further comprises a gear arrangement and an electric motor, wherein the gear arrangement is configured to reduce the velocity and increase the force of the movement generated by the electric motor.

[0680] In some embodiments, the gear arrangement is configured to transfer a force with a high velocity into a stronger force with lower velocity.

[0681] In some embodiments, the gear arrangement is configured to transfer a rotating force into a linear force. [0682] In some embodiments, the gear arrangement comprises a gear system.

[0683] In some embodiments, the second portion comprises a magnetic coupling for transferring mechanical work from the electric motor through one of: a barrier separating a first chamber of the second portion from a second chamber of the second portion, a housing enclosing at least the second portion.

[0684] In some embodiments, the second portion comprises at least one hydraulic pump.

[0685] In some embodiments, the hydraulic pump comprises a pump comprising at least one compressible hydraulic reservoir.

[0686] According to an embodiment of the inventive concept, an implantable energized medical device configured to be held in position by a tissue portion of a patient is provided, the medical device comprising: a first portion configured to be placed on a first side of the tissue portion, the first portion having a first cross-sectional area in a first plane and comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, a second portion configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion, and a connecting portion configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion, the connecting portion having a third cross-sectional area in a third plane and being configured to connect the first portion to the second portion, wherein the second portion comprises or forms a reservoir for holding a fluid; the implantable energized medical device further comprising: a sealed container configured to protrude into the reservoir; an actuator connected to the sealed container, the actuator being configured to expand or retract the sealed container to change the volume of the sealed container for pumping fluid to or from the reservoir; wherein: the first, second, and third planes are parallel to each other, the third cross-sectional area is smaller than the first and second cross-sectional areas, such that the first portion and second portion are prevented from travelling through the hole in the tissue portion in a direction perpendicular to the first, second and third planes.

[0687] In some embodiments, the actuator comprises an electric motor.

[0688] In some embodiments, the actuator is arranged in the connecting portion.

[0689] In some embodiments, the actuator is partly or fully arranged inside the sealed container.

[0690] In some embodiments, the second portion comprises a port in fluid communication with the reservoir for transferring fluid between the reservoir and an additional implant in the patient. [0691] In some embodiments, the implantable energized medical device further comprises a conduit connected to the port, the conduit being configured to transfer fluid between the reservoir and the additional implant.

[0692] In some embodiments, the implantable energized medical device further comprises an injection port for introducing fluid, the injection port being arranged in the first portion.

[0693] In some embodiments, the implantable energized medical device further comprises an internal conduit connecting the injection port to the reservoir.

[0694] In some embodiments, the sealed container is a bellows.

[0695] In some embodiments, the bellows is a metallic bellows.

[0696] In some embodiments, at least a portion of the sealed container configured to be in contact with fluid comprises metal.

[0697] In some embodiments, the volume of the sealed container can be altered such that the volume of the sealed container is more than 60% of the maximum volume of the reservoir.

[0698] In some embodiments, the sealed container comprises at least one flexible portion, and wherein the flexible portion enable at least one of compression and expansion of the sealed container.

[0699] In some embodiments, the sealed container comprises at least one elastic portion, and wherein the elastic portion enable at least one of compression and expansion of the sealed container.

[0700] In some embodiments, the implantable energized medical device further comprises a first energy storage unit and/or a second energy storage unit for powering the actuator.

[0701] In some embodiments, the first portion comprises a first wireless energy receiver for receiving energy transmitted wirelessly by an external wireless energy transmitter, and an internal wireless energy transmitter configured to transmit energy wirelessly to the second portion, and the second portion comprises a second wireless energy receiver configured to receive energy transmitted wirelessly by the internal wireless energy transmitter.

[0702] In some embodiments, the first energy storage unit is connected to the first wireless energy receiver.

[0703] In some embodiments, the second portion comprises the second energy storage unit, wherein the second energy storage unit is connected to the second wireless energy receiver. [0704] In some embodiments, at least one of the first and second energy storage unit is a solid-state battery.

[0705] In some embodiments, the solid-state battery is a thionyl -chloride battery.

[0706] In some embodiments, the first wireless energy receiver is configured to receive energy transmitted wirelessly by the external wireless energy transmitter and store the received energy in the first energy storage unit, the internal wireless energy transmitter is configured to wirelessly transmit energy stored in the first energy storage unit to the second wireless energy receiver, and the second wireless energy receiver is configured to receive energy transmitted wirelessly by the internal wireless energy transmitter and store the received energy in the second energy storage unit.

[0707] In some embodiments, the first portion comprises a first controller comprising at least one processing unit.

[0708] In some embodiments, the second portion comprises a second controller comprising at least one processing unit.

[0709] In some embodiments, the first controller and/or the second controller is configured to control the actuator.

[0710] In some embodiments, at least one of the first and second controller is connected to a wireless transceiver for communicating wirelessly with an external device.

[0711] In some embodiments, the first controller is connected to a first wireless communication receiver in the first portion for receiving wireless communication from an external device, the first controller is connected to a first wireless communication transmitter in the first portion for transmitting wireless communication to a second wireless communication receiver in the second portion.

[0712] In some embodiments, the second controller is connected to the second wireless communication receiver for receiving wireless communication from the first portion.

[0713] In some embodiments, the first wireless energy receiver comprises a first coil and the wireless energy transmitter comprises a second coil.

[0714] In some embodiments, the first portion comprises a combined coil, wherein the combined coil is configured to receive energy wirelessly from an external wireless energy transmitter, and transmit energy wirelessly to the second wireless receiver of the second portion.

[0715] In some embodiments, at least one of the coils are embedded in a ceramic material. [0716] In some embodiments, the implantable energized medical device further comprises a housing configured to enclose at least the first portion, and wherein a first portion of the housing is made from titanium and a second portion of the housing is made from a ceramic material.

[0717] In some embodiments, the portion of the housing made from a ceramic material comprises at least one coil embedded in the ceramic material.

[0718] In some embodiments, the implantable energized medical device further comprises a housing configured to enclose at least the second portion, and wherein a first portion of the housing is made from titanium and a second portion of the housing is made from a ceramic material.

[0719] In some embodiments, the portion of the housing made from a ceramic material comprises at least one coil embedded in the ceramic material.

[0720] In some embodiments, the first portion is detachably connected to at least one of the second portion and the connecting portion.

[0721] In some embodiments, the connecting portion comprising a flange having a flange area being larger than a cross-section area of the hole in the tissue portion, such that the flange is hindered from travelling through the hole in the tissue portion, such that the second portion and the connecting portion can be held in position by the tissue portion of the patient also when the first portion is disconnected from the connecting portion.

[0722] In some embodiments, a connecting interface between the connecting portion and the second portion is eccentric with respect to the second portion.

[0723] In some embodiments, a connecting interface between the connecting portion and the first portion is eccentric with respect to the first portion.

[0724] In some embodiments, the second portion has a first end and a second end opposing the first end, wherein the second portion has a length between the first and second end.

[0725] In some embodiments, the first end and second end are separated in a direction parallel to the second plane.

[0726] In some embodiments, the first and second ends comprise an elliptical point respectively.

[0727] In some embodiments, the first and second ends comprise a hemispherical end cap respectively. [0728] In some embodiments, the second portion has at least one circular cross-section along the length between the first and second end.

[0729] In some embodiments, the second portion has at least one oval cross-section along the length between the first and second end.

[0730] In some embodiments, the second portion has at least one elliptical cross-section along the length between the first and second end.

[0731] In some embodiments, the implantable energized medical device further comprises a gear arrangement, wherein the gear arrangement is configured to reduce the velocity and increase the force of the movement generated by the electric motor.

[0732] In some embodiments, the gear arrangement is configured to transfer a force with a high velocity into a stronger force with lower velocity.

[0733] In some embodiments, the gear arrangement is configured to transfer a rotating force into a linear force.

[0734] In some embodiments, the gear arrangement comprises a gear system.

[0735] In some embodiments, the second portion comprises a magnetic coupling for transferring mechanical work from the electric motor through one of: a barrier separating a first chamber of the second portion from a second chamber of the second portion, a housing enclosing at least the second portion.

Brief description of the drawings

[0736] The invention is now described, by way of example, with reference to the accompanying drawings, in which:

Fig. 1 shows the overall system of the present disclosure implanted in a patient’s body according to a first variation;

Fig. 2 shows the overall system of the present disclosure implanted in a patient’s body according to a second variation;

Fig. 3 shows a first general concept how a penetration area can be penetrated by an infusion needle at different penetration sites;

Fig. 4 shows a second general concept how a penetration area can be penetrated by an infusion needle at different penetration sites; Figs. 5 and 6 show a front view and a rear view, respectively, of a drive unit according to a first embodiment;

Fig. 7 shows a needle cooperating member of the drive unit according to the first embodiment to which an infusion needle is mounted;

Fig. 8 shows a perspective view of the needle cooperating member of Fig. 7 and a base;

Figs. 9 and 10 show a front view and a rear view, respectively, of a drive unit according to a second embodiment;

Figs. 11 and 12 show a front view and a rear view, respectively, of a drive unit according to a third embodiment;

Fig. 13 shows a needle cooperating member of the drive unit according to the third embodiment comprising two separable parts;

Fig. 14 shows an alignment structure of the drive unit according to the third embodiment;

Fig. 15 illustrates the injection of a substance into a vein using the drive unit according to the third embodiment;

Figs.l6A, 16B, 16B’ and 16C generally illustrate a system for communicating with an implanted medical device;

Fig. 17 shows an embodiment of a system for charging, programming and communicating with a controller of an implanted medical device;

Fig. 18 shows an elevated perspective view from the left of a housing unit;

Fig. 19 shows a plan view from the left of a housing unit:

Fig. 20 shows an elevated perspective view from the left of a housing unit;

Fig. 21 shows a plan view from the left of a housing unit;

Fig. 22 shows a system overview of an external device comprising a housing unit and a display device in wireless communication with an implanted medical device;

Fig. 21 shows an implant with an implant surface and a coating arranged on the surface;

Fig. 24 shows an implant with an implant surface and multiple coatings arranged on the surface; Figs. 25A and 25B show different micro patterns on the surface of an implant;

Fig. 26 shows a flow chart of a method of implantation of the system;

Figs. 27 and 28 show an embodiment of an implantable energized medical device;

Figs. 29A to 29D show a first portion and a connecting portion of the medical device of Figs. 27 and 28;

Figs. 30A to 32B show variants of an element of the connecting portion of Figs. 29A to 29C;

Fig. 33 shows a kit for assembling the medical device of Figs. 27 and 28;

Fig. 34 shows a further embodiment of an implantable energized medical device;

Fig. 35 shows a general example of an implantable energized medical device;

Fig. 36 shows a first variant of the general example of the medical device of Fig. 35;

Fig. 37 shows a second variant of the general example of the medical device of Fig. 35;

Figs. 38A and 38B show cross sections of the medical device of Fig. 35;

Figs. 39A to 39Q show different relative arrangements of first and second parts of the medical device of Fig. 35;

Figs. 40 and 41 show a third variant of the general example of the medical device of Fig. 35;

Figs. 42 and 43 show the medical device of Fig. 35 with first and second parts thereof being differently rotationally displaced relative to each other;

Figs. 44A to 44C illustrate a procedure of inserting the medical device of Figs. 40 and 41;

Fig. 45 shows an even further embodiment of an implantable energized medical device;

Figs. 46A and 46B illustrate a gear arrangement and magnetic coupling for coupling the implantable energized medical device to an implant;

Fig. 47A shows a perspective elevated view from the right of an embodiment of an implantable energized medical device for powering an implantable medical device;

Figs. 47B and 47C show lengthwise cross-sectional areas of the implantable medical device along the line A-A in Fig. 47A; Figs. 48 to 50 show cross-sectional plain side views of embodiments of an implantable energized medical device for powering an implantable medical device;

Fig. 51A shows a perspective elevated view from the right of an embodiment of an implantable energized medical device for powering an implantable medical device;

Figs. 5 IB and 51C show lengthwise cross-sectional areas of the implantable medical device along the line A-A in Fig. 51A;

Fig. 52 shows a cross-sectional plain side view of an embodiment of an implantable energized medical device;

Figs. 53A - 53C show cross-sectional plain side views of an embodiment of an implantable energized medical device;

Figs. 54A - 54D show cross-sectional plain side views of the embodiment in Figs. 53A - 53C when inserted into a tissue portion;

Figs. 55A - 55F show cross-sectional plain side views of embodiments of an implantable energized medical device;

Fig. 56 shows an embodiment of an implantable energized medical device for powering an implantable medical device or body engaging portion;

Figs. 57A - 57N and 57P - 57Q show schematic cross-sectional plain side views of systems comprising an implantable energized medical device;

Fig. 58A - 58B show cross-sectional plain side views of embodiments of an implantable energized medical device;

Fig. 59A - 59B show cross-sectional plain side views of embodiments of an implantable energized medical device;

Fig. 60A illustrates schematically a variant of the overall system according to the first general aspect of Fig. 3 comprising an inclined infusion needle;

Fig. 60B illustrates the variant of Fig. 60A with a curved surface of the housing;

Fig. 60C illustrates the variant of Fig. 60A with a plurality of infusion needles;

Fig. 60D illustrates the variant of Fig. 60A with a curved needle; Fig. 60E illustrates the variant of Fig. 60A with a curved surface of the housing and a curved needle;

Fig. 61 illustrates the principle of injecting a substance using an inclined infusion needle;

Figs. 62A and 62B show a front portion of an infusion needle in atop view and a cross-sectional side view, respectively, with an injection port arranged close to the tip end of the infusion needle;

Fig. 63 illustrates schematically the penetration area of the system with infusion needles being arranged in respective tubes;

Fig. 64 illustrates schematically the penetration area of the system with pre -configured passages having a widened entrance section for the infusion needle to enter;

Fig. 65 illustrates schematically the penetration area of the system with pre -configured passages into which the infusion needles extend with their respective tip ends;

Fig. 66 illustrates schematically the penetration area of the system with pre -configured passages having a widthwise extension and a compressor for opening these passages;

Fig. 67 illustrates the principle of injecting a substance using an infusion needle which comprises a retractable stylet (although the infusion needle is shown as being inclined, it does not need to be inclined according to this principle);

Fig. 68 illustrates the principle as shown in Fig. 67, wherein the stylet extends from the infusion needle;

Fig. 69 illustrates the principle as shown in Fig. 67, wherein the infusion needle with stylet extends from a laterally displaceable penetration area;

Fig. 70 illustrates the variant of Fig. 60E with a curved infusion needle and a stylet;

Fig. 71A to 7 ID illustrate a first principle of a mechanism for rotating a needle arm and a stylet arm, here involving a biasing element and releasable holder;

Fig. 72 illustrates the mechanism of Figs. 71A to 7 ID implemented in an overall system according to a first embodiment of the first principle;

Figs. 73A and 73B illustrate the mechanism of Figs. 71A to 71D implemented in an overall system according to a second embodiment of the first principle;

Figs. 74A to 74D illustrate a second principle of a mechanism for rotating a needle arm and a stylet arm, here involving at least one biasing element and a clutch; Figs. 75A to 75C illustrate a clutch for the mechanism according to the second principle;

Fig. 76 illustrates the mechanism of Figs. 74A to 74D implemented in an overall system according to the second principle;

Fig. 77 illustrates a third principle of a mechanism for rotating a needle arm and a stylet arm, here involving a needle crank arm and a stylet crank arm;

Fig. 78 illustrates the mechanism according to the third principle further involving a cam drive;

Figs. 79A to 79C illustrate different stages of the mechanism according to the third principle involving a needle crank arm, a stylet crank arm and a cam drive; and

Fig. 80 illustrates the mechanism of Figs. 79A to 79C implemented in an overall system according to the third principle.

Detailed description

[0737] In the following, a detailed description of embodiments of the invention will be given with reference to the accompanying drawings. It will be appreciated that the drawings are for illustration only and are not in any way restricting the scope of the invention. Thus, any references to directions, such as “up” or “down”, are referring only to the directions shown in the Figures. It should be noted that the features having the same reference numerals have the same function, a feature in one embodiment may thus be exchanged for a feature from another embodiment having the same reference numeral unless clearly contradictory. The descriptions of the features having the same reference numerals are thus to be seen as complementing each other in describing the fundamental idea of the feature and thereby showing the feature’s versatility.

Overall System

[0738] The overall system of the present disclosure will now be generally described in relation to Fig. 1 which shows a first variation of an overall system. The overall structure corresponds to the structure as disclosed in Fig. 1 ofWO 2010/040548 Al. Specifically shown in this variation is a housing 12 with a single infusion needle 11 and a drive unit D. Alternatively, there may be more than one infusion needle 11. The drive unit D schematically indicates by arrows that it is able to move the needle or needles 11 in different directions. The housing 12 is implanted with a self-sealing penetration area 14 positioned adjacent a patient’s vessel 7 which is in the form of a corpus cavemosum here, but which may be any other kind of vessel, in particular a blood vessel, such as a vein or an artery. The infusion needle or needles may have a tube-like body closed at the tip end and provided with a laterally arranged delivery exit port for delivery of the drug. Therefore, the needle will not cut out any material but will simply divide it during penetration. Thus, when the needle penetrates any material, such as fibrosis and/or the self-sealing penetration area 14 arranged in the housing’s wall, there will be no material entering and blocking the drug delivery passageway.

[0739] A motor M is contained in the housing 12 for driving a part of the drive unit D. The motor M within the housing 12 is controlled by means of a control unit C2 constituting an implantable part of a control system which further comprises an external data processing device Cl by which commands and any other kind of data can be sent to the control unit C2. For instance, the external data processing device Cl may be used to initiate an injection cycle from outside the patient’s body, this being done wirelessly as indicated by arrow 23. The implanted control unit C2 not only controls the motor M inside the housing 12 but also controls energy supply from an accumulator A to the motor M inside the housing 12.

[0740] The external data processing device Cl may likewise be used to program the implanted control unit C2. Also, a data transfer port for transferring data between the external data processing device C 1 and the implanted control unit C2 may be adapted to transfer data in both directions.

[0741] A feedback sensor F implanted inside the patient’s penis is shown here as being connected to the motor M inside the housing 12 and may likewise be connected to the implantable control unit C2. The feedback sensor F can sense one or more physical parameters of the patient, such as the drug level inside the corpora cavernosa, the flow volume through the corpora cavernosa, the pressure inside the corpora cavernosa and the like. Other feedback sensors may be provided at different locations so as to sense process parameters of the system, such as electrical parameters, distention, distance and the like.

[0742] The conduit 19 connecting the needle 11 with a reservoir comprising compartments R1 and R2 and wiring 24 for transmitting electric energy from the energy source A to the motor M inside the housing 12 are guided through a common conduit 25.

[0743] In this variation of the overall system, the reservoir comprises a first compartment R1 with e.g. a saline solution included therein, and a second compartment R2 with e.g. a drug in powder form or freeze-dried form included therein. A pump P driven by a second motor M2 is arranged to pump infusion liquid from the reservoir R1 to the infusion needle 11. The infusion liquid pumped by the pump P will pass through a mixing chamber 26 into which drugs will be released from the reservoir R2 in appropriate time coordination. The motor M2 or a different motor may cause the drugs to be released from the second reservoir R2. The motor M2 is also controlled by the control unit C2. Thus, infusion liquid pumped via the pump P from the relatively large first reservoir R1 through the mixing chamber 26, in which it is mixed with the drugs released from the second reservoir R2, will reach the infusion needle 11 which has meanwhile penetrated the self-sealing penetration area 14 of the housing 12 and will flow into the corpus cavemosum 7. [0744] In addition to or instead of the control unit C2, a pressure sensitive switch for activating the motor M inside the housing 12 and/or the motor M2 may be arranged subcutaneously.

[0745] Although the overall system may comprise one of a great variety of reservoir types, a particular reservoir type will now be described. The volume of the reservoir R1 is divided into two sections by means of a membrane 31. One section is fdled with gas whereas the other section is fdled with the infusion liquid (saline solution). An injection port 32 allows for refdling the reservoir R1 with infusion liquid by means of a replenishing needle. When the reservoir R1 is in its full state, the gas section is at ambient pressure or over-pressurized. As infusion liquid is drawn from the reservoir R1 by means of the pump P upon each infusion cycle, the pressure in the gas section will decrease below ambient pressure, i.e. to a negative relative value. Depending upon the particular type of pump P, it may be advantageous to provide a single acting ball valve to prevent any backflow from the pump P to the reservoir Rl.

[0746] There are various ways of providing the motors M and M2 with energy. In the variation shown, energy is supplied from outside the patient’s body either for direct use by the motors and/or for charging the accumulator A, which may be in the form of a rechargeable battery and/or a capacitor. An extracorporeal primary energy source E transmits energy of a first form through the patient’s skin 10 to an energy transforming device T which transforms the energy of the first form into energy of a second form, such as electric energy. The electric energy is used to recharge the accumulator A which provides secondary energy to the motor M upon demand.

[0747] The external primary energy source E may be adapted to create an external field, such as an electromagnetic field, magnetic field or electrical field, or create a wave signal, such as an electromagnetic wave or sound wave signal. For instance, the energy transforming device T may act as a solar cell, but adapted to the particular type of wave signal of the primary energy source E. The energy transforming device T may also be adapted to transform temperature changes into electrical energy.

[0748] Instead of the external primary energy source E, an implantable primary energy source E may be used, such as a regular long-life battery instead of the accumulator A.

[0749] The energy signal may also be used to transmit signals from the external data processing device C 1 by appropriate modulation of the energy signal, regardless of whether the energy is transmitted wirelessly or by wire, the energy signal thereby serving as a carrier wave signal for the digital or analog control signal. More particularly, the control signal may be a frequency-, phase- and/or amplitude-modulated signal. [0750] Fig. 2 shows a second variation of the entire system which basically differs from the system of Fig. 1 only in that the motor M inside the housing 12 is completely dispensed with. Instead, the motor M2 is used to drive the drive unit D. This is achieved by means of a cable 33 replacing the wiring 24 of the system shown in Fig. 1.

General Concepts

[0751] Figs. 3 and 4 show two different general concepts of how a penetration area 14 can be penetrated by an infusion needle 11 at different penetration sites. According to the first concept in Fig. 3, the infusion needle 11 is housed in a housing 12 and attached to a needle cooperating member 13 which is movable back and forth in a first direction (X direction) by means of a first actuator 16 and back and forth in a second direction (Y direction) by means of a second actuator 17. The first direction corresponds to a displacement direction of the infusion needle 11, i.e. the direction in which the infusion needle 11 is laterally displaced with respect to the penetration area from one penetration site to the next penetration site. For this purpose, the needle cooperating member 13 is mounted on a cross guide 15 along which the needle cooperating member 13 is movable in the displacement direction. The second direction corresponds to the advancing and retracting direction of the infusion needle 11, i.e. the direction in which the infusion needle 11 is moved so as to penetrate the penetration area 14 whenever an infusion cycle is carried out.

[0752] The second concept as shown in Fig. 4 differs from the first concept in that, instead of a single laterally movable infusion needle, a plurality of infusion needles 11 is arranged side by side along the penetration area 14, of which only two exemplary infusion needles 11 are shown in Fig. 4. In this concept, the infusion needle 11 is not fixedly mounted to the needle cooperating member 13. Instead, the needle cooperating member 13 comprises a positioning part 13A and a needle driver part 13B. The positioning part 13A is movable along the cross guide 15 in the displacement direction as described above. However, instead of laterally displacing an infusion needle 11, only the needle driver part 13B is moved in the displacement direction from one infusion needle 11 to the next infusion needle 11. Once the needle driver part 13B has been moved into a desired position adjacent to one of the infusion needles 11, it is advanced by means of the second actuator 17 so as to urge the infusion needle 11 to penetrate the penetration area 14. Thereafter, the respective infusion needle 11 may be retracted by the force of a counteracting spring element or by the needle driver part 13B which, at the end of the process, would need to be detached from the respective infusion needle 11 in order to be further laterally displaced to the next infusion needle 11.

[0753] In the following, the drive unit inside the housing 12 will be described by reference to three exemplary embodiments. Therein, the first and second actuators 16, 17 comprise cables. In one embodiment, a single cable is used for both laterally displacing as well as advancing and/or retracting the infusion needle 11.

The present disclosure provides different aspects. While these aspects are sometimes explained in respect of one or two of the three embodiments, they can likewise be realized in one or both of the other embodiments.

First Embodiment

[0754] A drive unit 100 according to a first embodiment is shown in Figs. 5 and 6 in a front view and rear view, respectively. The drive unit 100 may be mounted in the housing 12 shown in Figs. 3 and 4. The drive unit 100 comprises a base 101, two parallel linear bearings 102 protruding from opposite ends of the base 101, a translating frame 103 which is slidably movable along the two linear bearings 102 towards and away from the base 101, and two return springs 104, here in the form of coil springs arranged about a respective one of the two linear bearings 102. A needle cooperating member 113 to which the needle 11 is fixedly attached is mounted on a cross guide 115 along which it is movable in a (lateral) displacement direction. The cross guide 115, in turn, is fixedly attached with its opposite ends to the translating frame 103 so that movement of the translating frame 103 along the linear bearings 102 towards and away from the base 101 causes the infusion needle 11 to advance and retract in the advancing and retracting direction, respectively. Upon advancement of the infusion needle 11, it penetrates a septum 116 which is arranged adjacent to the penetration area 14 in the housing 12 mentioned above in relation to Figs. 3 and 4. Alternatively, the septum may be arranged in the wall of the housing and form the penetration area 14.

[0755] The base 101 is stationary with respect to the housing 12, e.g. bonded to or press-fitted into or mechanically held within the housing, so that within the context of the present disclosure elements being fixed to the base 101 and elements being fixed to the housing 12 are to be understood synonymously. This applies to all embodiments.

[0756] Lateral movement of the needle cooperating member 113 to which the infusion needle 11 is attached in opposed first and second displacement directions is realized by means of a displacement cable 120. The displacement cable 120 loops around a first wheel 121 and second wheel 122 which are respectively mounted on the first and second linear bearings 102, as shown in Fig. 6. The opposite ends 124 of the displacement cable 120 are crimped and fixedly held in a pocket of the needle cooperating member 113, as shown in Fig. 5. Thus, by moving the displacement cable 120 forward or backward, the needle cooperating member 113 and infusion needle 11 are moved in respective lateral displacement directions. The displacement cable 120 winds around each of the first and second wheels 121, 122 a plurality of times in order to increase friction between the displacement cable 120 and the first and second wheels 121, 122, thereby avoiding slippage of the displacement cable 120. A tensioning element 123 is fixedly held in the translating frame 103 so as to create a tensioning force on the displacement cable 120 in a direction transverse to the longitudinal axis of the displacement cable 120 so as to reduce any slack in the displacement cable 120. In the embodiment shown, the tensioning element 123 is a leaf spring placed in a pocket on the back of the translating frame 103 to maintain the cable tension in the loop. Notably, instead of the displacement cable 120 being a cable, it may be realized as a displacement belt, in particular as a toothed displacement belt winding around toothed first and second wheels 121, 122.

[0757] In order to set the displacement cable 120 in motion, a drive cable 125 extends from a remote motor, which may be an electric motor, through the wall of the housing 12 into the housing 12 (not shown). The drive cable 125 may be looped around the first wheel 121 or the second wheel 122 so as to drive the one or the other wheel. However, in the preferred embodiment shown in Figs. 5 and 6, the drive cable 125 winds around a third wheel 126 mounted on the linear bearing 102, here on the linear bearing 102 on which the first wheel 121 is mounted. Accordingly, the corresponding linear bearing 102 is rotatably mounted in both the base 101 and the translating frame 103 so that turning the wheel 126 by means of the drive cable 125 causes rotation of the linear bearing 102 and first wheel 121 fixedly mounted thereon, thereby causing movement of the displacement cable 120 as described above.

[0758] In an embodiment not shown, the displacement cable 120 may be replaced with the drive cable 125 in that the drive cable 125 may be fixedly connected to the needle cooperating member 113. In this case, the drive cable 125 would enter the housing on one side relative to the translating frame 103, loop around the second wheel 122, preferably a plurality of times, on the respective other side of the translating frame 103 and exit the housing again, e.g., on the first side relative to the translating frame 103. In this case, the first wheel 121 can be dispensed with. Further alternatively, the drive cable 125 being fixedly connected to the needle cooperating member 113 may enter the housing on one side and exit the housing on the other side, in which case both the first and second wheels 121 and 122 can be dispensed with.

[0759] In all embodiments where the displacement cable 120 and/or drive cable 125 winds around a corresponding wheel 121, 122 and/or 126, it may instead wind on and off the corresponding wheel. In this case, the cable may be attached to the respective wheel with one end thereof. This will be described further below in relation to the second embodiment.

[0760] As regards the advancement and retraction of the infusion needle 11 in the advancing and retracting directions, which are preferably perpendicular to the lateral displacement directions, a separate advancement cable 130 is provided. Similar to the drive cable 125, the advancement cable 130 is connected to a remotely arranged motor, i.e. a second motor which may be an electric motor, and the advancement cable 130 extends from the second motor through the wall of the housing 12 into the housing 12. The basic principle is to connect the advancement cable 130 to the translating frame 103 in such a manner that pulling the advancement cable 130 causes the translating frame 103 to move along the linear bearings 102 towards the base 101. According to a least complex construction, one end of the advancement cable 130 is fixed to the translating frame 103 from which the advancement cable 130 extends downwards towards the base 101 and is further guided out of the housing 12 towards the remote second motor either directly or over a guide wheel.

[0761] However, since the pulling forces on the advancement cable 130 required to insert and advance the infusion needle 11 into and through the septum 116 may be relatively high, the preferred embodiments shown in Figs. 5 and 6 include a block -and-tackle setup of which the advancement cable 130 forms a part. This setup reduces the amount of power needed to advance the infusion needle 11 through the septum 116 and the penetration area in the wall of the housing 12. Accordingly, the motor for driving the advancement cable 130 may be relatively small.

[0762] More specifically, one or, as shown in the embodiment of Figs. 5 and 6, preferably two pulleys are fixed to the translating frame 103 so as to move together with the translating frame 103 and another one or, as in the embodiment shown in Figs. 5 and 6, preferably two second pulleys 133 are fixed to the base 101, i.e. fixed to the housing 12, so as to be stationary. The end 131 of the advancement cable 130 is crimped and grounded to the base 101. It may alternatively by fixed to the translating frame 103, in which case one of the first pulleys 132 could be dispensed with (thereby reducing the block-and -tackle effect) or a further second pulley 133 could be provided on the base 101 (thereby further increasing the block-and-tackle effect). In the embodiment shown, the advancement cable 130 winds twice around one of the two second pulleys 133 so that this pulley is realized as a double pulley.

[0763] Fig. 7 shows the needle cooperating member 113 to which the infusion needle 11 is mounted. More specifically, the infusion needle 11 is curved and the curved section of the infusion needle 11 is placed in a correspondingly curved recess 114 of the needle cooperating member 113. This facilitates mounting of the infusion needle 11 in a correct position on the needle cooperating member 113 when the system is being assembled. The curved recess 114 provides a counter-force to forces acting on the infusion needle 11 when the infusion needle 11 is advanced to pierce with its front end through the septum 116 and further through the penetration area 14 in the wall of the housing 12. Preferably, the infusion needle 11 is welded or potted to the needle cooperating member 113 in the area of the recess 114 so as to securely hold the infusion needle 11 in place. An injection port 11A at the front end of the infusion needle 11 is designed as a side port arranged on a side of the tubular needle body 1 IB. At the opposite end of the infusion needle 11, there is provided a tubing connection 18 for connecting a drug supply line, such as the conduit 19 shown in Fig. 1. Finally, a needle-reinforcing tube 20 is placed around the infusion needle 11 to strengthen the tubular needle body 1 IB in order to minimize the deflection of the infusion needle 11 when it penetrates the septum 116 and the penetration area 14 of the housing 12.

[0764] Fig. 8 shows a perspective view of the needle cooperating member 113 with infusion needle 11 and the base 101. As can be seen, a window 105 is provided in the base 101 to allow the tubing 19 to be routed to the infusion needle 11. The base 101 offers sufficient space for the tubing 19 to be looped inside the housing 12 so that the tubing 19 can cover the full range of motion required when the needle 11 is laterally displaced and/or advanced and retracted.

[0765] The overall size of the drive unit 100 as shown in this first embodiment may be 40 mm in height, 30 mm in width, and 6 mm in depth, or smaller. This provides enough space for 15 injection sites assuming a space of one millimeter between the centers of adjacent injection sites. Increasing the width of the drive unit will increase the number of injection sites one-to-one, i.e. an increase by one millimeter will increase the number of injection sites by one.

Second Embodiment

[0766] A front view and a rear view of a second embodiment of a drive unit 200 is shown in Figs. 9 and 10, respectively. The structure is to a large extent identical to that of the first embodiment described above. Accordingly, the drive unit 200 comprises a base 201, two parallel linear bearings 202 extending from opposite ends of the base 201, a translating frame 203 slidably mounted on the two linear bearings 202 so as to be movable along the linear bearings 202 towards and away from the base 201, and two return springs 204 in the form of coil springs which are respectively mounted around the linear bearings 202. A cross guide 215 is fixedly mounted with its opposite ends to the translating frame 203, and a needle cooperating member 230 is slidable along the cross guide 215 in opposite lateral displacement directions, the displacement directions being different, in particular perpendicular, to the extension direction of the linear bearings 202. Accordingly, by moving the translating frame 203 along the linear bearings 202 towards and away from the base 201, the needle cooperating member 230 is advanced and retracted in opposite advancing and retracting directions along with the infusion needle 11 which is fixedly attached to the needle cooperating member 213.

[0767] The second embodiment differs from the first embodiment essentially in that a single advanced and displacement cable 240 is provided and arranged to perform both advancement of the infusion needle 11 in the advancement direction and displacement of the infusion needle 11 in the displacement directions. A first actuator, such as a first electric motor (not shown), may be attached to a first end of the advancement and displacement cable 240 and a second actuator, such as a second electric motor (not shown), may be attached to a second end of the advancement and displacement cable 240. The first and second motors are preferably remote from the housing and, therefore, the first and second ends of the advancement and displacement cable 240 are guided through the wall of the housing 12.

[0768] The advancement and displacement cable 240 is guided over two first pulleys 232 fixed to the base 201 so as to be stationary and two second pulleys 233 fixed to the translating frame 203 so as to move with the translating frame 203 in the advancing and retracting directions. More specifically, since the advancement and displacement cable 240 is guided over one of the two first pulleys 232 fixed to the base, further to the translating frame 203 and further over the other one of the two first pulleys 232 fixed to the housing, the translating frame is pulled along the linear bearings 202 in a direction towards the two first pulleys 232, i.e. in the advancing direction of the infusion needle 11, when the opposite ends of the advancement and displacement cable 240 are pulled over the same distance in opposite first and second pulling directions. The return springs 204 are arranged to urge the translating frame 203 towards a rest position so that, when the pulling force on the advancement and displacement cable 240 is reduced, the return springs 204 will cause automatic movement of the translating frame 203 back to its rest position shown in Figs. 9 and 10.

[0769] Furthermore, since the advancement and displacement cable 240 is not directly attached to the translating frame 203 but is rather attached to the needle cooperating member 213 which, in turn, is movable along the cross guide 215 attached to the translating frame 203, and since it is furthermore guided over the opposed two second pulleys 233 which are fixedly connected to the needle cooperating member 213, pulling the advancement and displacement cable 240 in the one or the other direction, e.g. pulling only one end of the advancement and displacement cable 240, causes the needle cooperating member 113 to move along the cross guide 215, thereby laterally displacing the infusion needle 11 in the displacement direction. Thus, when lateral displacement of the infusion needle 11 is desired while the translating frame 203 is in its rest position, only one end of the advancement end displacement cable 240 should be pulled because any simultaneous pulling of both ends of the advancement and displacement cable 240 would also cause the infusion needle 11 to advance towards the septum 216. Similarly, when advancement of the infusion needle 11 is desired, both ends of the advancement and displacement cable 240 should be pulled over the same distance in order to avoid that the infusion needle 11 moves laterally while being advanced. It is important to ensure that the return springs 204 are strong enough to prevent movement of the translating frame 203 along the linear bearings 202 when the advancement and displacement cable 240 is tensioned to cause lateral displacement of the needle cooperating member 213.

[0770] While the advancement and displacement cable 240 may have a continuous form with a central portion fixed to the needle cooperating member 213, in the embodiment shown in Figs. 9 and 10 the advancement and displacement cable 240 comprises two separate cable sections, each cable section having one end thereof connected to the needle cooperating member 213. Specifically, the respective ends are crimped and held in a crimp pocket 214 formed in the needle cooperating member 213.

[0771] Other than this, the second embodiment corresponds to the first embodiment. For instance, upon advancement of the needle cooperating member 213, the infusion needle 11 will penetrate the septum 216 and further into the patient so that a drug may be delivered through the injection port 11A. Furthermore, the infusion needle 11 is a bent needle which is attached and fixed to the needle cooperating member 213 in the same way as described in relation to the first embodiment. Again, a conduit applying the drug to be infused may be attached to the tubing connection 18 at the end of the infusion needle 11 opposite the injection port 11A.

[0772] With the drive unit 200 having the dimensions of 41 mm in height, 32 mm in width and 7 mm in depth, the design of the drive unit 200 may be such that there is enough space for 18 injection sites with a distance of one millimeter between the centers of neighboring injection sites. By reducing the number of injection sites from 18 to 16, the width can be further reduced to 30 mm.

Third Embodiment

[0773] Figs. 11 and 12 show a front view and a rear view, respectively, of a third embodiment of a drive unit 700. The third embodiment differs from the first and second embodiments mainly in that an array 705 of infusion needles 11 is provided rather than a single infusion needle. Thus, instead of laterally moving an infusion needle in a displacement direction, only the needle cooperating member 713 is moved laterally in the displacement direction to act on and thereby advance one infusion needle 11 of the array 705 of infusion needles 11.

[0774] As in the first and second embodiments, the drive unit 700 of the third embodiment comprises a base 701, two linear bearings 702 arranged in parallel and extending from opposite ends of the base 701, a translating frame 703 which is slidably movable along the linear bearings 702 towards and away from the base 701, and two return springs 702 respectively arranged around the linear bearings 702 so as to urge the translating frame 703 away from the base 701 into a rest position. Furthermore, a cross guide 715 in the form of a shaft, as in the previous embodiments, is fixedly connected with its opposed ends to the translating frame 703. A needle cooperating member 713 is mounted on the cross guide 715 so as to be slidable along the cross guide 715 in opposite displacement directions.

[0775] In this third embodiment, the needle cooperating member 713 comprises two components which are separable from each other, namely a needle driver part 713B, which is the component slidably mounted to the cross guide 715, and a positioning part 713A, which is slidably mounted on a secondary cross guide member 715A. Thus, the cross guide 715 to which the needle driver part 713B of the needle cooperating member 713 is movably mounted constitutes a main cross guide whereas the secondary cross guide member 715A to which the positioning part 713A of the needle cooperating member 713 is movably mounted constitutes a secondary cross guide. As will be described in more detail hereinafter, when the translating frame 703 is in its rest position shown in Figs. 11 and 12, the positioning part 713A and the needle driver part 713B are engaged with each other so that movement of the positioning part 713A along the secondary cross guide member 715A causes a corresponding movement of the needle driver part 713B along the (main) cross guide 715.

[0776] This is further shown in Fig. 13. As can be seen, a protrusion 707 of the positioning part 713A extends into a corresponding recess 708 of the needle driver part 713B. Of course, the protrusion 707 can likewise be arranged on the needle driver part 713B and the recess 708 in the positioning part 713A, or any other engagement structure may be provided which holds the positioning part 713A and needle driver part 713B together in the lateral displacement direction but allows disengagement of the positioning part 713A and needle driver part 713B in a direction different, preferably perpendicular, to the displacement direction, i.e. in the advancing direction of the infusion needles.

[0777] A crimped end 724 of a displacement cable 720 is attached to the positioning part 713A and guided over a wheel 721 towards an actuator, which may be an electric motor outside the housing 12. Pulling the displacement cable 720 in a first displacement direction, in Fig. 13 to the left, causes the positioning part 713 A to slide along the secondary cross guide member 715A into the first displacement direction and, since the secondary cross guide member 715A engages the needle driver part 713B, also the needle driver part 713B is caused to move in the same displacement direction along the (main) cross guide 715.

[0778] A constant-force spring 709 is also attached to the positioning part 713A so as to create a counter-force to the pulling force acting on the displacement cable 720. This helps to hold the positioning part 713 A in position relative to the secondary cross guide member 715A and, thus, the needle driver part 713B relative to the (main) cross guide 715. By designing the spring 709 as a constant-force tensioning spring, the pulling force required to move the needle cooperating member 713 along the cross guide 715 and, thus, the power provided by an associated motor is constant independent of the position of the needle cooperating member 713 relative to the cross guide 715. In the embodiment shown, the constant-force tensioning spring 709 comprises a metal band which winds on itself when it is not tensioned. One end of the metal band is attached to a reel and the other end is connected to the positioning part 713A of the needle cooperating member 713. When the needle cooperating member 713 is pulled along the cross guide 715 step by step with the aid of the displacement cable 720, the tensioning spring 709 creates a constant counter-force. When the pulling force of the displacement cable 720 is released, the tensioning spring winds automatically back onto the reel, thereby pulling the needle cooperating member 713 back to its starting position. The tensioning force provided by the tensioning spring 709 may range between 0.5 N and 2 N, preferably between 0.8 N and 1.2 N, more preferably about 1 N.

[0779] Exact positioning of the needle cooperating member 713 is supported by first and second alignment structures which engage each other so as to define different rest positions for the needle cooperating member 713. One of the alignment structures is stationary with respect to the displacement direction and the other alignment structure is movable along with the needle cooperating member 713. For instance, the first alignment structure may be a leaf spring and the second alignment structure may comprise a plurality of stationary detents or protrusions arranged to cooperate with the leaf spring. This concept can likewise be provided in the described first and second embodiments.

[0780] In the third embodiment as shown in Fig. 13, the first alignment structure is a leaf spring 711 mounted on the needle driver part 713B of the needle cooperating member 713, and the second alignment structure comprises a plurality of detents or protrusions 710 arranged on the translating frame 703 so as to cooperate with the leaf spring 711. This is shown in further detail in Fig. 14. Thus, when the needle cooperating member 713 is moved relative to the cross guide 715 in the displacing direction from one position to the next position, the free end of the leaf spring 711 is urged backwards to disengage from the detents or protrusions 710 and then snaps forward again in order to reengage with a neighboring one of the detents or protrusions. As is also recognizable from Fig. 14, the needle driver part 713B of the needle cooperating member 713 has the protrusion 712 arranged closely to the infusion needles 11, namely slightly above the infusion needles 11, so that, when the translating frame 703 moves downwards in the advancing direction, the protrusion 712 pushes a respective one of the infusion needles 11 downwards in the advancing direction.

[0781] The movement of the needle driver part 713B downwards in the advancing direction is realized in the same way as described above in relation to the first embodiment. Thus, similar to Fig. 6 relating to the first embodiment, Fig. 11 relating to the third embodiment shows a block-and-tackle setup comprising an advancement cable 730 which is fixed with its free end 731 to the base 701 and which is guided along two first pulleys 732 mounted on the translating frame 703 and two second pulleys 733 fixedly mounted to the base 701 and, thus, to the housing 12. Accordingly, once the needle cooperating member 713 has been moved to an appropriate position relative to one of the infusion needles 11 of the needle array 705 by means of the displacement cable 720, the advancement cable 730 may be pulled so that the needle driver part 713B of the needle cooperating member 713 moves downwards along with the translating frame 703, thereby, on the one hand, disengaging from the positioning part 713A of the needle cooperating member 713 and, on the other hand, urging the respective one infusion needle 11 of the needle array 705 downwards in the advancing direction. [0782] This is further shown in Fig. 15 which shows only some relevant parts of the drive unit 700. Accordingly, the needle driver part 713B is shown in a disengaged position in which it has already pushed one infusion needle 11 of the needle array 705 through the penetration area 14 of the housing 12 (not shown) into a vein 2 of the patient. Once the tension on the advancement cable 730 is released, the advanced infusion needle 11 will automatically be retracted into its rest position by means of the return springs 704. More specifically, a crossbar 703 A of the translating frame 703 is arranged below a sideways extension 11C of the infusion needles 11, as is shown in Fig. 11, so that the crossbar 703A contacts the sideways extension 11C and moves the infusion needle 11 upwards when the translating frame 713 is urged back into its rest position.

[0783] Fig. 15 further illustrates how drugs may be delivered through the infusion needle 11 into the patient. This concept utilizes infusion needles 11 having a feeding port 1 ID arranged distant from the tip end of the infusion needle 11 on a side of the tubular needle body 1 IB. Thus, the substance to be injected is fed sideways into the tubular needle body 1 IB. A needle lumen (not shown) inside the tubular needle body 1 IB connects the feeding port 1 ID with the injection port 11A, which is also realized as a side port, as discussed above.

[0784] As shown in Fig. 15, the septum 716 comprises an upper septum 716A and a lower septum 716B as well as an internal reservoir 717 between the upper septum 716A and lower septum 716B. The infusion needles 11 extend through the upper septum 716A, internal reservoir 717 and lower septum 716B. In their retracted positions, the feeding ports 1 ID are protected in the upper septum 716A and the injection ports 11A are protected in the lower septum 716B. In their advanced positions, the feeding port 1 ID is positioned inside the internal reservoir 717 and the injection port 11A is positioned outside the housing 12, thereby allowing the substance to be injected to flow from the internal reservoir 717 through the feeding port 1 ID and inner lumen of the tubular needle body 1 IB towards and through the injection port 11A into the patient’s body. The spacing between the feeding port 1 ID and injection port 11A is selected to ensure that the injection port 11A is fully inserted in the patient before the feeding port 1 ID accesses the internal reservoir 717.

[0785] A supply lumen 750 for supplying the substance to be injected to the internal reservoir 717 is arranged so as to run along an inner lumen of the linear bearing 702. The inner lumen connects directly to the internal reservoir 717, as shown in Fig. 15.

[0786] The overall size of the drive unit 700 is preferably no more than 46 mm in height, 33 mm in width and 8.5 mm in depth. This allows about 14 discrete injection sites in the needle array 705 spaced by 1.5 mm center-to-center distance.

Communication (Controller; Encryption / Decryption; Authentication / Verification) [0787] The communication between external devices or between an external device and the implant may be encrypted. Any suitable type of encryption may be employed such as symmetric or asymmetric encryption. The encryption may be a single key encryption or a multi -key encryption. In multi-key encryption, several keys are required to decrypt encrypted data. The several keys may be called first key, second key, third key, etc. or first part of a key, second part of the key, third part of the key, etc. The several keys are then combined in any suitable way (depending on the encryption method and use case) to derive a combined key which may be used for decryption. In some cases, deriving a combined key is intended to mean that each key is used one by one to decrypt data, and that the decrypted data is achieved when using the final key.

[0788] In other cases, the combination of the several keys results in one “master key” which will decrypt the data. In other words, it is a form of secret sharing, where a secret is divided into parts, giving each participant (external device(s), internal device) its own unique part. To reconstruct the original message (decrypt), a minimum number of parts (keys) is required. In a threshold scheme, this number is less than the total number of parts (e.g. the key at the implant and the key from one of the two external device are needed to decrypt the data). In other embodiments, all keys are needed to reconstruct the original secret, to achieve the combined key which may decrypt the data.

[0789] In should be noted that it is not necessary that the generator of a key for decryption is the unit that in the end sends the key to another unit to be used at that unit. In some cases, the generator of a key is merely a facilitator of encryption/decryption, and the working on behalf of another device/user.

[0790] A verification unit may comprise any suitable means for verifying or authenticating the use (i.e. user authentication) of a unit comprising or connected to the verification unit, e.g. the external device. For example, a verification unit may comprise or be connected to an interface (UI, GUI) for receiving authentication input from a user. The verification unit may comprise a communication interface for receiving authentication data from a device (separate from the external device) connected to the device comprising the verification unit. Authentication input/data may comprise a code, a key, biometric data based on any suitable techniques such as fingerprint, a palm vein structure, image recognition, face recognition, iris recognition, a retinal scan, a hand geometry, and genome comparison, etc. The verification/authentication may be provided using third-party applications, installed at or in connection with the verification unit.

[0791] The verification unit may be used as one part of a two-part authentication procedure. The other part may e.g. comprise conductive communication authentication, sensation authentication, or parameter authentication.

[0792] The verification unit may comprise a card reader for reading a smart card. A smart card is a secure microcontroller that is typically used for generating, storing and operating on cryptographic keys. Smart card authentication provides users with smart card devices for the purpose of authentication. Users connect their smart card to the verification unit. Software on the verification unit interacts with the key’s material and other secrets stored on the smart card to authenticate the user. In order for the smart card to operate, a user may need to unlock it with a user PIN. Smart cards are considered a very strong form of authentication because cryptographic keys and other secrets stored on the card are very well protected both physically and logically, and are therefore hard to steal.

[0793] The verification unit may comprise a personal e-ID that is comparable to, for example, passport and driving license. The e-ID system comprises is a security software installed at the verification unit, and an e-ID which is downloaded from a website of a trusted provider or provided via a smart card from the trusted provider.

[0794] The verification unit may comprise software for SMS-based two-factor authentication. Any other two-factor authentication systems may be used. Two-factor authentication requires two things to get authorized: something you know (your password, code, etc.) and something you have (an additional security code from your mobile device (e.g. an SMS or an e-ID) or a physical token such as a smart card).

[0795] Other types of verification/user authentication may be employed. For example, a verification unit which communicates with an external device using visible light instead of wired communication or wireless communication using radio. A light source of the verification unit may transmit (e.g. by flashing in different patterns) secret keys or similar to the external device which uses the received data to verify the user, decrypt data or by any other means perform authentication. Light is easier to block and hide from an eavesdropping adversary than radio waves, which thus provides an advantage in this context. In similar embodiments, electromagnetic radiation is used instead of visible light for transmitting verification data to the external device.

[0796] Parameters relating to functionality of the implant may be subject of the communication and comprise sensitive information, for example a status indicator of the implant such as battery level, version of control program, properties of the implant, status of a motor of the implant, etc. Furthermore, data comprising operating instructions may be subject of the communication and comprise other sensitive information, for example a new or updated control program, parameters relating to specific configurations of the implant, etc. Such data may for example comprise instructions on how to operate the electrical stimulation device and/or implantable constriction device, instructions to collect patient data, instructions to transmit feedback, etc. These parameters and data must be protected from being compromised.

Controller [0797] A controller for controlling the implantable medical device according to any of the embodiments disclosed herein and for communicating with devices external to the body of the patient and/or implantable sensors will now be described in a general way with reference to Figs. 16A to 16C. Fig. 16A shows a patient when an implantable medical device M comprising a controller 300 has been implanted, such as for example the constriction devices in the form of the exit and entry valves 30, 40 and/or electrical stimulation devices 10 with the controllers Ci and/or CE described above. The implantable medical device M comprises an active unit 302, which is a part of the electrical stimulation devices and/or mechanical or hydraulic constriction device and which comprises the one or more operable elements, valves, ports, etc. The active unit 302 is directly or indirectly connected to the body of the patient for acting on the intestine. The active unit 302 is connected to the controller 300 via an electrical connection C2. The controller 300 (further described with reference to Fig. 16B) is configured to communicate with an external device 320 (further described with reference to Fig. 16C). The controller 300 can communicate wirelessly with the external device 320 through a wireless connection WL1 and/or through an electrical connection Cl.

[0798] Referring now to Fig. 16B, one embodiment of the controller 300 will be described in more detail. The controller 300 comprises an internal computing unit 306 configured to control the function performed by the implantable medical device MD. The computing unit 306 comprises an internal memory 307 configured to store programs therein. In the embodiment described in Fig. 13b, the internal memory 307 comprises a first control program 310 which can control the function of the implantable medical device MD. The first control program 310 may be seen as a program with minimum functionality to be run at the implantable medical device M only during updating of the second control program 312. When the implantable medical device M is running with the first control program 310, the implantable medical device M may be seen as running in safe mode, with reduced functionality. For example, the first control program 310 may result in that no sensor data is stored in the implantable medical device M while being run, or that no feedback is transmitted from the implantable medical device M while the first control program 310 is running. By having a low- complexity first control program, memory at the implantable medical device M is saved, and the risk of failure of the implantable medical device M during updating of the second control program 312 is reduced.

[0799] The second control program 312 is the program controlling the implantable medical device M in normal circumstances, providing the implantable medical device M with full functionality and features.

[0800] The memory 307 can further comprise a second, updatable, control program 312. The term updatable is to be interpreted as the program being configured to receive incremental or iterative updates to its code or be replaced by a new version of the code. Updates may provide new and/or improved functionality to the implant as well as fixing previous deficiencies in the code. The computing unit 306 can receive updates to the second control program 312 via the controller 300. The updates can be received wirelessly via WL1 or via the electrical connection Cl. As shown in Fig. 16B, the internal memory 307 of the controller 300 can possibly store a third program 314. The third program 314 can control the function of the implantable medical device M, and the computing unit 306 may be configured to update the second program 312 to the third program 314. The third program 314 can be utilized when rebooting an original state of the second program 312. The third program 314 may thus be seen as providing a factory reset of the controller 300, e.g. restore it back to factory settings. The third program 314 may thus be included in the implant 300 in a secure part of the memory 307 to be used for resetting the software (second control program 312) found in the controller 300 to original manufacturer settings.

[0801] The controller 300 may comprise a reset function 316 connected to or part of the internal computing unit 306 or transmitted to said internal computing unit 306. The reset function 316 is configured to make the internal computing unit 306 switch from running the second control program 312 to the first control program 310. The reset function 316 may be configured to make the internal computing unit 306 delete the second control program 312 from the memory 307. The reset function 316 can be operated by palpating or pushing/put pressure on the skin of the patient. This may be performed by having a button on the implant. Alternatively, the reset function 316 can be invoked via a timer or a reset module. Temperature sensors and/ or pressure sensors can be utilized for sensing the palpating. The reset function 316 may also be operated by penetrating the skin of the patient. It is further plausible that the reset function 316 can be operated by magnetic means. This may be performed by utilizing a magnetic sensor and applying a magnetic force from outside the body. The reset function 316 may be configured such that it responds only to magnetic forces applied for a duration of time exceeding a limit, such as 2 seconds. The time limit may equally plausible be 5 or 10 seconds, or longer. In these cases, the implant may comprise a timer. The reset function 316 may thus include or be connected to a sensor for sensing such magnetic force.

[0802] In addition to or as an alternative to the reset function described above, the implant may comprise an internal computing unit 306 (comprising an internal processor) comprising the second control program 312 for controlling a function of the implantable medical device M, and a reset function 318. The reset function 318 may be configured to restart or reset said second control program 312 in response to: i. a timer of the reset function 318 not having been reset, or ii. a malfunction in the first control program 310.

[0803] The reset function 318 may comprise a first reset function, such as, for example, a computer operating properly, COP, function connected to the internal computing unit 306. The first reset function may be configured to restart or reset the first or the second control program 312 using a second reset function. The first reset function comprises a timer, and the first or the second control program is configured to periodically reset the timer.

[0804] The reset function 318 may further comprise a third reset function connected to the internal computing unit and to the second reset function. The third reset function may in an example be configured to trigger a corrective function for correcting the first 310 or second control program 312, and the second reset function is configured to restart the first 310 or second control program 312 sometime after the corrective function has been triggered. The corrective function may be a soft reset or a hard reset.

[0805] The second or third reset function may, for example, configured to invoke a hardware reset by triggering a hardware reset by activating an internal or external pulse generator which is configured to create a reset pulse. Alternatively, the second or third reset function may be implemented by software.

[0806] The controller 300 may further comprise an internal wireless transceiver 308. The transceiver 308 communicates wirelessly with the external device 320 through the wireless connection WL1. The transceiver may further communicate with an external device 320, 300 via wireless connection WL2 or WL4. The transceiver may both transmit and receive data via either of the connections Cl, WL1, WL2 and WL4. Optionally, the external devices 320 and 300, when present, may communicate with each other, for example via a wireless connection WL3.

[0807] The controller 300 can further be electrically connected Cl to the external device 320 and communicate by using the patient’s body as a conductor. The controller 300 may thus comprise a wired transceiver 303 or an internal transceiver 303 for the electrical connection Cl.

[0808] The controller 300 of the implantable medical device M according to Fig. 16B further comprises a feedback unit 349. The feedback unit 349 provides feedback related to the switching from the second control program 312 to the first control program 310. The feedback may for example represent the information on when the update of the software, i.e. the second control program 312, has started, and when the update has finished. This feedback can be visually communicated to the patient, via for example a display on the external device 320. This display may be located on a wristwatch, or a phone, or any other external device 320 coupled to the controller 300. Preferably, the feedback unit 349 provides this feedback signal wirelessly via WL1 to the external device 320. Potentially, the words “Update started”, or “Update finished”, may be displayed to the patient, or similar terms with the same meaning. Another option may be to display different colors, where green for example may mean that the update has finished, and red or yellow that the update is ongoing. Obviously, any color is equally plausible, and the user may choose these depending on personal preference. Another possibility would be to flash a light on the external device 320. In this case, the external device 320 comprises the light emitting device(s) needed. Such light may for example be an UED. Different colors may, again, represent the status of the program update. One way of representing that the update is ongoing and not yet finished may be to flash the light, i.e. turning the light on and off. Once the light stops flashing, the patient would be aware of that the update is finished. The feedback may also be audible and provided by the implantable constriction device M directly, or by the external device 320. In such cases, the implantable medical device M and external device 320 comprise means for providing audio. The feedback may also be tactile, for example in the form of a vibration that the user can sense. In such a case, either the implantable medical device M or external device 320 comprises means for providing a tactile sensation, such as a vibration and/or a vibrator.

[0809] As seen in Fig. 16B, the controller 300 can further comprise a first energy storage unit 40A. The first energy storage unit 40A runs the first control program 310. The controller 300 further comprises a second energy storage unit 40B which runs the second control program 312. This may further increase security during an update, since the first control program 310 has its own separate energy storage unit 40A. The first power supply 40A can comprise a first energy storage 304a and/or a first energy receiver 305a. The second energy storage unit 40B can comprise a second energy storage 304b and/or a second energy receiver 305b. The energy can be received wirelessly by inductive or conductive means. An external energy storage unit can for example transfer an amount of wireless energy to the energy receivers 305a, 305b inside the patient’s body by utilizing an external coil which induces a voltage in an internal coil (not shown in Figures). It is plausible that the first energy receiver 305a receives energy via an RFID pulse. The feedback unit 349 can provide feedback pertaining to the amount of energy received via the RFID pulse. The amount of RFID pulse energy that is being received can be adjusted based on the feedback, such that the pulse frequency is successively raised until a satisfying level is reached.

[0810] The controller 300 of the implantable medical device M according to Fig. 16B further comprises an electrical switch 309. The electrical switch 309 may be mechanically connected to an implantable element configured to exert a force on a body portion of a patient and being configured to be switched as a result of the force exerted on the body portion of a patient exceeding a threshold value. The switch 309 may for example be bonded to a portion of the implantable medical device M in any of the embodiments herein. The switch 309 may alternatively be electrically connected to the implantable medical device M and configured to be switched as a result of the current supplied to the implantable medical device M exceeding a threshold value. The switch 309 may for example be connected to the electrical stimulation devices 10 and/or the constriction devices in the form of the exit and entry valves 30, 40 and configured to be switched if the current to the implantable medical device M exceeds a threshold value. Such a switch may for example be a switch 309 configured to switch if exposed to a temperature exceeding a threshold value, such as a bimetal switch which is switched by the heat created by the flow of current to e.g. the electrodes of the electrical stimulation devices 10 or a motor of the mechanical or hydraulic constriction devices. In the alternative, the switch 309 configured to switch if exposed to a temperature exceeding a threshold value may be placed at a different location on the implantable medical device M to switch in case of exceeding temperatures, thereby hindering the implantable medical device M from overheating which may cause tissue damage.

[0811] The switch 309 may either be configured to cut the power to the operation device or to generate a control signal to the processor 306 of the implantable controller 300, such that the controller 300 can take appropriate action, such as reducing power or turning off the operation of the implantable medical device M.

[0812] The external device 320 is represented in Fig. 16C. The external device 320 can be placed anywhere on the patient’s body, preferably at a convenient and comfortable place. The external device 320 may be a wristband, and/or have the shape of a wristwatch. It is also plausible that the external device is a mobile phone or other device not attached directly to the patient. The external device 320 as shown in Fig. 16C comprises a wired transceiver 323, and an energy storage 324. It also comprises a wireless transceiver 328 and an energy transmitter 325. It further comprises a computing unit 326 and a memory 327. The feedback unit 322 in the external device 320 is configured to provide feedback related to the computing unit 326. The feedback provided by the feedback unit 322 may be visual. The external device 320 may have a display showing such visual feedback to the patient. It is equally plausible that the feedback is audible and that the external device 320 comprises means for providing audio. The feedback given by the feedback unit 322 may also be tactile, such as vibrating. The feedback may also be provided in the form of a wireless signal WL1, WL2, WL3, WL4.

[0813] The second, third or fourth communication method WL2, WL3, WL4 may be a wireless form of communication. The second, third or fourth communication method WL2, WL3, WL4 may preferably be a form of electromagnetic or radio-based communication. The second, third and fourth communication method WL2, WL3, WL4 may be based on telecommunication methods. The second, third or fourth communication method WL2, WL3, WL4 may comprise or be related to the items of the following list: Wireless Local Area Network (WLAN), Bluetooth, Bluetooth 5, BLE, GSM or 2G (2nd generation cellular technology), 3G, 4G or 5G.

[0814] The external device 320 may be adapted to be in electrical connection Cl with the implantable medical device M, using the body as a conductor. The electrical connection Cl is in this case used for conductive communication between the external device 320 and the implantable medical device M.

Encryption / Decryption [0815] In one embodiment, the communication between controller 300 and the external device 320 over either of the communication methods WL2, WL3, WL4, Cl may be encrypted and/or decrypted with public and/or private keys, now described with reference to Figs. 16A to 13c. For example, the controller 300 may comprise a private key and a corresponding public key, and the external device 320 may comprise a private and a corresponding public key.

[0816] The controller 320 and the external device 320 may exchange public keys and the communication may thus be performed using public key encryption. The person skilled in the art may utilize any known method for exchanging the keys.

[0817] The controller may encrypt data to be sent to the external device 320 using a public key corresponding to the external device 320. The encrypted data may be transmitted over a wired, wireless or electrical communication channel Cl, WL1, WL2, WL3 to the external device. The external device 320 may receive the encrypted data and decode it using the private key comprised in the external device 320, the private key corresponding to the public key with which the data has been encrypted. The external device 320 may transmit encrypted data to the controller 300. The external device 320 may encrypt the data to be sent using a public key corresponding to the private key of the controller 300. The external device 320 may transmit the encrypted data over a wired, wireless or electrical connection Cl, WL1, WL2, WL3, WL4, directly or indirectly, to the controller of the implant. The controller may receive the data and decode it using the private key comprised in the controller 300.

[0818] In an alternative to the public key encryption, described with reference to Figs. 16A to 16C, the data to be sent between the controller 300 of the implantable medical device M and an external device 320, 330 or between an external device 320, 330 and the controller 300 may be signed. In a method for sending data from the controller 300 to the external device 320, 330, the data to be sent from the controller 300 may be signed using the private key of the controller 300. The data may be transmitted over a communication channel or connection Cl, WL1, WL2, WL3, WL4. The external device 320, 330 may receive the message and verify the authenticity of the data using the public key corresponding to the private key of the controller 300. In this way, the external device 320, 330 may determine that the data were sent from the controller 300 and not from another device or source.

[0819] A method for communication between an external device 320 and the controller 300 of the implantable medical device M using a combined key is now described with reference to Figs. 16A to 16C. A first step of the method comprises receiving, at the implant, by a wireless transmission WL1, WL2, WL3, WL4 or otherwise, a first key from an external device 320, 330. The method further comprises receiving, at the implant, by a wireless transmission WL1, WL2, WL3, a second key. The second key may be generated by a second external device, separate from the external device 320, 330 or by another external device being a generator of the second key on behalf of the second external device 320, 330. The second key may be received at the implant from any one of: the external device 320, the second external device 330, and the generator of the second key. The second external device may be controlled by a caretaker or any other stakeholder. Said another external device may be controlled by a manufacturer of the implant, or medical staff, caretaker, etc.

[0820] In case the controller 300 is receiving the second key from the external device 320, this means that the second key is routed through the external device from the second external device 330 or from another external device (generator). The routing may be performed as described herein under the tenth aspect. In these cases, the implant and/or external device(s) comprises the necessary features and functionality (described in the respective sections of this document) for performing such routing. Using the external device 320 as a relay, with or without verification from the patient, may provide an extra layer of security as the external device 320 may not need to store or otherwise handle decrypted information. As such, the external device 320 may be lost without losing decrypted information. The controller 300 comprises a computing unit 306 configured for deriving a combined key by combining the first key and the second key with a third key held by the controller 300, for example in memory 307 of the controller 300. The third key may for example be a license number of the implant or a chip number of the implantable medical device MD. The combined key may be used for decrypting, by the computing unit 306, encrypted data transmitted by a wireless transmission WL1 from the external device 320 to the controller 300. Optionally, the decrypted data may be used for altering, by the computing unit 306, an operation of the implantable medical device MD. The altering of an operation of the implantable medical device M may comprise controlling or switching an active unit 302 of the implant. In some embodiments, the method further comprises at least one of the steps of, based on the decrypted data, updating a control program running in the controller 300, and operating the implantable medical device M using operation instructions in the decrypted data.

[0821] Methods for encrypted communication between an external device 320 and the controller 300 may comprise: receiving, at the external device 320, by a wireless transceiver 328, a first key, the first key being generated by a second external device 330, separate from the external device 320 or by another external device being a generator of the second key on behalf of the second external device 330, the first key being received from any one of the second external device 330 and the generator of the second key, receiving, at the external device 320 by the wireless transceiver 328, a second key from the controller 300, deriving a combined key, by a computing unit 326 of the external device 320, by combining the first key and the second key with a third key held by the external device 320 (e.g. in memory 307), transmitting encrypted data from the implant to the external device and receiving the encrypted data at the external device by the wireless transceiver 328, and decrypting, by the computing unit 326, the encrypted data, in the external device 320, using the combined key.

[0822] As described above, further keys may be necessary to decrypt the data. Consequently, the wireless transceiver 328 is configured for: receiving a fourth key from a third external device, wherein the computing unit 326 is configured for: deriving a combined key by combining the first, second and fourth key with the third key held by the external device, and decrypting the encrypted data using the combined key.

[0823] These embodiments further increase the security in the communication. The computing unit 326 may be configured to confirm the communication between the implant and the external device, wherein the confirmation comprises: measuring a parameter of the patient, by the external device 320, receiving a measured parameter of the patient, from the implantable medical device M, comparing the parameter measured by the implantable medical device M with the parameter measured by the external device 320, performing confirmation of the connection based on the comparison, and as a result of the confirmation, decrypting the encrypted data, in the external device, using the combined key.

[0824] The keys described in this section may in some embodiments be generated based on data sensed by sensors described hereinafter, e.g. using the sensed data as seed for the generated keys. A seed is an initial value that is fed into a pseudo-random number generator to start the process of random number generation. The seed may thus be made hard to predict without access to or knowledge of the physiological parameters of the patient which it is based on, providing an extra level of security to the generated keys.

Method of Communication

[0825] A method of communication between an external device 320 and an implantable medical device MD is now described with reference to Figs. 16A to 16C, when the implantable medical device MD is implanted in a patient and the external device 320 is positioned external to the body of the patient. The external device 320 is adapted to be in electrical connection Cl with the controller 300, using the body as a conductor. The electrical connection Cl is used for conductive communication between the external device 320 and the implantable medical device MD. The implantable medical device MD comprises the controller 300. Both the controller 300 and the external device 320 comprise a wireless transceiver 308 for wireless communication Cl between the controller 300 and the external device 320. The wireless transceiver 308 (included in the controller 300) may in some embodiments comprise sub-transceivers for receiving data from the external device 320 and other external devices, e.g. using different frequency bands, modulation schemes, etc.

[0826] In a first step of the method, the electrical connection Cl between the controller 300 and the external device 320 is confirmed and thus authenticated. The confirmation and authentication of the electrical connection may be performed as described hereinafter. In these cases, the implant and/or external device(s) comprise the necessary features and functionality (described in the respective sections of this document) for performing such authentication. By authenticating according to these aspects, security of the authentication may be increased as it may require a malicious third party to know or gain access to either the transient physiological parameter of the patient or detect randomized sensations generated at or within the patient.

[0827] The controller 300 of the implanted medical device MD may comprise a first transceiver 303 configured to be in electrical connection Cl with the external device 320, using the body as a conductor. Alternatively, the first transceiver 303 of the controller 300 may be wireless. The external device 320 may comprise a first external transmitter 323 configured to be in electrical connection Cl with the implanted medical device M, using the body as a conductor, and a wireless transmitter configured to transmit wireless communication WL1 to the controller 300. Alternatively, the first external transmitter 323 of the external device 320 may be wireless. The first external transmitter 323 and the wireless transmitter of the external device 320 may be the same or separate transmitters.

[0828] The controller 300 may comprise a computing unit 306 configured to confirm the electrical connection between the external device 320 and the internal transceiver 303 and accept wireless communication WL1 (of the data) from the external device 320 on the basis of the confirmation. [0829] Data is transmitted from the external device 320 to the controller 300 wirelessly, e.g. using the respective wireless transceivers of the controller 300 and the external device 320. Data may alternatively be transmitted through the electrical connection C 1. As a result of the confirmation, the received data may be used for instructing the implantable medical device MD. For example, a control program 310 running in the controller 300 may be updated or the controller 300 may be operated using operation instructions in the received data. This may be handled by the computing unit 306.

[0830] The method may comprise transmitting data from the external device 320 to the controller 300 wirelessly which may comprise transmitting encrypted data wirelessly. To decrypt the encrypted data (for example using the computing unit 306), several methods may be used.

[0831] In one embodiment, a key is transmitted using the confirmed conductive communication channel Cl (i.e. the electrical connection) from the external device 320 to the controller 300. The key is received at the controller (by the first internal transceiver 303). The key is then used for decrypting the encrypted data.

[0832] In some embodiments the key is enough to decrypt the encrypted data. In other embodiments, further keys are necessary to decrypt the data. In one embodiment, a key is transmitted using the confirmed conductive communication channel Cl (i.e. the electrical connection) from the external device 320 to the controller 300. The key is received at the controller 300 (by the first internal transceiver 303). A second key is transmitted (by the wireless transceiver 208) from the external device 320 using the wireless communication WL1 and received at the controller 300 by the wireless transceiver 308. The computing unit 306 then derives a combined key from the key and second key and uses this for decrypting the encrypted data.

[0833] In yet other embodiments, a key is transmitted using the confirmed conductive communication channel Cl (i.e. the electrical connection) from the external device 320 to the controller 300. The key is received at the controller (by the first internal transceiver 303). A third key is transmitted from a second external device 330, separate from the external device 320, to the implant wirelessly via WL2. The third key may be received by a second wireless receiver (part of the wireless transceiver 308) of the controller 300 configured for receiving wireless communication via WL2 from the second external device 330.

[0834] The first and third key may be used to derive a combined key by the computing unit 306, which then decrypts the encrypted data. The decrypted data is then used for instructing the implantable medical device MD as described above.

[0835] The second external device 330 may be controlled by, for example, a care person to further increase security and validity of data sent and decrypted by the controller 300. [0836] It should be noted that in some embodiments, the external device is further configured to receive WL2 secondary wireless communication from the second external device 330, and transmit data received from the secondary wireless communication WL2 to the implantable medical device MD. This routing of data may be achieved using the wireless transceivers 308, 208 (i.e. the wireless connection WL1), or by using a further wireless connection WL4 between the controller 300 and the external device 320. In these cases, the implant and/or external device(s) comprise(s) the necessary features and functionality for performing such routing. Consequently, in some embodiments, the third key is generated by the second external device 330 and transmitted via WL2 to the external device 320 which routes the third key to the controller 300 to be used for decryption of the encrypted data. In other words, the step of transmitting a third key from a second external device, separate from the external device, to the implant wirelessly, comprises routing the third key through the external device 320. Using the external device 320 as a relay, with or without verification by the patient, may provide an extra layer of security as the external device 320 may not need to store or otherwise handle decrypted information. As such, the external device 320 may be lost without losing decrypted information.

[0837] In yet other embodiments, a key is transmitted using the confirmed conductive communication channel Cl (i.e. the electrical connection) from the external device 320 to the controller 300. The key is received at the implant (by the first internal transceiver 303). A second key is transmitted from the external device 320 to the controller 300 wirelessly via WL1, received at the controller 300. A third key is transmitted from the second external device, separate from the external device 320, to the controller 300 wirelessly via WL4. Encrypted data transmitted from the external device 320 to the controller 300 is then decrypted using a derived combined key from the key, the second key and the third key. The external device may be a wearable external device.

[0838] The external device 320 may be a handset. The second external device 330 may be a handset or a server or may be cloud-based.

[0839] In some embodiments, the electrical connection Cl between the external device 320 and the controller 300 is achieved by placing a conductive member 321, configured to be in connection with the external device 320, in electrical connection with a skin of the patient for conductive communication Cl with the implant. In these cases, the implant and/or external device(s) comprise(s) the necessary features and functionality (described in the respective sections of this document) for performing such conductive communication. The communication may thus be provided with an extra layer of security in addition to the encryption by being electrically confined to the conducting path e.g. external device 320, conductive member 321, conductive connection Cl, controller 300, meaning the communication will be excessively difficult to be intercepted by a third party not in physical contact with, or at least proximal to, the patient. Authentication / Verification

[0840] To further increase security of the communication between the controller 300 and the external device 320, different types of authentication, verification and/or encryption may be employed. In some embodiments, the external device 320 comprises a verification unit 340. The verification unit 340 may be any type of unit suitable for verification of a user, i.e. configured to receive authentication input from a user, for authenticating the conductive communication between the implant and the external device. In some embodiments, the verification unit and the external device comprise means for collecting authentication input from the user (which may or may not be the patient). Such means may comprise a fingerprint reader, a retina scanner, a camera, a GUI for inputting a code, a microphone, a device configured to draw blood, etc. The authentication input may thus comprise a code or anything based on a biometric technique selected from the list of: a fingerprint, a palm vein structure, image recognition, face recognition, iris recognition, a retinal scan, a hand geometry, and genome comparison. The means for collecting the authentication input may alternatively be part of the conductive member 321 which comprise any of the above examples of functionality, such as a fingerprint reader or other type of biometric reader.

[0841] In some embodiments, the security may thus be increased by receiving an authentication input from a user by the verification unit 340 of the external device 320 and authenticating the conductive communication between the controller 300 and the external device using the authentication input. Upon a positive authentication, the conductive communication channel C 1 may be employed for comprising transmitting a conductive communication to the controller 300 by the external device 320 and/or transmitting a conductive communication to the external device 320 by the controller 300. In other embodiments, a positive authentication is needed prior to operating the implantable medical device MD based on received conductive communication and/or updating a control program running in the controller 300 as described above.

[0842] Figs. 16A to 16C further show that the implantable medical device MD is connected to a sensation generator 381. The sensation generator 381 may be configured to generate a sensation. The sensation generator 381 may be contained within the implantable medical device MD or be a separate unit. The sensation generator 381 may be implanted. The sensation generator 381 may also be located so that it is not implanted as such but still is in connection with a patient so that only the patient may experience sensations generated. The controller 300 is configured for storing authentication data, related to the sensation generated by the sensation generator 381.

[0843] The controller 300 is further configured for receiving input authentication data from the external device 320. Authentication data related to the sensation generated may be stored by a memory 307 of the controller 300. The authentication data may include information about the generated sensation such that it may be analyzed, e.g. compared, to input authentication data to authenticate the connection, communication or device. Input authentication data relates to information generated by a patient input to the external device 320. The input authentication data may be the actual patient input or an encoded version of the patient input, encoded by the external device 320. Authentication data and input authentication data may comprise a number of sensations or sensation components.

[0844] The authentication data may comprise a timestamp. The input authentication data may comprise a timestamp of the input from the patient. The timestamps may be a time of the event such as the generation of a sensation by the sensation generator 381 or the creation of input authentication data by the patient. The timestamps may be encoded. The timestamps may feature arbitrary time units, i.e. not the actual time. Timestamps may be provided by an internal clock 360 of the controller 300 and an external clock 362 of the external device 320. The clocks 360, 362 may be synchronized with each other. The clocks 360, 362 may be synchronized by using a conductive connection Cl or a wireless connection WL1 for communicating synchronization data from the external device 320, and its respective clock 362, to the controller 300, and its respective clock 360, and vice versa.

Synchronization of the clocks 360, 362 may be performed continuously and may not be reliant on secure communication.

[0845] Authentication of the connection may comprise calculating a time difference between the timestamp of the sensation and the time stamp of the input from the patient, and upon determining that the time difference is less than a threshold, authenticating the connection. An example of a threshold may be 1 s. The analysis may also comprise a low threshold as to fdter away input from the patient that is faster than normal human response times. The low threshold may e.g. be 50 ms.

[0846] Authentication data may comprise a number of times that the sensation is generated by the sensation generator, and wherein the input authentication data comprises an input from the patient relating to a number of times the patient detected the sensation. Authenticating the connection may then comprise: upon determining that the number of times that the authentication data and the input authentication data are equal, authenticating the connection.

[0847] A method of authenticating the connection between the implantable medical device MD and the external device 320 accordingly includes the following steps.

[0848] Generating, by the sensation generator 381, a sensation detectable by a sense of the patient. The sensation may comprise a plurality of sensation components. The sensation or sensation components may comprise a vibration (e.g. a fixed frequency mechanical vibration), a sound (e.g. a superposition of fixed-frequency mechanical vibrations), a photonic signal (e.g. a non-visible light pulse such as an infrared pulse), a light signal (e.g. a visual light pulse), an electrical signal (e.g. an electrical current pulse) or a heat signal (e.g. a thermal pulse). The sensation generator may be implanted, configured to be worn in contact with the skin of the patient or capable of creating sensation without being in physical contact with the patient, such as a beeping alarm. Sensations may be configured to be consistently felt by a sense of the patient while not risking harm to or affecting internal biological processes of the patient.

[0849] Storing, by the controller 300, authentication data related to the generated sensation.

[0850] Providing, by the patient, input to the external device, resulting in input authentication data. Providing the input may e.g. comprise engaging an electrical switch, using a biometric input sensor or entering the input into a digital interface running on the external device 320, to name just a few examples.

[0851] Transmitting the input authentication data from the external device to the controller 300. If the step was performed, the analysis may be performed by the controller 300.

[0852] Transmitting the authentication data from the implantable medical device MD to the external device 320. If the step was performed, the analysis may be performed by the external device 320. The wireless connection WL1 or the conductive connection Cl may be used to transmit the authentication data or the input authentication data.

[0853] Authenticating the connection based on an analysis of the input authentication data and the authentication data e.g. by comparing a number of sensations generated and experienced or comparing timestamps of the authentication data and the input authentication data. If the step was performed, the analysis may be performed by the implantable medical device MD.

[0854] Communicating further data between the controller 300 and the external device 320 following positive authentication. The wireless connection WL1 or the conductive connection Cl may be used to communicate the further data. The further data may comprise data for updating a control program 310 running in the controller 300 or operation instructions for operating the implantable medical device M.

[0855] If the analysis was performed by the controller 300, the external device 320 may continuously request or receive information of an authentication status of the connection between the controller 300 and the external device 320, and upon determining, at the external device 320, that the connection is authenticated, transmit further data from the external device 320 to the controller 300.

[0856] If the analysis was performed by the external device 320, the controller 300 may continuously request or receive information of an authentication status of the connection between the controller 300 and the external device 320, and upon determining, at the controller 300, that the connection is authenticated, transmit further data from the controller 300 to the external device 320. [0857] A main advantage of authenticating a connection according to this method is that only the patient may be able to experience the sensation. Thus, only the patient may be able to authenticate the connection by providing authentication input corresponding to the sensation generation.

Security Module

[0858] According to one embodiment described with reference to Fig. 16A - 16C, the communication unit 300 or internal controller 300 or control unit 300 comprises a wireless transceiver 308 for communicating wirelessly with an external device, a security module 389, and a central unit, also referred to herein as a computing unit 306 306, which is to be considered as equivalent. The central unit 306 is configured to be in communication with the wireless transceiver 308, the security module 389 and the implantable medical device or active unit 302. The wireless transceiver 308 is configured to receive communication from the external device 320 including at least one instruction to the implantable medical device MD and transmit the received communication to the central unit or computing unit 306. The central unit or computing unit 306 is configured to send secure communication to the security module 389, derived from the received communication from the external device 320, and the security module 389 is configured to decrypt at least a portion of the secure communication and verify the authenticity of the secure communication. The security module is further configured to transmit a response communication to the central unit or computing unit 306 and the central unit or computing unit is configured to communicate the at least one instruction to the active unit 302. In the embodiment shown in Fig. 16A - 16C, the at least one instruction is based on the response communication, or a combination of the response communication and the received communication from the external device 320.

[0859] In the embodiment shown in Fig. 16A - 16C, the security module 389 comprises a set of rules for accepting communication from the central unit or computing unit 306. In the embodiment shown in Fig. 16A - 16C, the wireless transceiver 308 is configured to be able to be placed in an off-mode, in which no wireless communication can be transmitted or received by the wireless transceiver 308. The set of rules comprises a rule stipulating that communication from the central unit or computing unit 306 to the security module 389 or to the active unit 302 is only accepted when the wireless transceiver 308 is placed in the off-mode.

[0860] In the embodiment shown in Fig. 16A - 16C, the set of rules comprises a rule stipulating that communication from the central unit or computing unit 306 is only accepted when the wireless transceiver 308 has been placed in the off-mode for a specific time period.

[0861] In the embodiment shown in Fig. 16A - 16C, the central unit or computing unit 306 is configured to verify a digital signature of the received communication from the external device 320. The digital signature could be a hash-based digital signature which could be based on a biometric signature from the patient or a medical professional. The set of rules further comprises a rule stipulating that communication from the central unit 306 is only accepted when the digital signature of the received communication has been verified by the central unit 306. The verification could for example comprise the step of comparing the digital signature or a portion of the digital signature with a previously verified digital signature stored in the central unit 306. The central unit 306 may be configured to verify the size of the received communication from the external device and the set of rules could comprise a rule stipulating that communication from the central unit 306 is only accepted when the size of the received communication has been verified by the central unit 306. The central unit could thus have a rule stipulating that communication above or below a specified size range is to be rejected.

[0862] In the embodiment shown in Fig. 16A - 16C, the wireless transceiver is configured to receive a message from the external device 320 being encrypted with at least a first and second layer of encryption. The central unit 306 the decrypts the first layer of decryption and transmit at least a portion of the message comprising the second layer of encryption to the security model 389. The security module 389 then decrypts the second layer of encryption and transmits a response communication to the central unit 306 based on the portion of the message decrypted by the security module 389.

[0863] In the embodiment shown in Fig. 16A - 16C, the central unit 306 is configured to decrypt a portion of the message comprising a digital signature, such that the digital signature can be verified by the central unit 306, also the central unit 306 is configured to decrypt a portion of the message comprising message size information, such that the message size can be verified by the central unit 306.

[0864] In the embodiment shown in Fig. 16A - 16C, the central unit 306 is configured to decrypt a first and second portion of the message, and the first portion comprises a checksum for verifying the authenticity of the second portion.

[0865] In the embodiment shown in Fig. 16A - 16C, the response communication transmitted from the security module 389 comprises a checksum, and the central unit 306 is configured to verify the authenticity of at least a portion of the message decrypted by the central unit 306 using the received checksum, i.e. by adding portions of the message decrypted by the central unit 306 and comparing the sum to the checksum.

[0866] In the embodiment shown in Fig. 16A - 16C, the set of rules further comprise a rule related to the rate of data transfer between the central unit 306 and the security module 389. The rule could stipulate that the communication should be rejected or aborted if the rate of data transfer exceeds a set maximum rate of data transfer, which may make it harder for unauthorized persons to inject malicious code or instructions to the medical implant.

[0867] In the embodiment shown in Fig. 16A - 16C, the security module 389 is configured to decrypt a portion of the message comprising the digital signature being encrypted with the second layer of encryption, such that the digital signature can be verified by the security module 389. The security module 389 then transmits a response communication to the central unit 306 based on the outcome of the verification, which can be used by the central unit 306 for further decryption of the message or for determining if instructions in the message should be communicated to the active unit 302.

[0868] In the embodiment shown in Fig. 16A - 16C, the central unit 306 is only capable of decrypting a portion of the received communication from the external device 320 when the wireless transceiver 308 is placed in the off-mode. In the alternative, or as an additional layer of security, the central unit 306 may be limited such that the central unit 306 is only capable of communicating instructions to the active unit 302 of the implantable medical device MD when the wireless transceiver 308 is placed in the off-mode. This ensures that no attacks can take place while the central unit 306 is communicating with the active unit 302.

[0869] In the embodiment shown in Fig. 16A - 16C, the implantable controller 300 is configured to receive, using the wireless transceiver 308, a message from the external device 320 comprising a first non-encrypted portion and a second encrypted portion. The implantable controller 300 (e.g. the central unit 306 or the security module 389) then decrypts the encrypted portion, and uses the decrypted portion to verify the authenticity of the non-encrypted portion. As such, computing power and thereby energy can be saved by not encrypting the entire communication, but rather only the portion required to authenticate the rest of the message (such as a checksum and/or a digital signature)

[0870] In the embodiment shown in Fig. 16A - 16C, the central unit 306 is configured to transmit an encrypted portion to the security module 389 and receive a response communication from the security module 389 based on information contained in the encrypted portion being decrypted by the security module. The central unit 306 is then configured to use the response communication to verify the authenticity of the non-encrypted portion. The non-encrypted portion could comprise at least a portion of the at least one instruction to the implantable medical device 306.

[0871] In the embodiment shown in Fig. 16A - 16C, the implantable controller 300 is configured to receive, using the wireless transceiver 308, a message from the external device 320 comprising information related to at least one of: a physiological parameter of the patient and a physical parameter of the implanted medical device MD, and use the received information to verify the authenticity of the message. The physiological parameter of the patient could be a parameter such as a parameter based on one or more of: a temperature, a heart rate and a saturation value. [0872] The physical parameter of the implanted medical device MD could comprise at least one of a current setting or value of the implanted medical device MD, a prior instruction sent to the implanted medical device MD or an ID of the implanted medical device MD.

[0873] The portion of the message comprising the information related to the physiological parameter of the patient and/or physical or functional parameter of the implanted medical device MD could be encrypted, and the central unit 306 may be configured to transmit the encrypted portion to the security module 389 and receive a response communication from the security module 389 based on the information having been decrypted by the security module 389.

[0874] In the embodiment shown in Fig. 16A - 16C, the security module 389 is a hardware security module comprising at least one hardware-based key. The security module 389 may have features that provide tamper evidence such as visible signs of tampering or logging and alerting. It may also be so that the security module 389 is “tamper resistant”, which makes the security module 389 inoperable in the event that tampering is detected. For example, the response to tampering could include deleting keys is tampering is detected. The security module 389 could comprise one or more secure cryptoprocessor chip. The hardware -based key(s) in the security module 389 could have a corresponding hardware-based key placeable in the external device 320. The corresponding external hardware -based key could be placed on a key-card connectable to the external device 320.

[0875] In alternative embodiments, the security module 389 is a software security module comprising at least one software -based key, or a combination of a hardware and software -based security module and key. The software -based key may correspond to a software-based key in the external device 320. The software -based key may correspond to a software -based key on a key-card connectable to the external device 320.

[0876] In the embodiment shown in Fig. 16A - 16C, the external device 320 is a handheld external device, however, in alternative embodiments, the external device may be a remote external device or a cloud based external device

[0877] In the embodiment shown in Fig. 16A - 16C, the at least one instruction to the implantable medical device MD comprises an instruction for changing an operational state of the implantable medical device MD.

[0878] In the embodiment shown in Fig. 16A - 16C, the wireless transceiver 308 is configured to communicate wirelessly with the external 320 device using electromagnetic waves at a frequency below 100 kHz, or more specifically below 40 kHz. The wireless transceiver 308 is thus configured to communicate with the external device 320 using “Very Low Frequency” communication (VLF). VLF signals have the ability to penetrate a titanium housing of the implantable medical device MD, such that the electronics of the implantable medical device MD can be completely encapsulated in a titanium housing.

[0879] The wireless transceiver 308 is configured to communicate wirelessly with the external device 320 using a first communication protocol and the central unit 306 is configured to communicate with the security module 389 using a second, different, communication protocol. This adds an additional layer of security as security structures could be built into the electronics and/or software in the central unit 306 enabling the transfer from a first to a second communication protocol. The wireless transceiver 308 may be configured to communicate wirelessly with the external device using a standard network protocol, which could be one of an RFIDtype protocol, a WLAN-type protocol, a Bluetooth-(BT)-type protocol, a BLE-type protocol, an NFC-type protocol, a 3G/4G/5G-type protocol, and a-GSM type protocol. In the alternative, or as a combination, the wireless transceiver 308 could be configured to communicate wirelessly with the external device 320 using a proprietary network protocol. The wireless transceiver 308 could comprises a Ultra-Wide Band (UWB) transceiver and the wireless communication between the implantable controller 300 and the external device 320 could thus be based on UWB. The use of UWB technology enables positioning of the remote control 320” which can be used by the implanted medical device MD as a way to establish that the external device 320 is at a position which the implanted medical device MD and/or the patient can acknowledge as being correct, e.g. in the direct proximity to the medical device MD and/or the patient, such as within reach of the patient and/or within 1 or 2 meters of the implanted medical device MD. In the alternative, a combination of UWB and BT could be used, in which case the UWB communication can be used to authenticate the BT communication, as it is easier to transfer large data sets using BT.

Variable Impedance

[0880] According to one embodiment described with reference to Fig. 16A - 16C, the communication unit 300 or controller of the implantable medical device MD comprises a receiving unit 305 or energy receiver 305 comprising a coil 192 (specifically shown in Fig. 16B’) configured for receiving transcutaneously transferred energy. The receiving unit further comprises a measurement unit 194 configured to measure a parameter related to the energy received by the coil 192 and a variable impedance 193 electrically connected to the coil 192. The receiving unit 305 further comprises a switch 195a placed between the variable impedance 193 and the coil 192 for switching off the electrical connection between the variable impedance 193 and the coil 192. The communication unit 300 or controller 300 is configured to control the variable impedance 193 for varying the impedance and thereby tune the coil 192 based on the measured parameter. The communication unit 300 or controller 300 is further configured to control the switch 195a for switching off the electrical connection between the variable impedance 193 and the coil 192 in response to the measured parameter exceeding a threshold value. The controller 300 may further be configured to vary the variable impedance in response to the measured parameter exceeding a threshold value. As such, the coil can be tuned or turned off to reduce the amount of received energy if the amount of received energy becomes excessive. The measurement unit 194 is configured to measure a parameter related to the energy received by the coil 192 over a time period and/or measure a parameter related to a change in energy received by the coil 192 by for example measure the derivative of the received energy over time. The variable impedance 193 is in the embodiment shown in Fig. 16B’ placed in series with the coil 192. In alternative embodiments it is however conceivable that the variable impedance is placed parallel to the coil 192.

[0881] The first switch 195a is placed at a first end portion 192a of the coil 192, and the implantable medical device MD further comprises a second switch 195b placed at a second end portion of the coil 192, such that the coil 192 can be completely disconnected from other portions of the implantable medical device MD. The receiving unit 305 is configured to receive transcutaneously transferred energy in pulses according to a pulse pattern. The measurement unit 194 is in the embodiment shown in Fig. 16B’ configured to measure a parameter related to the pulse pattern. The controller 300 is configured to control the variable impedance in response to the pulse pattern deviating from a predefined pulse pattern. The controller 300 is configured to control the switch 195a for switching off the electrical connection between the variable impedance 193 and the coil 192 in response to the pulse pattern deviating from a predefined pulse pattern. The measurement unit is configured to measure a temperature in the implantable medical device MD or in the body of the patient, and the controller 300 is configured to control the first and second switch 195a, 195b in response to the measured temperature.

[0882] The variable impedance 193 may comprise a resistor and a capacitor and/or a resistor and an inductor and/or an inductor and a capacitor. The variable impedance 193 may comprise a digitally tuned capacitor or a digital potentiometer. The variable impedance 193 may comprise a variable inductor. The first and second switch comprises a semiconductor, such as a MOSFET. The variation of the impedance is configured to lower the active power that is received by the receiving unit. As can be seen in Fig. 16B’, the variable impedance 193, the first and second switch 195a, 195b and the measurement unit 194 are connected to the communication unit/controller 300 and the receiving unit 305 is connected to an energy storage unit 40 such that the energy storage unit 40 can store energy received by the receiving unit 305.

Plurality of external devices with different levels of authority for increased security

[0883] Fig. 17 shows one embodiment of a system for charging, programming and communicating with the controller 300 of the implanted medical device MD. Fig. 17 further describes the communication and interaction between different external devices which may be devices held and operated by the patient, by a health care provider (HCP) or by a Dedicated Data Infrastructure (DDI), which is an infrastructure supplier for example by the manufacturer of the implanted medical device MD or the external devices 320’, 320”, 320’”. The system of the embodiment of Fig. 17 comprises three external devices 320’, 320”, 320’” capable of communicating with the controller 300. The basic idea is to ensure the security of the communication with, and the operation of, the medical device MD by having three external devices 320’, 320”, 320’” with different levels of authority. The lowest level of authority is given to the patient-operated remote control 320”. The remote control 320” is authorized to operate functions of the implanted medical device MD via the implanted controller 300, on the basis of patient input. The remote control 320” is further authorized to fetch some necessary data from the controller 300. The remote control 320” is capable of operating the controller 300 only by communicating with the software currently running on the controller 300 with the current settings or the software. The next level of authority is given to the Patient External Interrogation Device (P- EID) 320’” which is a charging and communication unit which is held by the patient but is partially remotely operated by the Health Care Provider (HCP). (This is usually a medical doctor of the clinic providing the treatment with help of the implanted medical device MD). The P-EID 320’” is authorized to make setting changes to the software running on the controller 300 of the implanted medical device MD when remotely operated by the HCP. The highest level of authority is given to the HCP-EID 320’. The HCP-EID 320’ is a charging and communication unit which is held by the HCP physically at the clinic of the HCP. The HCP-EID 320’ is authorized to freely alter or replace the software running on the controller 300 when the patient is physically in the clinic or the HCP.

[0884] Starting from the lowest level of authority, the remote control 320” comprises a wireless transceiver 328 for communicating with the implanted medical device MD. The remote control 320” is capable of controlling the operation of the implanted medical device MD via the controller 300, by controlling pre-set functions of the implantable medical device MD, e.g. for operating an active portion of the implanted medical device MD for performing the intended function of the implanted medical device MD. In the embodiment shown in Fig. 17, the wireless transceiver 328 comprises a Bluetooth (BT) transceiver, and the remote control 320” is configured to communicate with implanted medical device MD using BT. In an alternative configuration, the remote control 320” communicates with the implanted medical device MD using a combination of Ultra-Wide Band (UWB) wireless communication and BT. The use of UWB technology enables positioning of the remote control 320” which can be used by the implanted medical device MD as a way to establish that the remote control 320” is at a position which the implanted medical device MD and/or the patient can acknowledge as being correct, e.g. in the direct proximity to the medical device MD and/or the patient, such as within reach of the patient and/or within 1 or 2 meters of the implanted medical device MD. [0885] UWB communication is performed by the generation of radio energy at specific time intervals and occupying a large bandwidth, thus enabling pulse-position or time modulation. The information can also be modulated on UWB signals (pulses) by encoding the polarity of the pulse and/or its amplitude and/or by using orthogonal pulses. A UWB radio system can be used to determine the "time of flight" of the transmission at various frequencies. This helps to overcome multipath propagation since some of the frequencies have a line-of-sight trajectory while other indirect paths have longer delay. With a cooperative symmetric two-way metering technique, distances can be measured with high resolution and accuracy. UWB is useful for real-time location systems, and its precision capabilities and low power make it well-suited for radio frequency-sensitive environments.

[0886] In embodiments in which a combination of BT and UWB technology is used, the UWB technology may be used for location-based authentication of the remote control 320”, whereas the communication and/or data transfer can take place using BT. The UWB signal can in some embodiments also be used as a wake-up signal for the controller 300, or for the BT transceiver such that the BT transceiver in the implanted medical device MD can be turned off when not in use, which eliminates the risk that the BT is intercepted, or that the controller 300 of the implanted medical device MD is hacked by means of BT communication. In embodiments in which a BT/UWB combination is used, the UWB connection may be used also for the transmission of data. In the alternative, the UWB connection can be used for the transmission of some portions of the data, such as sensitive portions of the data, or for the transmission of keys for the unlocking of encrypted communication sent over BT.

[0887] The remote control 320” comprises control logic which runs a control logic application for communicating with the implanted medical device MD. The control logic can receive input directly from control buttons 335 arranged on the remote control 320” or from a control interface 334i displayed on a display device 334 operated by the patient. In the embodiments in which the remote control 320” receives input from a control interface 334i displayed on a display device 334 operated by the patient, the remote control 320” transmits the control interface 334i in the form of a web -view, i.e. a remote interface that runs in a sandbox environment on the patient’s display device 334. The patient’s display device 334 can be, for example, a mobile phone, a tablet or a smart watch. In the embodiment shown in Fig. 17, the patient’s display device 334 communicates with the remote control 320” by means of BT. The control interface 334i in the form of a web-view is transmitted from the remote control 320” to the patient’s display device 334 over BT. Control commands in the form of inputs from the patient to the control interface 334i are transmitted from the patient’s display device 334 to the remote control 320” and provide input to the remote control 320” equivalent to the input that may be provided using the control buttons 335. The control commands created in the patient’s display device 334 are encrypted in the patient’s display device 334 and transmitted to the remote control 320’ using BT. [0888] The patient’s display device 334 may (in the case of the display device 334 being a mobile phone or tablet) comprise auxiliary radio transmitters for providing auxiliary radio connection, such as Wi-Fi or mobile connectivity (e.g. according to the 3G, 4G or 5G standards). The auxiliary radio connection(s) may have to be disconnected to enable communication with the remote control 320”. Disconnecting the auxiliary radio connections reduces the risk that the integrity of the control interface 334i displayed on the patient’s display device 334 is compromised or that the control interface 334i displayed on the patient’s display device 334 is remote controlled by an unauthorized device.

[0889] In alternative embodiments, control commands are generated and encrypted by the patient’s display device and transmitted to the DDI 330. The DDI 330 can either alter the created control commands to commands readable by the remote control 320” before further encrypting the control commands for transmission to the remote control 320’ ’ or can add an extra layer of encryption before transmitting the control commands to the remote control 320” or can simply act as a router for relaying the control commands from the patient’s display device 334 to the remote control 320”. It is also possible that the DDI 330 adds a layer of end-to-end encryption directed at the implanted medical device MD, such that only the implanted medical device MD can decrypt the control commands to perform the command intended by the patient.

[0890] The patient’s display device 334 can have a first and second application related to the implanted medical device MD. The first application is the control application displaying the control interface 334i for controlling the implanted medical device MD, whereas the second application is a general application for providing the patient with general information about the status of the implanted medical device MD or information from the DDI 330 or HCP or for providing an interface for the patient to provide general input to the DDI 330 or HCP related to the general well-being of the patient, lifestyle of the patient or general input from the patient concerning the function of the implanted medical device MD. The second application does not provide input to the remote control 320” and/or the implanted medical device MD, thus handles data which are less sensitive. As such, the general application can be configured to function also when all auxiliary radio connections are activated, whereas switching to the control application which handles the more sensitive control commands and communication with the implanted medical device MD can require that the auxiliary radio connections are temporarily de-activated. It is also possible that the control application is a sub-application running within the general application, in which case the activation of the control application as a sub- application in the general application can require the temporary de-activation of auxiliary radio connections. In the embodiment shown in Fig. 17, access to the control application requires the use of optical and/or NFC means of a hardware key 333’ in combination with biometric input to the patient’s display device, whereas accessing the general application only requires biometric input to the patient’s display device and/or a pin code. In the alternative, a two -factor authentication solution, such as a digital key in combination with a pin code, can be used for accessing the general application and/or the control application.

[0891] In the embodiments in which the patient’s display device 334 is configured to display and interact only with a web-view provided by another unit of the system, it is possible that the web-view is a view of a back-end provided on the DDI 330, and in such embodiments, the patient interacting with the control interface on the patient’s display device is equivalent to the patient interacting with an area of the DDI 330.

[0892] Turning now to the P-EID 320’”, the P-EID 320’” is an external device which communicates with, and charges, the implanted medical device MD. The P-EID 320’” can be remotely controlled by the HCP to read information from the implanted medical device MD, control the operation of the implanted medical device MD, control the charging of the implanted medical device MD, and adjust the settings to the software running on the controller 300 of the implanted medical device MD, e.g. by adding or removing pre-defined program steps and/or by the selection of pre-defined parameters within a limited range. Just as the remote control 320”, the P-EID 320”’ can be configured to communicate with the implanted medical device MD using BT or UWB communication. Just as with the remote control 320”, it is also possible to use a combination of UWB wireless communication and BT for enabling positioning of the P-EID 320” as a way to establish that the P-EID 320” is at a position which the implanted medical device MD and/or patient and/or HCP can acknowledge as being correct, e.g. in the direct proximity to the correct patient and/or the correct medical device MD. Just as for the remote control 320”, in embodiments in which a combination of BT and UWB technology is used, the UWB technology may be used for location-based authentication of the P-EID 320”, whereas the communication and/or data transfer can take place using BT. The P-EID 320” comprises a wireless transmitter/transceiver 328 for communication and also comprises a wireless transmitter 325 configured for transferring energy wirelessly, in the form of a magnetic field, to a wireless receiver 395 of the implanted medical device MD configured to receive the energy in the form of a magnetic field and transform the energy into electric energy for storage in an implanted energy storage unit 40, and/or for consumption in an energy consuming part of the implanted medical device MD (such as the operation device, controller 300, etc.). The magnetic field generated in the P- EID and received in the implanted medical device MD is denoted a “charging signal”. In addition to enabling the wireless transfer of energy from the P-EID to the implanted medical device MD, the charging signal may also function as a means of communication. For instance, variations in the frequency of the transmission and/or amplitude of the signal may be used as a signaling means for enabling communication in one direction, from the P-EID to the implanted medical device MD, or in both directions between the P-EID and the implanted medical device MD. The charging signal in the embodiment shown in Fig. 17 is a signal in the range of 120 to 140 kHz, and the communication follows a proprietary communication signaling protocol, i.e. it is not based on an open standard. In alternative embodiments, BT can be combined with communication using the charging signal or communication using the charging signal can be combined with a UWB signal.

[0893] Just as for the remote control 320”, the UWB signal can in some embodiments also be used as a wake-up signal for the controller 300, or for the BT transceiver, such that the BT transceiver in the implanted medical device MD can be turned off when not in use, which eliminates the risk that the BT is intercepted or that the controller 300 of the implanted medical device MD is hacked by means of BT communication. In the alternative, the charging signal can be used as a wake-up signal for the BT, as the charging signal does not travel very far. Also, as a means of location -based authentication, the effect of the charging signal or the RSSI can be assessed by the controller 300 in the implanted medical device MD to establish that the transmitter is within a defined range. In the BT/UWB combination, the UWB may be used also for transmission of data. In some embodiments, the UWB and/or the charging signal can be used for the transmission of some portions of the data, such as sensitive portions of the data, or for the transmission of keys for unlocking encrypted communication sent by BT.

[0894] UWB can also be used for waking up the charging signal transmission, starting the wireless transfer of energy or initiating communication using the charging signal. As the signal for transferring energy has a very high effect in relation to normal radio communication signals, the signal for transferring energy cannot be active all the time, as this signal may be hazardous, e.g. by generating heat.

[0895] The P-EID 320” ’ communicates with the HCP over the Internet by means of a secure communication, such as over a VPN. The communication between the HCP and the P-EID 320” ’ is preferably encrypted. The communication from the HCP to the implanted medical device MD may be performed using an end-to-end encryption, in which case the communication cannot be decrypted by the P-EID 320”’. In such embodiments, the P-EID 320”’ acts as a router which merely passes on encrypted communication from the HCP to the controller 300 of the implanted medical device MD. This solution further increases security as the key for decrypting the information rests only with the HCP and with the implanted medical device MD, which reduces the risk that an unencrypted signal is intercepted by an unauthorized device.

[0896] When the implanted medical device MD is to be controlled and/or updated remotely by the HCP via the P-EID 320’”, an HCP Dedicated Device (DD) 332 displays an interface in which predefined program steps or setting values are presented to the HCP. The HCP provides input to the HCP DD 332 by selecting program steps, altering settings and/or values or altering the order in which pre-defined program steps are to be executed. The instructions/parameters put into the HCP DD 332 for remote operation is, in the embodiment shown in Fig. 17, routed to the P-EID 320”’ via the DDI 330 which may or may not be able to decrypt/read the instructions. The DDI 330 may store the instructions for a time period to later transfer the instructions in a package of created instructions to the P-EID 320’”. It is also possible that an additional layer of encryption is provided to the package by the DDI 330. The additional layer of encryption may be a layer of encryption to be decrypted by the P-EID 330 or a layer of encryption which may be decrypted only by the controller 300 of the implanted medical device MD, which reduces the risk that unencrypted instructions or packages are intercepted by unauthorized devices. The instructions/parameters are then provided to the P-EID 320”, which then loads the instructions/parameters into the implanted medical device MD during the next charging/energy transfer using any of the signal transferring means (wireless or conductive) disclosed herein.

[0897] The Health Care Provider EID (HCP EID) 320’ has the same features as the P- EID 320” and can communicate with the implanted medical device MD in the same alternative ways (and combinations of alternative ways) as the P-EID 320’”. However, in addition, the HCP EID 320’ also enables the HCP to freely re-program the controller 300 of the implanted medical device MD, including replacing the entire program code running in the controller 300. The idea is that the HCP EID 320’ always remains with the HCP and, as such, all updates to the program code or retrieval of data from the implanted medical device MD using the HCP EID 320’ is performed with the HCP being present (i.e. not remote). The physical presence of the HCP is an additional layer of security for these updates which may be critical to the function of the implanted medical device MD.

[0898] In the embodiment shown in Fig. 17, the HCP communicates with the HCP EID 320’ using the HCP Dedicated Device 332 (HCP DD), which is a display device comprising a control interface for controlling and communicating with the HCP EID 320’. As the HCP EID 320’ always stays physically at the HCP’s clinic, communication between the HCP EID 320’ and HCP DD 332 does not have to be sent over the Internet. Instead, the HCP DD 332 and the HCP EID 320’ can communicate using one or more of BT, a proprietary wireless communication channel and a wired connection. Then the alteration to the programming is sent to the implanted medical device MD directly via the HCP EID 320’. Inputting into the HCP DD 332 for direct operation by means of the HCP EID 320’ is the same as inputting directly into the HCP EID 320’, which then directly transfers the instructions into the implanted medical device MD.

[0899] In the embodiment shown in Fig. 17, both the patient and the HCP have a combined hardware key 333’, 333”. The combined key 333’, 333” comprises a hardware component comprising a unique circuitry (providing the highest level of security), a wireless NFC transmitter 339 for transmitting a specific code (providing mid-level security), and a printed QR code 344 for optical recognition of the card (providing the lowest level of security). [0900] The patient’s key 333’ in the embodiment shown in Fig. 17 is in the form of a key card having an interface for communicating with the P-EID 320”’ such that the key card can be inserted into a key card slot in the P-EID 320” . The NFC transmitter 339 and/or the printed QR code 344 can be used as means for accessing the control interface 334i of the display device 334. In addition, the display device 334 may require a pin-code and/or a biometric input, such as face recognition or fingerprint recognition.

[0901] The HCP’s key 333” in the embodiment shown in Fig. 17 is in the form of a key card having an interface for communicating with the HCP-EID 320’, such that the key card can be inserted into a key card slot in the HCP-EID 320’ . The NFC transmitter 339 and/or the printed QR code 344 can be used as means for accessing the control interface of the HCP DD 332. In addition, the HCP DD 332 may require a pin-code and/or a biometric input, such as face recognition or fingerprint recognition.

[0902] In alternative embodiments, it is however possible that the hardware key solution is replaced by a two-factor authentication solution, such as a digital key in combination with a PIN code or a biometric input (such as face recognition and/or fingerprint recognition).

[0903] In the embodiment shown in Fig. 17, communication over the Internet takes place over the Dedicated Data Infrastructure (DDI) 330 which runs on a cloud service. The DDI 330 handles communication between the HCP DD 332 and the P-EID 320’”, between the HCP and the remote control 320”, between the HCP and the patient’s display device 334, as well as between the HCP and auxiliary devices 336 (such as tools for following up the patient’s treatments, e.g. a scale in an obesity treatment example or a blood pressure monitor in a blood pressure treatment example). In some embodiments, the HCP DD 332 also handles the communication between the patient’s display device 334 and the remote control 335. In all examples, the communication from the HCP to the P-EID 320’”, remote control 320”, patient’s display device 334 and auxiliary devices 336 may be performed using an end-to-end encryption. In embodiments with end-to-end encryption, the communication cannot be decrypted by the DDI 330. In such embodiments, the DDI 330 acts as a router which merely passes on encrypted communication from the HCP to various devices. This solution further increases security as the keys for decrypting the information rests only with the HCP and with the device sending or receiving the communication, which reduces the risk that an unencrypted signal is intercepted by an unauthorized device.

[0904] In addition to acting as an intermediary or router for communication, the DDI 330 collects data of the implanted medical device MD, of the treatment and of the patient. The data may be collected in an encrypted, anonymized or open form. The form of the collected data may depend on the sensitivity of the data or on the source from which the data is collected. In the embodiment shown in Fig. 17, the DDI 330 sends a questionnaire to the patient’s display device 334. The questionnaire can comprise questions to the patient related to the general health of the patient, related to the way of life of the patient, or specifically related to the treatment provided by the implanted medical device MD (such as for example a visual analogue scale for measuring pain). The DDI 330 can compile and/or combine input from several sources and communicate such input to the HCP which can use the provided information to create instructions to the various devices to be sent back over the DDI 330. The data collection performed by the DDI 330 can also be in the form a log to make sure that all communication between the units in the system can be back-traced. Logging the communication ensures that all alterations to software or settings of the software as well as the frequency and operation of the implanted medical device MD can be followed. Following the communication enables the DDI 330 or the HCP to follow the treatment and react if something in the communication indicates that the treatment does not provide the intended results or if something appears to be wrong with any of the components in the system.

[0905] In the specific embodiment shown in Fig. 17, the wireless connections between the different units are as follows. The wireless connection 411 between the auxiliary device 336 and the DDI 330 is based on Wi-Fi or a mobile telecommunication regime, and the wireless connection 411 between the auxiliary device 336 and the patient’s display device 334 is based on BT. The wireless connection 412 between the patient’s display device 334 and the DDI 330 is based on Wi-Fi or a mobile telecommunication regime. The wireless connection 413 between the patient’s display device 334 and the remote control 320” is based on BT. The wireless connection 414 between the remote control 320” and the implanted medical device MD is based on BT and UWB. The wireless connection 415 between the remote control 320” and the DDI 330 is based on Wi-Fi or a mobile telecommunication regime. The wireless connection 416 between the P-EID 320’” and the implanted medical device MD is based on BT, UWB and the charging signal. The wireless connection 417 between the P-EID 320”’ and the DDI 330 is based on Wi-Fi or a mobile telecommunication regime. The wireless connection 418 between the HCP-EID 320’ and the implanted medical device MD is based on BT, UWB and the charging signal. The wireless connection 419 between the P-EID 320”’ and the HCP DD 332 is based on BT. The wireless connection 420 between the HPC-EID 320’ and the DDI 330 is based on Wi-Fi or a mobile telecommunication regime. The wireless connection 421 between the HPC DD 332 and the DDI 330 is based on Wi-Fi or a mobile telecommunication regime. The wireless connection 422 between the HCP-EID 320’ and the HCP DD 332 is based on BT.

[0906] The wireless connections specifically described in the embodiment shown in Fig. 17 may, however, be replaced or assisted by wireless connections based on radio frequency identification (RFID), near-field communication (NFC), Bluetooth, Bluetooth low energy (BLE), or wireless local area network (WLAN). The mobile telecommunication regimes may for example be 1G, 2G, 3G, 4G, or 5G. The wireless connections may further be based on modulation techniques such as amplitude modulation (AM), frequency modulation (FM), phase modulation (PM), or quadrature amplitude modulation (QAM). The wireless connection may further feature technologies such as time-division multiple access (TDMA), frequency-division multiple access (FDMA), or code-division multiple access (CDMA). The wireless connection may also be based on infra-red (IR) communication. The wireless connection may feature radio frequencies in the high frequency band (HF), very-high frequency band (VHF), and ultra-high frequency band (UHF) as well as essentially any other applicable band for electromagnetic wave communication. The wireless connection may also be based on ultrasound communication to name at least one example that does not rely on electromagnetic waves.

[0907] Although wireless transfer is primarily described in the embodiment disclosed with reference to Fig. 17, the wireless communication between any of the external device may be substituted for wired communication. Also, some or all of the wireless communication between an external device and the implanted medical device MD may be substituted for conductive communication using a portion of the human body as a conductor (such as further described with reference to Figs. 16A to 16C).

General Communication Housing

[0908] As has been discussed before in this application, communication with a medical implant needs to be reliable and secure. For this purpose, it is desirable to have a standalone device as an external remote control (for example described as 320’ ’ in Fig. 17 for the medical implant, such that no other programs or applications run on the same device which may disturb or corrupt the communication to the medical implant. However, the smartphone or tablet (for example described as 334 in Fig. 17) has become an integrated part of everyday life for most people. This means that we almost always have our smartphones at hand. For this reason, it would have been convenient for the patient to communicate with the medical implant directly using the smartphone, such that no additional standalone device would have to be carried. However, as a lot of other applications are running on the smartphone, it does not fulfdl the requirement of being a secure and reliable communication tool without interference from other communication. It is therefore desirable to split the tasks of providing secure communication between the external device and the implant from the task of communicating with the Internet and providing a familiar and intuitive user interface. For this purpose, and external device providing secure communication and tamperproof soft- and hardware, where the display device allows for intuitive and easy use is provided. In the embodiments described with reference to Figs. 18 - 22 a device fulfilling these combinatory needs will be described in the form of a standalone remote control external device integrated in a housing unit 320” connectable to a smartphone or another display device 334, such as a smart watch or a tablet. [0909] Fig. 18 shows the housing unit 320” in an elevated perspective view form the left, and Fig. 19 shows the housing unit 320” in a plain view from the left. In the embodiment shown in Fig. 18, the housing unit 320” has a rectangular shape with rounded edges, having a height 1521 which is more than 1.5 times the width 1522. The housing unit 320” comprises recess 1525 configured to receive a display device 334, in the form of a smartphone, configured to be fitted in the housing unit 320’ ’ for mechanically and disconnectably connecting the display device 334 to the housing unit 320”. The boundaries of the recess 1525 in the housing unit 320” forms an edge 1528 configured to encircle the display device 334, when the display device 334 is inserted into the recess 1525. In the embodiment shown in Fig. 18, the recess 1525 has a depth 1526 configured to allow the display device 334 to be entirely inserted into the recess 1525. As such, the depth 1526 of the recess 1525 exceeds the depth 1531 of the display device 334. In the embodiment shown in Figs. 18 and 19, the edge is relatively thin, and has a width 1527 which is in the range 1/8 - 1/100 of the width of the display device 334, as such, the housing unit 320” has a width in the range 1.02 - 1.25 times the width 1522 of the housing unit 320”. In the same way, the housing unit 320” has a height 1521 in the range 1.01 - 1.25 times the height 1521 of the display device 334. In the embodiment shown in Figs. 120 - 19, the edges 1528 are configured to clasp the display device 334 and thereby mechanically fixate the display device 334 in the housing unit 320”. The minimum bounding box of the housing unit 320” and the display device 334 when mechanically connected, is no more than, 10 % wider, 10 % longer or 100 % higher, than the minimum bounding box of the display device 334.

[0910] For creating a clasping fixation, the edges of the housing unit 320” is made from an elastic material crating a tension between the edge 1528 and the display device 334 holding the display device 334 in place. The elastic material could be an elastic polymer material, or a thin sheet of elastic metal. For the purpose of further fixating the display device 334 in the housing unit 320”, the inner surface of the edges 1528 may optionally comprise a recess or protrusion (not shown) corresponding to a recess or protrusion of the outer surface of the display device 334. The edges 1528 may in the alterative comprise concave portions for creating a snap-lock clasping mechanical fixation between the housing unit 320” and the display device 334.

[0911] In the embodiment shown in Figs. 18 and 19, the housing unit 320” functions as a remote control for communicating with an implanted medical device, including receiving information from, and providing instructions and updates to, the implanted medical device. Information could be information related to a state of the implanted medical device including any functional parameter of the implanted medical device or could be related to a state of the patient, including any physiological parameter pertaining to the body of the patient (further described on other sections of this disclosure). For the purpose of providing input to the implanted medical device and controlling and updating the functions of the housing unit 320”, the housing unit 320” comprises a control interface comprising switches in the form of control buttons 335. The control buttons 335 are configured to be used when the external device is disconnected from the display device 334. The control interface further comprises a display 1505, which is a smaller and typically less sophisticated display 1505 than the display of the display device 334. In an alternative embodiment, the control buttons 335 and display 1505 are integrated into a single touch-responsive (touchscreen) display on which the control buttons may be displayed. In the embodiment shown in Figs. 18 and 19, one of the control buttons 335 is a control button for activating the implanted medical device and another of the control buttons 335 is a control button for deactivating the implanted medical device. When the display device 334 is attached to the housing unit 320”, the control buttons 335 and the display is covered by the display device 334 and are as such not in an operational state. In the embodiment shown in Figs. 18 and 19, the housing unit 320” is configured to transmit information pertaining to the display of the user interface to the display device 334 and the display device 334 is configured to receive input pertaining to communication to or from the implantable medical device from the patient, and transmit signals based on the received input to the housing unit 320”. The input may be a command to change the operational state of the implantable medical device. The display device 334 comprises a touch screen configured to display the user interface and receive the input from the patient. The display of the display device 334 may comprise one or more OLEDs or IPS LCDs elements. When the display device 334 is connected to the housing unit 320”, the display device 334 is configured to display a control interface which is used to communicate with the housing unit 320”, i.e. providing input to and receiving information from the housing unit 320”. The input provided the housing unit 320” is then relayed to the implanted medical device - and in the same way information communicated from the implanted medical device to the housing unit 320” may be relayed or displayed on the display device 334. Having an external device comprising a combination of a housing unit 320” comprising the communication means for communicating with the implanted medical device and a display device 334 basically only functioning as an Input/Output device connected to the housing unit 320” makes it possible to have a secure communication between the housing unit 320” and the display device 334, which is out of reach from the Internet connection of the display device 334, which makes it much harder for an external attacker to get access to any of the vital communication portions of the housing unit 320”. The communication between the housing unit and the display device 334 is very restricted and the only communication allowed from the display device 334 to the housing unit 320” is input from the patient or a healthcare professional, and authentication parameters created by an authentication application running on the display device 334. The authentication application running on the display device 334 could be a number-generating authenticator or a biometric authenticator for authenticating the patient or health care professional, and the authentication parameters could for example be parameters derived from a facial image or a fingerprint. In the opposite direction, i.e. from the housing unit 320” to the display device 334, the communication could be restricted to only communication needed for displaying information and/or a graphical user interface on the display device 334. The communication restrictions could for example be based on size of the communication packages or the frequency with which the communication takes place which reduces the risk that an un-authorized person makes multiple attempts to extract information from, or transit information to, the hand-held device.

[0912] In the embodiment shown with reference to Figs. 18 and 19, the housing unit 320” comprises a first communication unit providing a wireless connection 413 to the display device 334. The wireless connection 413 is in the embodiment shown in Fig. 18 and 19 based on NFC, but could in alternative embodiment be based on Bluetooth or any other communication pathway disclosed herein. The housing unit 320” further comprises a second communication unit providing a wireless connection with the implanted medical device. The wireless communication between the housing unit 320” and the implanted medical device is in the embodiment shown in Figs. 18 and 19 based on Bluetooth, but could in alternative embodiments be based on NFC or UWB or any other communication pathway disclosed herein.

[0913] As mentioned, in the embodiment shown in Figs. 18 and 19, the wireless communication between the housing unit 320” and the display device 334 is based on NFC, while the wireless communication between the housing unit 320” and the is based on Bluetooth. As such, the first communication unit of the housing unit 320” is configured to communicate wirelessly with the display device 334’ using a first communication frequency and the second communication unit of the housing unit 320” is configured to communicate wirelessly with the implantable medical device using a second different communication frequency. For this purpose, the first communication unit of the housing unit 320” comprises a first antenna configured for NFC-based wireless communication with the display device 334, and the second communication unit comprises a second antenna configured for Bluetooth-based wireless communication with the implantable medical device. The first and second antennae may be a wire-based antennae or a substrate-based antennae. As such, the first communication unit is configured to communicate wirelessly with the display device 334 on a first frequency and the second communication unit is configured to communicate wirelessly with the implantable medical device using a second different communication frequency. Also, first communication unit of the housing unit 320’ is configured to communicate wirelessly with the display device 334 using a first communication protocol (the NFC -communication protocol), and the second communication unit is configured to communicate wirelessly with the implantable medical device using a second communication protocol (the Bluetooth communication protocol). The first and second communication protocols are different which adds an additional layer of security as security structures could be built into the electronics and/or software enabling the transfer from a first to a second communication protocol. [0914] In an alternative embodiment, the second communication unit may be configured to communicate wirelessly with the implantable medical device using electromagnetic waves at a frequency below 100 kHz, or preferably at a frequency below 40 kHz. The second communication unit may thus be configured to communicate with the implantable medical device using “Very Low Frequency” communication (VLF). VLF signals have the ability to penetrate a titanium housing of the implant, such that the electronics of the implantable medical device can be completely encapsulated in a titanium housing. In yet further embodiments, the first and second communication units may be configured to communicate by means of an RFID type protocol, a WLAN type protocol, a BLE type protocol, a 3G/4G/5G type protocol, or a GSM type protocol.

[0915] In yet other alternative embodiments, it is conceivable that the mechanical connection between the housing unit 320” and the display device 334 comprises an electrical connection for creating a wire-based communication channel between the housing unit 320” and the display device 334. The electrical connection could also be configured to transfer electric energy from the display device 334 to the housing unit, such that the housing unit 320” may be powered or charged by the display device 334. A wired connection is even harder to access for a non-authorized entity than an NFC-based wireless connection, which further increases the security of the communication between the housing unit 320” and the display device 334.

[0916] In the embodiment shown with reference to Figs. 18 and 19, the display device 334 comprises a first communication unit providing a wireless connection 413 to the housing unit 320” based on NFC. The display device 334 further comprises a second communication unit providing a wireless connection with a further external device and/or with the Internet. The second external device may be far away, for example at a hospital or a place where a medical professional practice. The wireless communication between the display device 334 and a further external device is in the embodiment shown in Figs. 18 and 19 based on WiFi, but could in alternative embodiments be based on for example Bluetooth.

[0917] As mentioned, in the embodiment shown in Figs. 18 and 19, the wireless communication between the display device 334 and the housing unit 320” is based on NFC, while the wireless communication between the display device and a further external unit is based on WiFi. As such, the first communication unit of the display device 334 is configured to communicate wirelessly with the housing unit 320” using a first communication frequency and the second communication unit of the display device 334 is configured to communicate wirelessly with a further external device using a second different communication frequency. For this purpose, the first communication unit of the display device 334 comprises a first antenna configured for NFC-based wireless communication with the housing unit 320”, and the second communication unit comprises a second antenna configured for WiFi-based wireless communication with a further external device. The first and second antennae may be wire-based antennae or substrate-based antennae. As such, the first communication unit is configured to communicate wirelessly with the housing unit 320” on a first frequency and the second communication unit is configured to communicate wirelessly with the further external device using a second different communication frequency. Also, the first communication unit of the display device 334 is configured to communicate wirelessly with the housing unit 320” using a first communication protocol (the NFC communication protocol), and the second communication unit is configured to communicate wirelessly with the further external device using a second communication protocol (the WiFi communication protocol). The first and second communication protocols are different which adds an additional layer of security as security structures could be built into the electronics and/or software enabling the transfer from a first to a second communication protocol.

[0918] In alternative embodiments, the second communication unit of the display device 334 may be configured to communicate with the further external device by means of, a WLAN-type protocol, or a 3G/4G/5G-type protocol, or a GSM-type protocol.

[0919] In the embodiment shown in Figs. 18 and 19, the communication range of the first communication unit of the housing unit 320” is less than a communication range of the second communication unit of the housing unit 320’, such that the communication distance between the housing unit 320” and the medical implant may be longer than the communication distance between the housing unit 320” and the display device 334. In the embodiment shown in Figs. 18 and 19, the communication range of the first communication unit may be constrained to a length that is less than five times the longest dimension of the minimal bounding box of the display device 334, or more precisely constrained to a length that is less than three times the longest dimension of the minimal bounding box of the display device 334.

[0920] In the embodiment shown in Figs. 18 and 19, communication between the housing unit 320” and the display device 334 is only enabled when the housing unit 320” is connected to the display device 334. 1.e. at least one of the housing unit 320” and the display device 334 is configured to allow communication between the housing unit 320” and the display device 334 on the basis of the distance between the housing unit 320” and the display device 334. In the alternative, the housing unit 320” and/or the display device 334 may comprise a sensor configured to estimate whether the housing unit 320” is attached to the display device 334 or not, such as a mechanically activated switch or a photo resistive sensor which providing sensor input when the housing unit 320” and display device 334 are mechanically connected to each other. The signal from the at least one sensor then may be used to permit usage of the communication unit configured for communication with the display device 334.

[0921] In the embodiment shown in Figs. 18 and 19, communication between the housing unit 320” and the implantable medical device is only enabled on the basis of a distance between the housing unit 320” and the implantable medical device. In the embodiment shown in Figs. 18 and 19, the distance should be less than twenty times the longest dimension of the minimal bounding box of the display device, or more specifically less than ten times the longest dimension of the minimal bounding box of the display device. The distance between the housing unit 320” and the medical implant may be measured using electromagnetic waves, or acoustic waves. The process of measuring the distance may comprise triangulation.

[0922] In the embodiment shown in Figs. 18 and 19, the second communication unit of the display device 334 need to be disabled to enable communication between the display device 334 and the housing unit 320”, and further the second communication unit of the display device 334 needs to be disabled to enable communication between the housing unit 320” and the medical implant. Also, the second communication unit of the housing unit 320” needs to be disabled to enable communication between the housing unit 320” and the medical implant.

[0923] In the embodiment shown in Figs. 18 and 19, the housing unit 320” further comprises an encryption unit configured to encrypt communication received from the display device 334 before transmitting the communication to the implanted medical device. The encryption unit may for example be based on one of the following algorithms: AES, Blowfish, DES, Kalyna, Serpent or Twofish. For the purpose for handling the communication, I/O and encryption, the housing unit 320” comprises a processor which could be a general-purpose microprocessor and/or an instruction set processor and/or related chips sets and/or special purpose microprocessors such as ASICs (Application Specific Integrated Circuit). The processor also comprise memory for storing instruction and/or data.

[0924] Figs. 20 and 21 shows an embodiment of the external unit similar to the embodiment described with reference to Figs. 18 and 19. The difference being that in the embodiment of Figs. 20 and 21, the housing unit 320” does not clasp the display device 334. Instead, the housing unit comprises two magnets 1510 for magnetically fixating the display device 334 to the housing unit 320”. In alternative embodiments, it is equally conceivable that the external device comprises an intermediate portion, which is fixedly fixated to the housing unit for providing a detachable connection with the display device 334. In the alternative, the intermediate device could be fixedly fixated to the display device 334 and provide a detachable connection with the housing unit 320”.

[0925] Fig. 22 shows a system overview of the external device (which could be the external device of the embodiment described with reference to Figs. 18 and 19, or of the embodiment described with reference to Figs. 20 and 21). The housing unit 320” is connected to the display device 334. A wireless connection 413 is provided between the housing unit 320” and the display device 334, and a further wireless connection 413 is provided between the housing unit 320” and the implanted medical device MD, such that the housing unit can send instructions and updates to the implanted medical device MD, and receive information, parameters (such as sensor values) and alarms from the implanted medical device MD. The communication between the external device and the medical implant MD is further described in other portions of this disclosure.

Surface coatings

[0926] Fig. 23 shows an implantable medical device or implant MD comprising a body 510, an implant surface 520 and a coating 530 arranged on the surface 520. The coating 530 may be configured to have antibacterial characteristics. Depending on the use of the implantable medical device, one or both of these effects may be advantageous. The coating 530 may be arranged on the surface 520 so that the coating shields the surface 520 from direct contact with the host body where the implantable medical device MD is inserted.

[0927] The coating 530 may comprise at least one layer of a biomaterial. The coating 530 may comprise a material that is antithrombotic. The coating 530 may also comprise a material that is antibacterial. The coating 530 may be attached chemically to the surface 520.

[0928] Fig. 24 shows an exemplary implantable medical device or implant MD with a body 510 and a surface 520. The implantable medical device MD comprises multiple coatings, 530a, 530b, 530c arranged on the surface. The implant MD may comprise any number of coatings, the particular embodiment of Fig. 24 discloses three layers of coating 530a, 530b, 530c. The second coating 530b is arranged on the first coating 530a. The different coatings 530a, 530b, 530c may comprise different materials with different features to prevent either fibrin sheath formation or bacteria gathering at the surface 520. As an example, the first coating 530a may comprise a layer of perfluorocarbon chemically attached to the surface. The second coating 530b may comprise a liquid perfluorocarbon layer arranged on the first coating 530a.

[0929] The coatings referred to may comprise any substance or any combination of substances. The coatings may comprise anticoagulant medicaments, such as: Apixaban, Dabigatran, Dalteparin, Edoxaban, Enoxaparin, Fondaparinux, Heparin, Rivaroxaban, and Warfarin.

[0930] The coatings may also comprise medicines or substances that are so-called antiplatelets. These may include Aspiring. Cilostazol, Clopidogrel, Dipyridamole, Eptifibatide, Prasugrel, Ticagrelor, Tirofiban, Vorapaxar.

[0931] The coatings may also comprise any other type of substance with antithrombotic, antiplatelet or antibacterial features, such as sortase A, perfluorocarbon and more.

[0932] The coatings may also be combined with an implantable medical device comprising certain materials that are antibacterial or antithrombotic. For example, some metals have shown to be antibacterial. In case the implant or at least the outer surface of the implant is made of such a metal, this may be advantageous in order to reduce bacterial infections. The medical implant or the surface of the implant may be made of any other suitable metal or material. The surface may for example comprise any of the following metals or any combination of the following metals: titanium, cobalt, nickel, copper, zinc, zirconium, molybdenum, tin or lead.

Porous coatings slowly realizing medicine

[0933] An implantable medical device can also be coated with a local and slow -releasing anti -fibrotic or antibacterial drug in order to prevent fibrin sheath creation and bacterial inflammation. The drug or medicament may be coated on the surface and arranged to slowly release from the implant in order to prevent the creation of fibrin or inflammation. The drug may also be covered in a porous or soluble material that slowly disintegrates in order to allow the drug to be administered into the body and prevent the creation of fibrin. The drug may be any conventional anti -fibrotic or antibacterial drug.

Physical structure of implant surface

[0934] Figs. 25A and 25B show different micro patterns on the surface of an implant. In order to improve blood compatibility, the implant material’s physical structure may be altered or controlled. By creating a certain topography on the surface of an implant, fibrin creation and inflammatory reactions may be inhibited. Fig. 25A is an example of a micro pattern that mimics the features of sharkskin. The micro pattern may have many different shapes and many different depths into the surface of the implant and they may be a complement to other coatings or used individually. In Fig. 25B another example of a micro pattern is disclosed.

[0935] The micro pattern may, for example, be etched into the surface of the implantable medical device prior to insertion into the body. The surface of the implantable medical device may for example comprise a metal. The surface may for example comprise any of the following metals, or any combination of the following metals: titanium, cobalt, nickel, copper, zinc, zirconium, molybdenum, tin or lead. This may be advantageous in that these metals have proven to be antibacterial which may ensure that the implant functions better when inserted into the host body.

Method of Implantation

[0936] Fig. 26 shows a flow chart of a method of implantation of at least one component of the afore- described system, comprising the steps of: cutting the skin, dissecting free at least one area within the patient’s body, placing the housing accommodating the at least one infusion needle within said dissected area such that the tip end of the at least one infusion needle, when penetrating the housing's outer wall, can penetrate the patient’s tissue so as to allow for injecting a substance through said at least one penetration area via the at least one infusion needle, and closing at least the skin after implantation of at least parts of the system.

[0937] The method may further comprise the step of placing one or more of the following components of the system within the patient’s body remote from the housing accommodating the at least one infusion needle: at least part of the drive unit (D), a reservoir, a pump (P), at least one motor (M, M2) for actuation of one or more elements of the drive unit, the pump (P) or any other energy consuming part of the system, energy storage means (A) for providing the at least one motor with energy, galvanic coupling elements between either an external energy source (E) or the energy storage means (A) and the motor (M, M2) for transmitting energy to the motor in contacting fashion, wireless coupling elements adapted to connect either the motor (M, M2) or the energy storage means (A) or both to an extracorporeal primary energy source for transmitting energy to either the motor or the energy storage means or both in non-contacting fashion, a control unit (Cl) for controlling the motor (M, M2), a data transmission interface for wirelessly transmitting data from an external data processing device (C2) to the control unit (Cl), a feedback sensor (F), wireless energy transforming means, an injection port for refilling the reservoir (Rl), and at least one tube for injecting thereinto a substance to be injected by means of the at least one injection needle. POP RIVET FLANGE

[0938] Figs. 27 and 28 show an embodiment of an implantable energized medical device MD, which may be referred to as a remote unit in other parts of the present disclosure. The medical device MD is configured to be held in position by a tissue portion 610 of a patient. The first portion MD’ and the second portion MD” may comprise one or several functional parts, such as receivers, transmitters, transceivers, control units, processing units, sensors, energy storage units, etc., as is described in other parts of the present disclosure. The first portion MD’ may comprise a first energy storage unit for supplying the medical device MD with energy. While the second portion MD” in the illustrated embodiment comprises a pump, this is just to give an example of an implantable part of a medical device MD. It is to be understood that other embodiments of the second portion MD” can be connected to the first portion MD’ via the connecting portion MD-2, such as second portions MD” comprising a motor for providing mechanical work without the use of fluids.

[0939] The medical device MD comprises a first portion MD’ configured to be placed on a first side 612 of the tissue portion 610, the first portion MD’ having a first cross-sectional area Al in a first plane Pl and comprising a first surface 614 configured to face a first tissue surface 616 of the first side 612 of the tissue portion 610. The medical device MD further comprises a second portion MD” configured to be placed on a second side 618 of the tissue portion 610, the second side 618 opposing the first side 612, the second portion MD” having a second cross-sectional area A2 in a second plane P2 and comprising a second surface 620 configured to engage a second tissue surface 622 on the second side 618 of the tissue portion 610. The medical device MD further comprises a connecting portion MD-2 configured to be placed through a hole in the tissue portion 610 extending between the first and second sides 612, 618 of the tissue portion 610. The connecting portion MD-2 here has a third cross-sectional area A3 in a third plane P3 and a fourth cross-sectional area A4 in a fourth plane P4 and a third surface 624 configured to engage the first tissue surface 616 of the first side 612 of the tissue portion 610. The connecting portion MD-2 is configured to connect the first portion MD’ to the second portion MD”.

[0940] The connecting portion MD-2 thus has a portion being sized and shaped to fit through the hole in the tissue portion 610, such portion having the third cross-sectional area A3. Furthermore, the connecting portion MD-2 may have another portion being sized and shaped to not fit through the hole in the tissue portion 610, such portion having the fourth cross-sectional area A4. Likewise, the second portion MD” may have a portion being sized and shaped to not fit through the hole in the tissue portion 610, such portion having the second cross-sectional area A2. Thus, the connecting portion MD-2 may cooperate with the second portion MD” to keep the medical device MD in place in the hole of the tissue portion 610. [0941] In the embodiment illustrated in Fig. 27, the first portion MD’ is configured to detachably connect, i.e. reversibly connect, to the connecting portion MD-2 by a mechanical and/or magnetic mechanism. In the illustrated embodiment, a mechanic mechanism is used, wherein one or several spring -loaded spherical elements 601 lock in place in a groove 603 of the connecting portion MD-2 when the first portion MD’ is inserted into the connecting portion MD-2. Other locking mechanisms are envisioned, including corresponding threads and grooves, self-locking elements, and twist-and- lock fittings.

[0942] The medical device MD is configured such that, when implanted, the first portion MD’ will be placed closer to the outside of the patient than the second portion MD”. Furthermore, in some implantation procedures the medical device MD may be implanted such that space will be available beyond the second portion MD ” , i .e . beyond the second side 618 of the tissue portion 610, whereas there may be as much space on the first side 612 of the tissue portion. Furthermore, tissue and/or skin may exert a force on the first portion MD’ towards the tissue portion 610 and provide that the second portion MD” does not travel through the hole in the tissue portion 610 towards the first side 612 of the tissue portion 610. Thus, it is preferable if the medical device MD is primarily configured to prevent the first portion MD’ from traveling through the hole in the tissue portion 610 towards the second side 618 of the tissue portion 610.

[0943] The first portion MD’ may further comprise one or several connections 605 for transferring energy and/or communication signals to the second portion MD” via the connecting portion MD-2. The connections 605 in the illustrated embodiment are symmetrically arranged around a circumference of a protrusion 607 of the first portion MD’ and are arranged to engage with a corresponding connection 609 arranged at an inner surface of the connecting portion MD-2. The protrusion 607 may extend in a central extension Cl of the central portion MD-2. The second portion MD” may also comprise one or several connections 611, which may be similarly arranged and configured as the connections 605 of the first portion MD’ . For example, the one or several connections 611 may engage with the connection 609 of the connecting portion MD-2 to receive energy and/or communication signals from the first portion MD’. Although the protrusion 607 is illustrated separately in Fig. 27, it is to be understood that the protrusion 607 may be formed as one integral unit with the first portion MD’.

[0944] Other arrangements of connections are envisioned, such as asymmetrically arranged connections around the circumference of the protrusion 607. It is also envisioned that one or several connections may be arranged on the first surface 614 of the first portion MD’, wherein the connections are arranged to engage with corresponding connections arranged on the opposing surface 613 of the connecting portion MD-2. Such connections on the opposing surface 613 may cover a relatively large area as compared to the connection 609, thus allowing a larger area of contact and a higher rate and/or signal strength of energy and/or communication signal transfer. Furthermore, it is envisioned that a physical connection between the first portion MD’, connecting portion MD-2 and second portion MD” may be replaced or accompanied by a wireless arrangement, as described further in other parts of the present disclosure.

[0945] Any of the first surface 614 of the first portion MD’, the second surface 620 of the second portion MD’, the third surface 624 of the connecting portion MD-2, and an opposing surface 613 of the connecting portion MD-2, may be provided with at least one of ribs, barbs, hooks, a frictionenhancing surface treatment, and a friction-enhancing material, to facilitate the medical device MD being held in position by the tissue portion and/or to facilitate that the different parts of the medical device MD are held in mutual position.

[0946] The opposing surface 613 may be provided with a recess configured to house at least part of the first portion MD’ . In particular, such recess may be configured to receive at least a portion of the first portion MD’, including the first surface 614. Similarly, the first surface 614 may be provided with a recess configured to house at least part of the connecting portion MD-2. In particular, such recess may be configured to receive at least a portion of the connecting portion MD-2, and in some embodiments such recess may be configured to receive at least one protruding element to at least partially enclose at least one protruding element or flange.

[0947] In the illustrated embodiment, the first portion MD’ comprises a first energy storage unit 304a and a controller 300a comprising one or several processing units connected to the first energy storage unit 304a. The first energy storage unit 304a may be rechargeable by wireless transfer of energy. In some embodiments, the first energy storage unit 304a may be non -rechargeable. Upon reaching the lifetime end of such first energy storage, a replacement first portion comprising a new first energy storage unit may simply be swapped in place for the first portion having the depleted first energy storage unit. The second portion MD” may further comprise a controller 300b comprising one or several processing units.

[0948] As can be seen in Fig. 28, the first, second, third and fourth planes Pl, P2, P3 and P4, are parallel to each other. Furthermore, in the illustrated embodiment, the third cross-sectional area A3 is smaller than the first, second and fourth cross-sectional areas Al, A2 and A4 such that the first portion MD’, second portion MD” and connecting portion MD-2 are prevented from traveling through the hole in the tissue portion 610 in a direction perpendicular to the first, second and third planes Pl, P2 and P3. Hereby, the second portion MD” and the connecting portion MD-2 can be held in position by the tissue portion 610 of the patient even if the first portion MD’ is disconnected from the connecting portion MD-2.

[0949] It is to be understood that the illustrated planes Pl, P2, P3 and P4 are merely an example of how such planes may intersect the medical device MD. Other arrangements of planes are possible, as long as the conditions above are fulfilled, i.e. that the portions have cross-sectional areas, wherein the third cross-sectional area in the third plane P3 is smaller than the first, second and fourth cross- sectional areas, and that the planes Pl, P2, P3 and P4 are parallel to each other.

[0950] The connecting portion MD-2 illustrated in Fig. 28 may be defined as a connecting portion MD-2 comprising a flange 626. The flange 626 thus comprises the fourth cross-sectional area A4 such that the flange 626 is prevented from traveling through the hole in the tissue portion 610 in a direction perpendicular to the first, second and third planes Pl, P2 and P3. The flange 626 may protrude in a direction parallel to the first, second, third and fourth planes Pl, P2, P3 and P4. This direction is perpendicular to a central extension Cl of the connecting portion MD-2.

[0951] The connecting portion MD-2 is not restricted to flanges, however. Other protruding elements may additionally or alternatively be incorporated into the connecting portion MD-2. As such, the connecting portion MD-2 may comprise at least one protruding element comprising the fourth cross- sectional area A4 such that the at least one protruding element is prevented from traveling through the hole in the tissue portion 610 such that the second portion MD” and the connecting portion MD-2 can be held in position by the tissue portion 610 of the patient even if the first portion MD’ is disconnected from the connecting portion MD-2. The at least one protruding element may protrude in a direction parallel to the first, second, third and fourth planes Pl, P2, P3 and P4. This direction is perpendicular to a central extension Cl of the connecting portion MD-2. As such, the at least one protruding element will also comprise the third surface 624 configured to engage the first tissue surface 616 of the first side 612 of the tissue portion 610.

[0952] The connecting portion MD-2 may comprise a hollow portion 628. The hollow portion 628 may provide a passage between the first and second portions MD’, MD”. In particular, the hollow portion 628 may house a conduit for transferring fluid from the first portion MD’ to the second portion MD”. The hollow portion 628 may also comprise or house one or several connections or electrical leads for transferring energy and/or communication signals between the first portion MD’ and the second portion MD”.

[0953] It is important to note that although the implantable energized medical device is disclosed herein as having a third cross-sectional area being smaller than a first cross-sectional area, this feature is not essential. The third cross-sectional area may be equal to or larger than the first cross-sectional area.

[0954] Wireless energy receivers and/or communication receivers and/or transmitters in the first portion MD’ may be configured to receive energy from and/or communicate wirelessly with an external device outside the body using electromagnetic waves at a frequency below 100 kHz, or more specifically below 40 kHz, or more specifically below 20 kHz. The wireless energy receivers and/or communication receivers and/or transmitters in the first portion MD’ may thus be configured to communicate with the external device using “Very Low Frequency” communication (VLF). VLF signals have the ability to penetrate a titanium housing of the implantable energized medical device, such that the electronics of the implantable medical device can be completely encapsulated in a titanium housing. In addition, or alternatively, communication and energy transfer between the first portion MD’ and second portion MD” may be made using VLF signals. In such embodiments, receivers and transmitters (for energy and/or communication) of the first portion MD’ and second portion MD” are configured accordingly.

[0955] Some relative dimensions of the medical device MD will now be described with reference to Figs. 28 and 29A to 29D. However, it is to be understood that these dimensions may also apply to other embodiments of the medical device MD. The at least one protruding element 626 may have a height HF in a direction perpendicular to the fourth plane P4 being less than a height Hl of the first portion MD’ in said direction. The height HF may alternatively be less than half of said height Hl of the first portion MD’ in said direction, less than a quarter of said height Hl of the first portion MD’ in said direction, or less than a tenth of said height Hl of the first portion MD’ in said direction.

[0956] The height Hl of the first portion MD’ in a direction perpendicular to the first plane Pl may be less than a height H2 of the second portion MD’ ’ in said direction, such as less than half of said height H2 of the second portion MD’ ’ in said direction, less than a quarter of said height H2 of the second portion MD” in said direction, or less than a tenth of said height H2 of the second portion MD” in said direction.

[0957] The at least one protruding element 626 may have a diameter DF in the fourth plane P4 being one of: less than a diameter DI of the first portion MD’ in the first plane Pl, equal to a diameter DI of the first portion MD’ in the first plane Pl, and larger than a diameter DI of the first portion MD’ in the first plane P 1. Similarly, the cross-sectional area of the at least one protruding element 626 in the fourth plane P4 may be less, equal to, or larger than a cross-sectional area of the first portion in the first plane P 1.

[0958] The at least one protruding element 626 may have a height HF in a direction perpendicular to the fourth plane P4 being less than a height HC of the connecting portion MD-2 in said direction. Here, the height HC of the connecting portion MD-2 is defined as the height excluding the at least one protruding element, which forms part of the connecting portion MD-2. The height HF may alternatively be less than half of said height HC of the connecting portion MD-2 in said direction, less than a quarter of said height HC of the connecting portion MD-2 in said direction, or less than a tenth of said height HC of the connecting portion MD-2 in said direction. [0959] As shown in Fig. 29D, the first portion MD’ may have a first cross-sectional area Al being equal to or smaller than the third cross-sectional area A3 of the connecting portion MD-2. In particular, the first portion MD’ does not necessarily need to provide a cross-sectional area being larger than the third cross-sectional area of connecting portion MD-2, intended to pass through a hole in the tissue, if the connecting portion MD-2 provides an additional cross-sectional area being larger than the third cross-sectional area of the connecting portion MD-2. The first portion MD’ as illustrated in Fig. 29D may comprise the components discussed elsewhere in the present disclosure, although not shown, such as an energy storage unit, receiver, transmitter, etc.

[0960] As shown in Figs. 30A to 30B, the at least one protruding element 626 may have an annular shape, such as a disk shape. However, elliptical, elongated and/or other polyhedral or irregular shapes are also possible. In the illustrated embodiment, the at least one protruding element 626 extends a full revolution around the center axis of the connecting portion MD-2. However, other arrangements are possible, wherein the at least one protruding element 626 constitutes a partial circle sector. In the case of a plurality of protruding elements, such plurality of protruding elements may constitute several partial circle sectors.

[0961] As shown in Figs. 31 A to 3 IB, 32A to 32B, the connecting portion MD-2 may comprise at least two protruding elements 626, 627. For example, the connecting portion MD-2 may comprise at least three, four, five, six, seven, eight, nine, ten protruding elements, and so on. In such embodiments, the at least two protruding elements 626, 627 may together comprise the fourth cross-sectional area, thus providing a necessary cross-sectional area to prevent the first portion MD’ and second portion MD” from traveling through the hole in the tissue portion 610.

[0962] The at least two protruding elements 626, 627 may be symmetrically arranged about the central axis of the connecting portion MD-2, as shown in Figs. 31A to 3 IB, or asymmetrically arranged about the central axis of the connecting portion MD-2, as shown in Figs. 32A to 32B. In particular, the at least two protruding elements 626, 6 1 may be asymmetrically arranged so as to be located towards one side of the connecting portion MD-2, as shown in Figs. 32A to 32B. The arrangement of protruding element(s) may allow the medical device MD, and in particular the connecting portion MD-2, to be placed in areas of the patient where space is limited in one or more directions.

POP RIVET KIT

[0963] Although one type or embodiment of the implantable energized medical device MD, which may be referred to as a remote unit in other parts of the present disclosure, may fit most patients, it may be necessary to provide a selection of implantable energized medical devices MD or portions MD’, MD” to be assembled into implantable energized medical devices MD. For example, some patients may require different lengths, shapes, sizes, widths or heights depending on individual anatomy. Furthermore, some parts or portions of the implantable energized medical device MD may be common among several different types or embodiments of implantable energized medical devices, while other parts or portions may be replaceable or interchangeable. Such parts or portions may include energy storage devices, communication devices, fluid connections, mechanical connections, electrical connections, and so on.

[0964] To provide flexibility and increase user-friendliness, a kit of parts may be provided. The kit preferably comprises a group of one or more first portions, a group of one or more second portions, and a group of one or more connecting portions, the first portions, second portions and connecting portions being embodied as described throughout the present disclosure. At least one of the groups comprises at least two different types of said respective portions. By the term “type”, it is hereby meant a variety, class or embodiment of said respective portion.

[0965] In some embodiments of the kit, the group of one or more first portions, the group of one or more second portions, and the group of one or more connecting portions, comprise separate parts which may be assembled into a complete implantable energized medical device. The implantable energized medical device MD may thus be said to be modular, in that the first portion MD’, the second portion MD”, and/or the connecting portion MD-2 may be interchanged for another type of the respective portion.

[0966] With reference to Fig. 33, the kit for assembling the implantable energized medical device MD comprises a group 650 of one or more first portions MD’, in the illustrated example a group of one first portion MD’, a group 652 of one or more connecting portions MD-2, in the illustrated example a group of three connecting portions MD-2, and a group 654 of one or more second portions MD”, in the illustrated example a group of two second portions MD”. For simplicity, all types and combinations of first portions MD’, second portions MD” and connecting portions MD-2 will not be illustrated or described in detail.

[0967] Accordingly, the group 652 of one or more connecting portions MD-2 comprises three different types of connecting portions MD-2. Here, the different types of connecting portions MD-2 comprise connecting portions MD-2a, MD-2b, MD-2c having different heights. Furthermore, the group 654 of one or more second portions MD” comprises two different types of second portions MD ”.

[0968] Here, the different types of second portions MD” comprise a second portion MD”a being configured to eccentrically connect to a connecting portion, having a first end and a second end as described in other parts of the present disclosure, wherein the second end of the second portion MD”a comprises or is configured for at least one connection for connecting to an implant being located in a caudal direction from a location of the implantable energized medical device in the patient, when the medical device MD is assembled. In the illustrated figure, the at least one connection is visualized as a lead or wire. However, other embodiments are possible, including the second end comprising a port, connector or other type of connective element for transmission of power, fluid, and/or signals.

[0969] Furthermore, the different types of second portions MD” comprise a second portion MD”b being configured to eccentrically connect to a connecting portion, having a first end and a second end as described in other parts of the present disclosure, wherein the first end of the second portion MD”b comprises or is configured for at least one connection for connecting to an implant being located in a cranial direction from a location of the implantable energized medical device in the patient, when the medical device MD is assembled. In the illustrated figure, the at least one connection is visualized as a lead or wire. However, other embodiments are possible, including the first end comprising a port, connector or other type of connective element for transmission of power, fluid, and/or signals.

[0970] Thus, the implantable energized medical device MD may be modular, and different types of medical devices MD can be achieved by selecting and combining a first portion MD’, a connecting portion MD-2, and a second portion MD”, from each of the groups 652, 654, 656.

[0971] In the illustrated example, a first implantable energized medical device MDa is achieved by a selection of the first portion MD’, the connecting portion MD-2a, and the second portion MD”a. Such device MDa may be particularly advantageous in that the connecting portion MD-2a may be able to extend through a thick layer of tissue to connect the first portion MD’ and the second portion MD”a. Another implantable energized medical device MDb is achieved by a selection of the first portion MD’, the connecting portion MD-2c, and the second portion MD”b. Such device may be particularly advantageous in that the connecting portion MD-2c has a smaller footprint than the connecting portion MD-2a, i.e. occupying less space in the patient. Owing to the modular property of the medical devices MDa and MDb, a practician or surgeon may select a suitable connecting portion as needed upon having assessed the anatomy of a patient. Furthermore, since devices MDa and MDb share a common type of first portions MD’, it will not be necessary for a practitioner or surgeon to maintain a stock of different first portions MD’ (or a stock of complete, assembled medical devices MD) merely for the sake of achieving a medical device MD having different connections located in the first end or second end of the second portion MD” respectively, as in the case of second portions MD”a, MD”b.

[0972] The example illustrated in Fig. 33 is merely exemplifying to display the idea of a modular implantable energized medical device MD. The group 650 of one or more first portions MD’ may comprise a variety of different features, such as first portions with or without a first energy storage unit, with or without a first wireless energy receiver unit for receiving energy transmitted wirelessly by an external wireless energy transmitter, with or without an internal wireless energy transmitter, and/or other features as described throughout the present disclosure. Other features include different height, width, or length of the first portion. It is to be understood that first portions MD’ having one or more such features may be combined with a particular shape or dimension to achieve a variety of first portions. The same applies to connecting portions MD-2 and second portions MD”.

POP RIVET INTERNAL WIRELESS

[0973] With reference to Fig. 34, an embodiment of an implantable energized medical device MD, which may be referred to as a remote unit in other parts of the present disclosure, will be described. The medical device MD is configured to be held in position by a tissue portion 610 of a patient. The medical device MD comprises a first portion MD’ configured to be placed on a first side of the tissue portion 610, the first portion MD’ having a first cross-sectional area in a first plane Pl and comprising a first surface configured to face and/or engage a first tissue surface of the first side of the tissue portion 610. The medical device MD further comprises a second portion MD” configured to be placed on a second side of the tissue portion 610, the second side opposing the first side, the second portion MD” having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion 610. The medical device MD further comprises a connecting portion MD-2 configured to be placed through a hole in the tissue portion 610 extending between the first and second sides of the tissue portion 610. Here, the connecting portion MD-2 has a third cross-sectional area in a third plane. The connecting portion MD- 2 is configured to connect the first portion MD’ to the second portion MD” . Here, the first portion MD’ comprises a first wireless energy receiver 308a for receiving energy transmitted wirelessly by an external wireless energy transmitter, and an internal wireless energy transmitter 308a configured to transmit energy wirelessly to the second portion. Furthermore, here the second portion comprises a second wireless energy receiver 308b configured to receive energy transmitted wirelessly by the internal wireless energy transmitter 308a.

[0974] Although receivers and transmitters may be discussed and illustrated separately in the present disclosure, it is to be understood that the receivers and/or transmitters may be comprised in a transceiver. Furthermore, the receivers and/or transmitters in the first portion MD’ and second portion MD”, respectively, may form part of a single receiving or transmitting unit configured for receiving or transmitting energy and/or communication signals, including data. Furthermore, the internal wireless energy transmitter and/or a first wireless communication receiver/transmitter may be a separate unit 308c located in a lower portion of the first portion MD’ close to the connecting portion MD-2 and the second portion MD”. Such placement may provide that energy and/or communication signals transmitted by the unit 308c will not be attenuated by internal components of the first portion MD’ when being transmitted to the second portion MD”. Such internal components may include a first energy storage unit 304a.

[0975] The first portion MD’ here comprises a first energy storage unit 304a connected to the first wireless energy receiver 308a. The second portion comprises a second energy storage unit 304b connected to the second wireless energy receiver 308b. Such an energy storage unit may be a solid- state battery, such as a thionyl chloride battery. [0976] In some embodiments, the first wireless energy receiver 308a is configured to receive energy transmitted wirelessly by the external wireless energy transmitter and store the received energy in the first energy storage unit 304a. Furthermore, the internal wireless energy transmitter 308a is configured to wirelessly transmit energy stored in the first energy storage unit 304a to the second wireless energy receiver 308b, and the second wireless energy receiver 308b is configured to receive energy transmitted wirelessly by the internal wireless energy transmitter 308a and to store the received energy in the second energy storage unit 305b.

[0977] The first energy storage unit 304a may be configured to store less energy than the second energy storage unit 304b, and/or configured to be charged faster than the second energy storage unit 304b. Hereby, charging of the first energy storage unit 304a may be relatively quick, whereas transfer of energy from the first energy storage unit 304a to the second energy storage unit 304b may be relatively slow. Thus, a user can quickly charge the first energy storage unit 304a, and will not - during such charging - be restricted for a long period of time by being connected to an external wireless energy transmitter, e.g. at a particular location. After having charged the first energy storage unit 304a, the user may move freely while energy slowly transfers from the first energy storage unit 304a to the second energy storage unit 304b, via the first wireless energy transmitter 308a, 308c and the second wireless energy receiver 308b.

[0978] The first portion may comprise a first controller comprising at least one processing unit 306a. The second portion may comprise a second controller comprising at least one processing unit 306b. At least one of the first and second processing unit 306a, 306b may be connected to a wireless transceiver 308a, 308b, 308c for communicating wirelessly with an external device.

[0979] The first controller may be connected to a first wireless communication receiver 308a, 308c in the first portion MD’ for receiving wireless communication from an external device and/or from a wireless communication transmitter 308b in the second portion MD”. Furthermore, the first controller may be connected to a first wireless communication transmitter 308a, 308c in the first portion MD’ for transmitting wireless communication to a second wireless communication receiver 308b in the second portion MD”. The second controller may be connected to the second wireless communication receiver 308b for receiving wireless communication from the first portion MD’. The second controller may further be connected to a second wireless communication transmitter 308b for transmitting wireless communication to the first portion MD’.

In some embodiments, the first wireless energy receiver 308a comprises a first coil, and the wireless energy transmitter 308a, 308c comprises a second coil. POP RIVET SHOE

[0980] With reference to Figs. 30, 38A and 38B, an embodiment of an implantable energized medical device MD, which may be referred to as a remote unit in other parts of the present disclosure, will be described. The medical device MD is configured to be held in position by a tissue portion 610 of a patient. The medical device MD comprises a first portion MD’ configured to be placed on a first side 612 of the tissue portion 610, the first portion MD’ having a first cross-sectional area Al in a first plane Pl and comprising a first surface 614 configured to face and/or engage a first tissue surface 616 of the first side 612 of the tissue portion 610. The medical device MD further comprises a second portion MD” configured to be placed on a second side 618 of the tissue portion 610, the second side 618 opposing the first side 612, the second portion MD” having a second cross-sectional area A2 in a second plane P2 and comprising a second surface 620 configured to engage a second tissue surface 622 on the second side 618 of the tissue portion 610. The medical device MD further comprises a connecting portion MD-2 configured to be placed through a hole in the tissue portion 610 extending between the first and second sides 612, 618 of the tissue portion 610. Here, the connecting portion MD-2 has a third cross-sectional area A3 in a third plane P3. The connecting portion MD-2 is configured to connect the first portion MD’ to the second portion MD” . In the illustrated embodiment, a connecting interface 630 between the connecting portion MD-2 and the second portion MD” is eccentric with respect to the second portion MD”.

[0981] The first portion MD’ has an elongated shape in the illustrated embodiment of Fig. 1. Similarly, the second portion MD” has an elongated shape. However, the first portion MD’ and/or second portion MD” may assume other shapes, such as a flat disk, e.g., having a width and length being larger than the height, a sphere, an ellipsoid, or any other polyhedral or irregular shape, some of these being exemplified in Figs. 30 to 37.

[0982] As illustrated in Figs. 38A and 38B, the connecting interface 630 between the connecting portion MD-2 and the second portion MD” may be eccentric, with respect to the second portion MD” in a first direction 631, but not in a second direction 633 being perpendicular to the first direction. The first direction 631 is here parallel to the line A-A, to the second plane P2, and to a length of the second portion MD”. The second direction 633 is here parallel to the line B-B, to the second plane P2, and to a width of the second portion MD”. It is also possible that the connecting interface between the connecting portion MD-2 and the second portion MD” is eccentric, with respect to the second portion MD”, in the first direction 631 as well as in the second direction 633 being perpendicular to the first direction 631.

[0983] Similarly, a connecting interface between the connecting portion MD-2 and the first portion MD’ may be eccentric with respect to the first portion MD’ in the first direction 631 and/or in the second direction 633. [0984] The first portion MD’, connecting portion MD-2 and second portion MD” may structurally form one integral unit. It is, however, also possible that the first portion MD’ and the connecting portion MD-2 structurally form one integral unit while the second portion MD” forms a separate unit, or that the second portion MD” and the connecting portion MD-2 structurally form one integral unit while the first portion MD’ forms a separate unit.

[0985] Additionally, or alternatively, the second portion MD” may comprise a removable and/or interchangeable portion 639. In some embodiments, the removable portion 639 may form part of a distal region. A removable portion may also form part of a proximal region. Thus, the second portion MD” may comprise at least two removable portions, each being arranged at a respective end of the second portion MD”. The removable portion 639 may house, hold or comprise one or several functional parts of the medical device MD, such as gears, motors, connections, reservoirs, and the like as described in other parts of the present disclosure. An embodiment having such a removable portion 639 will be able to be modified as necessary to circumstances of a particular patient.

[0986] In the case of the first portion MD’, connecting portion MD-2 and second portion MD” structurally forming one integral unit, the eccentric connecting interface between the connecting portion MD-2 and the second portion MD”, with respect to the second portion MD”, will provide that the medical device MD will be able to be inserted into the hole in the tissue portion. The medical device MD may for example be inserted into the hole at an angle, similar to how a foot is inserted into a shoe, to allow most or all of the second portion MD” to pass through the hole, before it is angled, rotated and/or pivoted to allow any remaining portion of the second portion MD” to pass through the hole and allow the medical device MD to assume its intended position.

[0987] As illustrated in Figs. 30, 36 and 37, the first portion MD’ may assume a variety of shapes, such as an oblong shape, a flat disk shape, a spherical shape, or any other polyhedral or irregular shape. Similarly, the second portion MD” may assume a variety of shapes, such as an oblong shape, a flat disk shape, a spherical shape, or any other polyhedral or irregular shape. The proposed shapes of the first and second portions MD’, MD” may be mixed and combined to form embodiments not exemplified in the illustrated embodiments. For example, one or both of the first and second portions MD’, MD” may have a flat oblong shape. In this context, the term “flat” is related to the height of the first or second portion MD’, MD”, i.e. in a direction parallel to a central extension C 1 of the connecting portion MD-2. The term “oblong” is related to a length of the first or second portion MD’, MD ”.

[0988] With reference to Figs. 38A- 38B, the second portion MD” has a first end 632 and a second end 634 opposing the first end 632. The length of the second portion MD” is defined as the length between the first end 632 and the second end 634. The length of the second portion MD” is furthermore extending in a direction being different from the central extension Cl of the connecting portion MD-2. The first end 632 and second end 634 are separated in a direction parallel to the second plane P2. Similarly, the first portion MD’ has a length between a first and a second end, the length extending in a direction being different from the central extension Cl of the connecting portion MD-2.

[0989] The second portion MD” may be curved along its length. For example, one or both ends of the second portion MD” may point in a direction being substantially different from the second plane P2, i.e. curving away from or towards the tissue portion when implanted. In some embodiments, the second portion MD” curves within the second plane P2, exclusively or in combination with curving in other planes. The second portion MD” may also be curved in more than one direction, i.e. along its length and along its width, the width extending in a direction perpendicular to the length.

[0990] The first and second ends 632, 634 of the second portion MD” may respectively comprise an elliptical point. For example, the first and second ends 632, 634 may comprise a hemispherical end cap respectively. It is to be understood that also the first and second ends of the first portion MD’ may have such features.

[0991] The second portion MD” may have at least one circular cross-section along the length between the first end 632 and second end 634, as illustrated in Fig. 30. It is, however, possible for the second portion MD” to have at least one oval cross-section or at least one elliptical cross-section along the length between the first end 632 and the second end 634. Such cross-sectional shapes may also exist between ends in a width direction of the second portion MD” . Similarly, such cross- sectional shapes may also exist between ends in a length and/or width direction in the first portion MD’.

[0992] In the following paragraphs, some features and properties of the second portion MD” will be described. It is, however, to be understood that these features and properties may also apply to the first portion MD’.

[0993] The second portion MD” has a proximal region 636, an intermediate region 638, and a distal region 640. The proximal region 636 extends from the first end 632 to an interface between the connecting portion MD-2 and the second portion MD”, the intermediate region 638 is defined by the connecting interface 630 between the connecting portion MD-2 and the second portion MD”, and the distal region 640 extends from the connecting interface 630 between the connecting portion MD-2 and the second portion MD” to the second end 634. The proximal region 636 is shorter than the distal region 640 with respect to the length of the second portion, i.e. with respect to the length direction 631. Thus, a heel (the proximal region) and a toe (the distal region) are present in the second portion MD ”. [0994] The second surface 620, configured to engage with the second tissue surface 622 of the second side 618 of the tissue portion 610, is part of the proximal region 636 and the distal region 640. If a length of the second portion MD” is defined as x, and the width of the second portion MD” is defined as y along respective length and width directions 631, 633 being perpendicular to each other and substantially parallel to the second plane P2, the connecting interface between the connecting portion MD-2 and the second portion MD” is contained within a region extending from x > 0 to x < x/2 and/or y > 0 to y < y/2, x and y and 0 being respective end points of the second portion MD” along said length and width directions. In other words, the connecting interface between the connecting portion MD-2 and the second portion MD” is eccentric in at least one direction with respect to the second portion MD” such that a heel and a toe are formed in the second portion MD”.

[0995] The first surface 614 configured to face and/or engage the first tissue surface 616 of the first side 612 of the tissue portion 610 may be substantially flat. In other words, the first portion MD’ may comprise a substantially flat side facing towards the tissue portion 610. Furthermore, an opposing surface of the first portion MD’, facing away from the tissue portion 610, may be substantially flat. Similarly, the second surface 620 configured to engage the second tissue surface 622 of the second side 618 of the tissue portion 610 may be substantially flat. In other words, the second portion MD” may comprise a substantially flat side facing towards the tissue portion 610. Furthermore, an opposing surface of the second portion MD”, facing away from the tissue portion 610, may be substantially flat.

[0996] The second portion MD” may be tapered from the first end 632 to the second end 634, thus giving the second portion MD” different heights and/or widths along the length of the second portion MD”. The second portion may also be tapered from each of the first end 632 and second end 634 towards the intermediate region 638 of the second portion MD”.

[0997] Some dimensions of the first portion MD’, the second portion MD” and the connecting portion MD-2 will now be disclosed. Any of the following disclosures of numerical intervals may include or exclude the end points of said intervals.

[0998] The first portion MD’ may have a maximum dimension in the range of 10 to 60 mm, such as in the range of 10 to 40 mm, such as in the range of 10 to 30 mm, such as in the range of 10 to 25 mm, such as in the range of 15 to 40 mm, such as in the range of 15 to 35 mm, such as in the range of 15 to 30 mm, such as in the range of 15 to 25 mm. By the term “maximum dimension” it is hereby meant the largest dimension in any direction.

[0999] The first portion MD’ may have a diameter in the range of 10 to 60 mm, such as in the range of 10 to 40 mm, such as in the range of 10 to 30 mm, such as in the range of 10 to 25 mm, such as in the range of 15 to 40 mm, such as in the range of 15 to 35 mm, such as in the range of 15 to 30 mm, such as in the range of 15 to 25 mm. [01000] The connecting portion MD-2 may have a maximum dimension in the third plane P3 in the range of 2 to 20 mm, such as in the range of 2 to 15 mm, such as in the range of 2 to 10 mm, such as in the range of 5 to 10 mm, such as in the range of 8 to 20 mm, such as in the range of 8 to 15 mm, such as in the range of 8 to 10 mm.

[01001] The second portion MD” may have a maximum dimension in the range of 30 to 90 mm, such as in the range of 30 to 70 mm, such as in the range of 30 to 60 mm, such as in the range of 30 to 40 mm, such as in the range of 35 to 90 mm, such as in the range of 35 to 70 mm, such as in the range of 35 to 60 mm, such as in the range of 35 to 40 mm.

[01002] The first portion has a first height Hl, and the second portion has a second height H2, both heights being in a direction perpendicular to the first and second planes Pl, P2. The first height may be smaller than the second height. However, in the embodiments illustrated in Figs. 36A to 38B, the first height Hl is substantially equal to the second height H2. Other height ratios are possible, for example the first height Hl may be less than 2/3 of the second height H2, such as less than 1/2 of the second height H2, such as less than 1/3 of the second height H2, such as less than 1/4 of the second height H2, such as less than 1/5 of the second height H2, such as less than 1/10 of the second height H2.

[01003] As illustrated in Figs. 38A to 38B, the proximal region 636 has a length 642 being smaller than a length 646 of the distal region 640. The intermediate region 638 has a length 644, and a width 648. In some embodiments, the length 644 of the intermediate region 638 is greater than the width 648. In other words, the connecting interface between the connecting portion MD-2 and the second portion MD” may be elongated, having a longer dimension (in the exemplified case, the length) and a shorter dimension (in the exemplified case, the width). It is also possible that the length 644 of the intermediate region 638 is shorter than the width 648 of the intermediate region 638.

[01004] The length 646 of the distal region 640 is preferably greater than the length 644 of the intermediate region 638, however, an equally long distal region 640 and intermediate region 638 or a shorter distal region 640 than the intermediate region 638 are also possible. The length 642 of the proximal region 636 may be smaller than, equal to, or greater than the length 644 of the intermediate region 638.

[01005] The length 644 of the intermediate region 638 is preferably less than half of the length of the second portion MD”, i.e. less than half of the combined length of the proximal region 636, the intermediate region 638, and the distal region 630. In some embodiments, the length 644 of the intermediate region 638 is less than a third of the length of the second portion MD”, such as less than a fourth, less than a fifth, or less than a tenth of the length of the second portion MD” . [01006] The connecting portion may have one of an oval cross-section, an elongated crosssection, and a circular cross-section, in a plane parallel to the third plane P3. In particular, the connecting portion may have several different cross-sectional shapes along its length in the central extension C 1.

[01007] In some embodiments the distal region 640 is configured to be directed downwards in a standing patient, i.e. in a caudal direction when the medical device MD is implanted. As illustrated in Figs. 39A to 39D, different orientations of the second portion MD” relative to the first portion MD’ are possible. In some embodiments, a connection between either the first portion MD’ and the connecting portion MD-2 or between the second portion MD” and the connecting portion MD-2 may allow for a plurality of different connecting orientations. For example, a connection mechanism between the first portion MD’ and the connecting portion MD-2 (or between the second portion MD” and the connecting portion MD-2) may posses a 90-degrees rotational symmetry to allow the second portion MD’ to be set in four different positions with respect to the first portion MD, each differing from the other by 90 degrees. Other degrees of rotational symmetry are, of course, possible, such as 30 degrees, 45 degrees, 60 degrees, 120 degrees, 180 degrees and so on. In other embodiments there are no connective mechanisms between any of the first portion MD’, the connecting portion MD-2, and the second portion MD” (i.e. the portions are made as one integral unit), and in such cases different variants of the medical device MD can be achieved during manufacturing. In other embodiments, the connective mechanism between the first portion MD’ and the connecting portion MD-2 (or between the second portion MD” and the connecting portion MD-2) is non-reversible, i.e. the first portion MD’ and the second portion MD” may initially be handled as separate parts, but the orientation of the second portion MD” relative to the first portion MD’ cannot be changed once it has been selected and the parts have been connected via the connecting portion MD-2.

[01008] The different orientations of the second portion MD” relative to the first portion MD’ may be defined as the length direction of the second portion MD” having a relation or angle with respect to a length direction of the first portion MD’. Such angle may be 15, 30, 45, 60, 75 90, 105, 120, 135, 150, 165, 180, 195, 210, 225, 240, 255, 270, 285, 300, 315, 330, 345 or 360 degrees. In particular, the angle between the first portion MD’ and the second portion MD” may be defined as an angle in the planes Pl and P2, or as an angle in a plane parallel to the tissue portion 610, when the medical device MD is implanted. In the embodiment illustrated in Figs. 39A to 39D, the length direction of the second portion MD” is angled by 0, 90, 180, and 270 degrees with respect to the length direction of the first portion MD’.

[01009] Referring now to Figs. 39E-K, 39M, 39N, 39P and 39Q. The following will discuss some features of the first portion MD’, and in some cases additionally or alternatively of the connecting portion MD-2, which enable the first portion MD’ to increase its cross-sectional area in the first plane (i.e. to increase an area of the first surface configured to face the first tissue surface), and/or which enable the first portion MD’ to be rotated, translated, or otherwise moved in relation to the connecting portion MD-2. In some embodiments, the first portion MD’ will be configured to extend further away from the connecting portion MD-2 in or within the first plane. It is to be understood that these features can be combined with other features of the implantable energized medical device. In particular, the specific shape of the first portion, connecting portion and/or second portion in the illustrated embodiments are merely exemplary. Other shapes are possible, as discussed in the present disclosure. Accordingly, the elongated second portion MD” does not necessarily need to be elongated as shown for example in Fig. 39E, and furthermore, the first portion MD’ does not necessarily need to have a semicircular shape.

[01010] With reference to Fig. 39E, an implantable energized medical device MD is shown, wherein the first portion MD’ is configured and shaped such that an edge 710 of the first portion MD’ is substantially aligned with the connecting portion MD-2 with regard to the first direction 631. In other words, no part of the first portion MD’ protrudes forward of the connecting portion MD-2 with regard to the first direction 631. Hereby, insertion of the implantable energized medical device MD may be facilitated, in particular when angled downwards, since the first portion MD’ will not abut the tissue until most or all of the second portion MD” has been inserted through the hole in the tissue. Although the edge 710, as well as other edges of the first portion MD’, are hereby shown as having no radius, radiused edges are possible. Thus, the edge 710 may have a radius, and/or the first portion MD’, and/or the second portion MD”, and/or the connecting portion MD-2, may comprise radiused edges.

[01011] With reference to Figs. 39F and 39G, a first portion MD’ is shown being configured to have its surface area increased. Here, the first cross-sectional area is increased, thereby increasing an area of the first surface configured to face (and in some embodiments also configured to contact) the first tissue surface. In the illustrated embodiment, the first portion MD’ comprises a first element 712 and a second element 714 being hingedly interconnected to allow the first element 712 to assume a first state (not shown) wherein the first element 712 is arranged on top of the second element 714, and a second state wherein the first element 712 is folded to be located adjacent or next to the second element 714. A similar configuration may be achieved by other means of interconnection between the first element 712 and second element 714, i.e. the configuration is not limited to a hinge-type connection. For example, the first element 712 and second element 714 may be constructed of a single piece of material being flexible enough to be able to fold over itself to assume the first and second state respectively.

[01012] Preferably, the first and second element 712, 714 are interconnected and formed such that a transition between the first and second element 712, 714 along the first direction 631 is flush. Furthermore, while in the first state, the first portion MD’ may possess the same feature as discussed in conjunction with Fig. 39E, i.e. the first portion MD’ may be substantially aligned with the connecting portion MD-2. [01013] With reference to Figs. 39H and 391, a first portion MD’ is shown being configured to have its surface area increased. Here, the first cross-sectional area is increased, thereby increasing an area of the first surface configured to face (and in some embodiments also configured to contact) the first tissue surface. In the illustrated embodiment, the first portion MD’ comprises a first element 712 and a second element 714. The second element 714 here comprises a slot 715 configured to partially or fully house the first element 712. The first element 712 is configured to rotate about an axis to assume a first state, wherein the first element 712 is partially or completely housed in within the slot 715, and a second state wherein the first element 712 protrudes from the slot 715 to increase the first cross- sectional area. The first element 712 may be configured to rotate 180 degrees about the axis. In the illustrated example, the first and second elements 712, 714 are shaped as semi-circles and form a shape conforming to a full circle in the second state. However, it is also possible that the first element 712 only rotate about the axis up to 90 degrees, thus forming a shape conforming to three quarters of a circle in the second state. Other shapes are also possible, e.g. polygons.

[01014] With reference to Figs. 39J and 39K, a similar configuration as described with reference to Figs. 39H and 391 is shown. However, here the second element 714 does not comprise a slot, and the first element is thus not housed in a slot. Instead, the first element 712 is arranged on top of the second element 714 (similar to the embodiment of Figs. 39F and 39G). The first portion MD’ is here configured to have its surface area increased, in particular the first cross-sectional area is increased, thereby increasing an area of the first surface configured to face (and in some embodiments also configured to contact) the first tissue surface. The first element 712 is configured to rotate about an axis to assume a first state, wherein the first element 712 is partially or completely arranged on top of the second element 714. Here, “completely arranged on top of’ means that the first element 712 is confined within the borders of the second element 714. By rotation of the first element 712 about the axis, the first element 712 can assume a second state wherein the first element 712 protrudes over an edge or border of the second element 714 to increase the first cross-sectional area. The first element 712 may be configured to rotate 180 degrees about the axis. However, it is also possible that the first element 712 only rotate about the axis up to 90 degrees. Other shapes of the first and second element 712, 714 are also possible, e.g. polygons.

[01015] With reference to Figs. 39M and 39N, a first portion MD’ is shown being configured to have its surface area increased. Here, the first cross-sectional area is increased, thereby increasing an area of the first surface configured to face (and in some embodiments also configured to contact) the first tissue surface. In the illustrated embodiment, the first portion MD’ comprises a first element 712 and a second element 714. The first element 712 here comprises a slot configured to partially or completely house the second element 714. The first element 712 is configured to assume a first state, as shown in Fig. 39M, wherein the second element 714 is arranged partially or fully within the slot of the first element 712, and a second state, as shown in Fig. 39N, wherein the first element 712 has been moved in a first direction to cause the second element 714 to protrude from the slot of the first element 712, and to cause the first element 712 to extend further away from the connecting portion MD-2 in the first plane. As will be understood, other variations are possible, e.g. the second element 714 may comprise the slot, and the first element 712 may be partially or fully housed within such slot, and subsequently the first element 712 or the second element 714 may be moved to protrude from such slot.

[01016] With reference to Figs. 39P and 39Q, a first portion MD’ is shown being configured to be moved in relation to the connecting portion MD-2. The expression “configured to be moved” may in this context be interpreted as the first portion MD’ being configured to assume at least two different positions with regard to the connecting portion MD-2 while still remaining in direct contact with the connecting portion. Here, the connecting portion MD-2 comprises a protruding element 717 and the first portion MD’ comprises a slot 718, wherein the protruding element 717 is configured to slide within the slot 718 along a predetermined path, e.g. in a first direction and a direction opposite said first direction. The protruding element 717 may be configured to be interlocked within the slot 718 such that the protruding element 717 can only be removed from the slot 718 in a preconfigured position. In other embodiments, the protruding element 717 may be permanently enclosed within the slot 718. By sliding the first portion MD’ in the first direction, an extension of the first portion MD’ in the first plane with respect to the connecting portion MD-2 will be able to be adjusted. Any position between the endpoints of the slot 718 may be able to be assumed by the first portion MD’. In particular, first portion MD’ and/or the connecting portion MD-2 may comprise a locking mechanism configured to secure a position of the first portion MD’ in relation to the connecting portion MD-2. Such locking mechanism may rely on flexible parts being biased towards each other to maintain the first portion MD’ and connecting portion MD-2 in a fixed position in relation to each other. Other possible locking mechanisms include the use of friction, snap-locking means, etc.

[01017] The second end 634 of the second portion MD” may comprise one or several connections for connecting to an implant being located in a caudal direction from a location of the implantable energized medical device MD in the patient. Hereby, when the medical device MD is implanted in a patient, preferably with the distal region 640 and second end 634 pointing downwards in a standing patient, the connections will be closer to the implant as the second end 634 will be pointing in the caudal direction whereas the first end 632 will be pointing in the cranial direction. It is also possible that the second end 634 of the second portion MD” is configured for connecting to an implant, i.e. the second end 634 may comprise a port, connector or other type of connective element for transmission of power, fluid and/or signals.

[01018] Likewise, the first end 632 of the second portion MD” may comprise one or several connections for connecting to an implant which is located in a cranial direction from a location of the implantable energized medical device MD in the patient. Hereby, when the medical device MD is implanted in a patient, preferably with the distal region 640 and second end 634 pointing downwards in a standing patient, the connections will be closer to the implant as the first end 632 will be pointing in the cranial direction whereas the second end 634 will be pointing in the caudal direction. It is also possible that the first end 632 of the second portion MD” is configured for connecting to an implant, i.e. the first end 632 may comprise a port, connector or other type of connective element for transmission of power, fluid and/or signals.

POP RIVET CROSS

[01019] With reference to Figs. 40 and 41, an embodiment of an implantable energized medical device MD, which may be referred to as a remote unit in other parts of the present disclosure, will be described. The medical device MD is configured to be held in position by a tissue portion 610 of a patient. The medical device MD comprises a first portion MD’ configured to be placed on a first side 612 of the tissue portion 610, the first portion MD’ having a first cross-sectional area in a first plane Pl and comprising a first surface 614 configured to face and/or engage a first tissue surface 616 on the first side 612 of the tissue portion 610. The medical device MD further comprises a second portion MD” configured to be placed on a second side 618 of the tissue portion 610, the second side 618 opposing the first side 612, the second portion MD” having a second cross-sectional area in a second plane and comprising a second surface 620 configured to engage a second tissue surface 622 on the second side 618 of the tissue portion 610. The medical device MD further comprises a connecting portion MD-2 configured to be placed through a hole in the tissue portion 610 extending between the first and second sides 612, 618 of the tissue portion 610. The connecting portion MD-2 here has a third cross-sectional area in a third plane. The connecting portion MD-2 is configured to connect the first portion MD’ to the second portion MD”.

[01020] With reference to Fig. 42, the first cross-sectional area has a first cross-sectional distance CD la and a second cross-sectional distance CD2a, the first and second cross-sectional distances CD la, CD2a being perpendicular to each other and the first cross-sectional distance CD la being longer than the second cross-sectional distance CD2a. Furthermore, the second cross-sectional area has a first cross-sectional distance CD lb and a second cross-sectional distance CD2b, the first and second cross-sectional distances CD2a, CD2b being perpendicular to each other and the first cross- sectional distance CD lb being longer than the second cross-sectional distance CD2b. The first cross- sectional distance CD la of the first cross-sectional area and the first cross-sectional distance CD lb of the second cross-sectional area are rotationally displaced in relation to each other by an angle exceeding 45 degrees to facilitate insertion of the second portion MD” through the hole in the tissue portion 610. In the embodiment illustrated in Fig. 42, the rotational displacement is 90 degrees.

[01021] The rotational displacement of the first portion MD’ and second portion MD” forms a cross-like structure, being particularly advantageous in that insertion through the hole in the tissue portion 610 may be facilitated and, once positioned in the hole in the tissue portion 610, a secure position may be achieved. In particular, if the medical device MD is positioned such that the second portion MD” has its first cross-sectional distance CD lb extending along a length extension of the hole 611 in the tissue portion 610, insertion of the second potion MD” through the hole 611 may be facilitated. Furthermore, if the first portion MD’ is then displaced in relation to the second portion MD” such that the first cross-sectional distance CD la of the first portion MD’ is displaced in relation to a length extension of the hole 611, the first portion MD’ may be prevented from traveling through the hole 611 in the tissue portion. In these cases, it is particularly advantageous if the hole 611 in the tissue portion is oblong, ellipsoidal or at least has one dimension in one direction longer than a dimension in another direction. Such oblong holes in a tissue portion may be formed for example in tissue having a fiber direction, where the longest dimension of the hole may be aligned with the fiber direction.

[01022] In the embodiment illustrated in Fig. 40, the first surface 614 of the first portion MD’ is flat, thus providing a larger contact surface to the first tissue surface 616 and consequently less pressure on the tissue portion. A more stable position may also be achieved by the flat surface. Also, the second surface 620 of the second portion MD” may be flat. However, other shapes, such as those described in other parts of the present disclosure, are possible.

[01023] As shown in Fig. 42, the connecting portion MD-2 may have an elongated cross-section in the third plane. It may be particularly advantageous if the connecting portion MD-2 has a longer length 644 than width 648, said length 644 extending in the same direction as a length direction of the second portion MD”, i.e. in the same direction as an elongation of the second portion MD”. Hereby, the elongation of the connecting portion MD-2 may run in the same direction as an elongation of the hole in the tissue portion.

[01024] With reference to Fig. 43, the rotational displacement of first cross-sectional distance of the first cross-sectional area and the first cross-sectional distance of the second cross-sectional area is shown, here at an angle of about 45 degrees. Accordingly, there is a rotational displacement, in the first, second and third planes, between a length direction 633 of the first portion MD’ and a length direction 631 of the second portion MD”. Other angles of rotational displacement are possible, such as 60, 75, 90, 105, 120, 135 degrees, etc.

[01025] One and the same device MD may be capable of assuming several different arrangements with regard to a rotational displacement of the first portion MD’ and second portion MD”. In particular, this is possible when the first portion MD’ and/or the second portion MD” is configured to detachably connect to the interconnecting portion MD-2. For example, a connection mechanism between the first portion MD’ and the connecting portion MD-2, or between the second portion MD” and the connecting portion MD-2, may possess a rotational symmetry to allow the first portion MD’ to be set in different positions in relation to the connecting portion MD-2 and in extension also in relation to the second portion MD”. Likewise, such rotational symmetry may allow the second portion MD-2” to be set in different positions in relation to the connecting portion MD-2 and in extension also in relation to the first portion MD’ .

[01026] With reference to Figs. 44A to 44C, a procedure of insertion of the medical device MD in a tissue portion 610 will be described. The medical device MD may be oriented such that a length direction 631 of the second portion MD” points downwards into the hole 611. Preferably, the second portion MD” is positioned such that it is inserted close to an edge of the hole 611. The second portion MD” may then be inserted partially through the hole 611 until the point where the first portion MD’ abuts the first tissue surface 616. Here, a 90 degrees rotational displacement between the first portion MD’ and the second portion MD”, as described above, will allow a relatively large portion of the second portion MD” to be inserted before the first portion MD’ abuts the first tissue surface 616. Subsequently, the medical device MD may be pivoted to slide or insert the remaining portion of the second portion MD” through the hole 611. While inserting the remaining portion of the second portion MD”, the tissue may naturally flex and move to give way for the second portion MD”. Upon having fully inserted the second portion MD” through the hole 611 such that the second portion MD” is completely located on the other side of the tissue portion 610, the tissue may naturally flex back.

POP RIVET CERAMIC COILS

[01027] With reference to Fig. 45, an embodiment of an implantable energized medical device MD, which may be referred to as a remote unit in other parts of the present disclosure, will be described. The medical device MD is configured to be held in position by a tissue portion 610 of a patient. The medical device MD comprises a first portion MD’ configured to be placed on a first side 612 of the tissue portion 610, the first portion MD’ having a first cross-sectional area in a first plane Pl and comprising a first surface 614 configured to face and/or engage a first tissue surface of the first side 612 of the tissue portion 610. The medical device MD further comprises a second portion MD” configured to be placed on a second side 618 of the tissue portion 610, the second side 618 opposing the first side 612, the second portion MD” having a second cross-sectional area in a second plane and comprising a second surface 620 configured to engage a second tissue surface of the second side 618 of the tissue portion 610. The medical device MD further comprises a connecting portion MD-2 configured to be placed through a hole in the tissue portion 610 extending between the first and second sides 612, 618 of the tissue portion 610. Here, the connecting portion MD-2 has a third cross-sectional area in a third plane. The connecting portion MD-2 is configured to connect the first portion MD’ to the second portion MD”.

[01028] At least one of the first portion and the second portion comprises at least one coil embedded in a ceramic material, the at least one coil being configured for at least one of: receiving energy transmitted wirelessly, transmitting energy wirelessly, receiving wireless communication, and transmitting wireless communication. In the illustrated embodiment, the first portion MD’ comprises a first coil 658 and a second coil 660, and the second portion MD” comprises a third coil 662. The coils are embedded in a ceramic material 664

[01029] As discussed in other part of the present disclosure, the first portion MD’ may comprise a first wireless energy receiver configured to receive energy transmitted wirelessly from an external wireless energy transmitter, and further the first portion MD’ may comprise a first wireless communication receiver. The first wireless energy receiver and the first wireless communication receiver may comprise the first coil 658. Accordingly, the first coil 658 may be configured to receive energy wirelessly and/or to receive communication wirelessly.

[01030] By the expression “the receiver/transmitter comprising the coil” it is to be understood that said coil may form part of the receiver/transmitter.

[01031] The first portion MD’ comprises a distal end 665 and a proximal end 666, here defined with respect to the connecting portion MD-2. In particular, the proximal end 665 is arranged closer to the connecting portion MD-2 and closer to the second portion MD” when the medical device MD is assembled. In the illustrated embodiment, the first coil 658 is arranged at the distal end 665.

[01032] The first portion MD’ may comprise an internal wireless energy transmitter and further a first wireless communication transmitter. In some embodiments, the internal wireless energy transmitter and/or the first wireless communication transmitter comprise(s) the first coil 658. However, in some embodiments the internal wireless energy transmitter and/or the first wireless communication transmitter comprises the second coil 660. Here, the second coil 660 is arranged at the proximal end 665 of the first portion MD’ . Such placement of the second coil 660 may provide that energy and/or communication signals transmitted by the second coil 660 will not be attenuated by internal components of the first portion MD’ when being transmitted to the second portion MD”.

[01033] In some embodiments, the first wireless energy receiver and the internal wireless energy transmitter comprise a single coil embedded in a ceramic material. Accordingly, a single coil may be configured for receiving energy wirelessly and for transmitting energy wirelessly. Similarly, the first wireless communication receiver and the first wireless communication transmitter may comprise a single coil embedded in a ceramic material. Even further, in some embodiments a single coil may be configured for receiving and transmitting energy wirelessly, and for receiving and transmitting communication signals wirelessly.

[01034] The coils discussed herein are preferably arranged in a plane extending substantially parallel to the tissue portion 610. [01035] The second portion MD” may comprise a second wireless energy receiver and/or a second wireless communication receiver. In some embodiments, the third coil 662 in the second portion MD” comprises the second wireless energy receiver and/or the second wireless communication receiver.

[01036] The second portion MD” comprises a distal end 668 and a proximal end 670, here defined with respect to the connecting portion MD-2. In particular, the proximal end 668 is arranged closer to the connecting portion MD-2 and closer to the first portion MD’ when the medical device MD is assembled. In the illustrated embodiment, the third coil 662 is arranged at the proximal end 668 of the second portion MD”. Such placement of the third coil 662 may provide that energy and/or communication signals received by the third coil 662 will not be attenuated by internal components of the second portion MD” when being received from the first portion MD’.

[01037] The first portion MD’ may comprise a first controller 300a connected to the first coil 658, second coil 660 and/or third coil 662. The second portion MD” may comprise a second controller 300b connected to the first coil 658, second coil 660 and/or third coil 662.

[01038] In the illustrated embodiment, the first portion MD’ comprises a first energy storage unit 304a connected to the first wireless energy receiver 308a, i.e. the first coil 658. The second portion comprises a second energy storage unit 304b connected to the second wireless energy receiver 308b, i.e. the third coil 662. Such an energy storage unit may be a solid-state battery, such as a thionyl chloride battery.

[01039] In some embodiments, the first coil 658 is configured to receive energy transmitted wirelessly by the external wireless energy transmitter and to store the received energy in the first energy storage unit 304a. Furthermore, the first coil 658 and/or the second coil 660 may be configured to wirelessly transmit energy stored in the first energy storage unit 304a to the third coil 662, and the third coil 662 may be configured to receive energy transmitted wirelessly by the first coil 658 and/or the second coil 660 and to store the received energy in the second energy storage unit 305b.

[01040] The first energy storage unit 304a may be configured to store less energy than the second energy storage unit 304b and/or to be charged faster than the second energy storage unit 304b. Herein, charging of the first energy storage unit 304a may be relatively quick, whereas transfer of energy from the first energy storage unit 304a to the second energy storage unit 304b may be relatively slow. Thus, a user can quickly charge the first energy storage unit 304a and will not - during such charging - be restricted for a long period of time by being connected to an external wireless energy transmitter, e.g. at a particular location. After having charged the first energy storage unit 304a, the user may move freely while energy slowly transfers from the first energy storage unit 304a to the second energy storage unit 304b via the first and/or second coil and the third coil. GEAR POP RIVET

[01041] Figs. 46A and 46B illustrate a gear arrangement and magnetic coupling for coupling the implantable energized medical device MD to an implant exerting force on a body part, and in particular a gear arrangement for transferring mechanical movement through an outer housing of the medical device MD or an outer housing of the second portion MD”.

[01042] The housing 484 of the medical device MD or second portion MD” may be present in some embodiments of the medical device MD. In such embodiments, the housing 484 is configured to enclose, at least, the controller (not shown), motor M, any receivers and transmitters if present (not shown), and any gear arrangements G, Gl, G2 if present. Herein, such features are protected from bodily fluids. The housing 484 may be an enclosure made from one of or a combination of: a carbonbased material (such as graphite, silicon carbide, or a carbon fiber material), a boron material, a polymer material (such as silicone, Peek®, polyurethane, UHWPE or PTFE), a metallic material (such as titanium, stainless steel, tantalum, platinum, niobium or aluminum), a ceramic material (such as zirconium dioxide, aluminum oxide or tungsten carbide) or glass. In any instance the enclosure should be made from a material with low permeability such that migration of fluid through the walls of the enclosure is prevented.

[01043] The implantable energized medical device may comprise at least part of a magnetic coupling, such as a magnetic coupling part 490a. A complementary part of the magnetic coupling, such as magnetic coupling part 490b, may be arranged adjacent to the medical device MD, so as to magnetically couple to the magnetic coupling part 490a and form the magnetic coupling. The magnetic coupling part 490b may form part of an entity not forming part of the medical device MD. However, in some embodiments the second portion MD” comprises several chambers being hermetically sealed from each other. Such chambers may be coupled via the magnetic coupling as discussed herein. The magnetic coupling 490a, 490b provides for that mechanical work output by the medical device MD via, e.g., an electric motor can be transferred from the medical device MD to, e.g., an implant configured to exert force on a body part of a patient. In other words, the magnetic coupling 490a, 490b provides forthat mechanical force can be transferred through the housing 484.

[01044] The coupling between components, such as between a motor and gear arrangement, or between a gear arrangement and a magnetic coupling, may be achieved by, e.g., a shaft or the like.

[01045] In some embodiments, for example as illustrated in Fig. 46A, a force output by a motor M in the second portion MD” is connected to the magnetic coupling part 490a. The magnetic coupling part 490a transfers the force output from the motor M to the magnetic coupling part 490b, i.e. via the magnetic coupling 490a, 490b. The force output transferred via the magnetic coupling 490a, 490b here has a torque Tl, which is substantially the same torque as delivered by the motor M. The magnetic coupling part 490b is connected to a gear arrangement G, located external to the medical device MD, for example in a medical implant configured to exert force on a body part or intermediate to a medical implant configured to exert force on a body part. The gear arrangement G is configured to increase the torque of the force delivered via the magnetic coupling 490a, 490b to deliver a force with torque T2 being higher than torque T1 to a medical implant. Consequently, low torque may be provided by the motor M, i.e. a relatively small force with high angular velocity, which is transferred via the magnetic coupling 490a, 490b before the torque is increased via gear arrangement G to achieve a relatively large force with low angular velocity. Hereby, the magnetic coupling 490a, 490b may utilize relatively weak magnetic forces to transfer the mechanical work through the housing 484 of the medical device MD without the risk of slipping between the magnetic coupling parts 490a, 490b.

[01046] In some embodiments, for example as illustrated in Fig. 46A, a force output of a motor M in the second portion MD’ ’ is connected to a first gear arrangement Gl, which in turn is coupled to the magnetic coupling part 490a. The motor M here provides a mechanical force with torque TO. The magnetic coupling part 490a transfers the force output from the motor M to the first gear arrangement Gl. The first gear arrangement Gl is configured to increase the torque of the force delivered from the motor M to deliver a force with a higher torque T1 to the magnetic coupling 490a, 490b. The magnetic coupling part 490a transfers the force with torque T1 to the magnetic coupling part 490b. The magnetic coupling part 490b is connected to a second gear arrangement G2 located external to the medical device, for example in a medical implant configured to exert force on a body part, or intermediate to a medical implant configured to exert force on a body part. The second gear arrangement G2 is configured to increase the torque of the force delivered via the magnetic coupling 490a, 490b to deliver a force with torque T2 being higher than torque Tl, and thus higher than torque TO, to a medical implant. Consequently, low torque may be provided by the motor M, i.e. a relatively small force with high angular velocity. The torque of the force provided by the motor M is then increased by the first gear arrangement Gl, before the force is transferred via the magnetic coupling 490a, 490b. The torque of the force transferred via the magnetic coupling 490a, 490b is then yet again increased via the second gear arrangement G2 to achieve a relatively large force with low angular velocity. Hereby, the magnetic coupling 490a, 490b may utilize relatively weak magnetic forces to transfer the mechanical work through the housing 484 of the medical device MD without the risk of slipping between the magnetic coupling parts 490a, 490b. Furthermore, since some of the torque increase is made within the second portion MD”, and a remaining portion of the torque increase is made external to the medical device and the second portion MD”, the gear arrangements Gl, G2 may be sized and configured appropriately to share the work of increasing the torque.

POP RIVET TAPERED [01047] With reference to Figs. 47A-C, 48, 49, 50 and 51A-C, embodiments of an energized medical device MD, which may be referred to as a remote unit in other parts of the present disclosure, will be described. As illustrated, these implantable energized medical devices have a second portion being shaped in a particular manner in order to facilitate removal of the implantable energized medical device once it has been implanted for a period of time and fibrotic tissue has begun to form around the second portion. It is hereby disclosed that these types of second portions, as illustrated in Figs. 47A-C, 48, 49, 50 and 51A-C, and as disclosed below, may be combined with any of the other features of the implantable energized medical device discussed in the present disclosure.

[01048] The device MD is configured to be held in position by a tissue portion 610 of a patient. The device MD comprises a first portion MD’ configured to be placed on a first side 612 of the tissue portion 610, the first portion MD’ having a first cross-sectional area in a first plane and comprising a first surface configured to face and/or engage a first tissue surface 616 of the first side 612 of the tissue portion 610. The device MD further comprises a second portion MD” configured to be placed on a second side 618 of the tissue portion 610, the second side 618 opposing the first side 612, the second portion MD” having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface 622 of the second side 618 of the tissue portion 610. The device MD further comprises a connecting portion MD-2 configured to be placed through a hole in the tissue portion 610 extending between the first and second sides 612, 618 of the tissue portion 610. The connecting portion MD-2 here has a third cross-sectional area in a third plane. The connecting portion MD-2 is configured to connect the first portion MD’ to the second portion MD” . In the illustrated embodiment, a connecting interface 630 between the connecting portion MD-2 and the second portion MD” is arranged at an end of the second portion MD”.

[01049] The first portion MD’ may have an elongated shape. Similarly, the second portion MD” may have an elongated shape. However, the first portion MD’ and/or second portion MD” may assume other shapes, such as a flat disk e.g. having a width and length being larger than the height, a sphere, an ellipsoid, or any other polyhedral or irregular shape, some of these being exemplified in Figs. 35 to 37.

[01050] To provide a frame of reference for the following disclosure, and as illustrated in Figs. 48, 49 and 50, a first direction 631 is here parallel to the line A-A, to the second plane, and to a length of the second portion MD”. A second direction 633 is here parallel to the line B-B, to the second plane, and to a width of the second portion MD”. The second portion MD” has a first end 632 and a second end 634 opposing the first end 632. The length of the second portion MD” is defined as the length between the first end 632 and the second end 634. The length of the second portion MD” is furthermore extending in a direction being different to the central extension C 1 of the connecting portion MD-2. The first end 632 and second end 634 are separated in a direction parallel to the second plane. Similarly, the first portion MD’ has a length between a first and a second end, the length extending in a direction being different to the central extension Cl of the connecting portion MD-2.

[01051] The first portion MD’, connecting portion MD-2 and second portion MD” may structurally form one integral unit. It is however also possible that the first portion MD’ and the connecting portion MD-2 structurally form one integral unit, while the second portion MD” form a separate unit, or, that the second portion MD” and the connecting portion MD-2 structurally form one integral unit, while the first portion MD’ form a separate unit.

[01052] Additionally, or alternatively, the second portion MD” may comprise a removable and/or interchangeable portion 639 as described in other parts of the present disclosure.

[01053] In the following paragraphs, some features and properties of the second portion MD” will be described. It is however to be understood that these features and properties may also apply to the first portion MD’.

[01054] The second portion MD” has an intermediate region 638, and a distal region 640. A proximal region may be present, as described in other parts of the present disclosure, The intermediate region 638 is defined by the connecting interface 630 between the connecting portion MD-2 and the second portion MD”, and the distal region 640 extends from the connecting interface 630 between the connecting portion MD-2 and the second portion MD” to the second end 634.

[01055] The first surface 614 configured to face and/or engage the first tissue surface 616 of the first side 612 of the tissue portion 610 may be substantially flat. In other words, the first portion MD’ may comprise a substantially flat side facing towards the tissue portion 610. Furthermore, an opposing surface of the first portion MD’, facing away from the tissue portion 610, may be substantially flat. Similarly, the second surface 620 configured to engage the second tissue surface 622 of the second side 618 of the tissue portion 610 may be substantially flat. In other words, the second portion MD” may comprise a substantially flat side facing towards the tissue portion 610. Furthermore, an opposing surface of the second portion MD”, facing away from the tissue portion 610, may be substantially flat.

[01056] The second portion MD” may be tapered from the first end 632 to the second end 634, thus giving the second portion MD” different heights and/or widths along the length of the second portion MD”. The second portion may also be tapered from each of the first end 632 and second end 634 towards the intermediate region 638 of the second portion MD”.

[01057] Still referring to Figs. 47A-C, 48, 49, 50, and 51A-C, the second portion MD” and connecting portion MD-2 here form a connecting interface 630. Furthermore, the second portion MD” has a lengthwise cross-sectional area along the first direction, wherein a second lengthwise cross- sectional area 690 is smaller than a first lengthwise cross-sectional area 689 and wherein the first lengthwise cross-sectional area 689 is located closer to the connecting interface 630 with regard to the first direction 631. Hereby, a tapered second portion is formed, being tapered towards the second end 634. The lengthwise cross-sectional area of the second portion MD” may decrease continuously from an end of the intermediate region 638 towards the second end 634, as illustrated for example in Fig. 48. The decrease may be linear, as illustrated for example in Fig. 48. However, other types of decreasing lengthwise cross-sectional areas are possible, such as a parabolic, exponential, stepwise, or stepwise with radiused edges between each step thus forming a smooth rounded contour.

[01058] Figs. 47B and 47C illustrate how the lengthwise cross-sectional area decrease over the length of the second portion MD” towards the second 634, as viewed along the line A-A. Fig. 47B illustrate the first lengthwise cross-sectional area 689, and Fig. 47C illustrate the second lengthwise cross-sectional area 690.

[01059] In some embodiments, the lengthwise cross-sectional area may decrease over a majority of the length of the second portion towards the second end 634. In some embodiments, a decrease of the lengthwise cross-sectional area over at least ! of the length of the second portion towards the second end 634 may be sufficient. In the example illustrated in Fig. 48, the lengthwise cross-sectional area decrease over about 85% of the length of the second portion.

[01060] With the second portion MD” having rotational symmetry along the first direction 631, as illustrated for example in Fig. 47A, the shape of the second portion MD” may be conical.

[01061] As illustrated in Fig. 49, the second portion MD” may have an upper surface, which include the second surface 620 configured to engage a second tissue surface of the second side of the tissue portion as discussed in other parts of the present disclosure, wherein the upper surface or second surface 620 is substantially flat and parallel to the second plane. In some embodiments the upper surface may be substantially perpendicular to the central extension Cl of the connecting portion MD- 2. Hereby, the second surface may be configured to lay flat against the second side of the tissue portion. In such embodiments, a lower surface of the second portion MD”, opposite the second surface 620 and facing away from the first portion MD’, may be configured to taper towards the second end 634, thus achieving the decreasing lengthwise cross-sectional area along the first direction 631 towards the second end 634.

[01062] Fig. 50 illustrate an embodiment wherein the lengthwise cross-sectional area decrease in a stepwise manner towards the second end 634 of the second portion MD”. Here, the second portion MD” has three major segments 692, 693, 694 having substantially constant diameter and each respective diameter being smaller moving towards the second end 634, being connected by intermediate segments 695, 696, wherein the diameter decreases along the first direction 631. Other variations of major segments having substantially constant diameter, and intermediate segments, having a decreasing diameter along the first direction 632, are possible, such as at least two major segments connected by a single intermediate segment with decreasing diameter, at least four major segments connected by three intermediate segments with decreasing diameter, and so on.

[01063] Referring now to Figs. 51A-C, an implantable energized medical device similar to the one illustrated in Fig. 49 is illustrated. As can be seen in the perspective view of Fig. 51 A, the second portion MD” has a decreasing lengthwise cross-sectional area towards the second end. The upper surface 697 is also visible in this view, being substantially flat and providing a contact area to the second tissue surface 622. The first lengthwise cross-sectional area 689 is larger than the second cross- sectional area 690, as can be seen in Figs. 5 IB and 51C, and the first lengthwise cross-sectional area 689 is located closer to the connecting interface between the connecting portion MD-2 and the second portion MD” with regard to the first direction.

[01064] Referring now to Fig. 52, an implantable energized medical device which may incorporate one or several of the features described in conjunction with Figs. 1-51C, and which may be referred to as a remote unit in other parts of the present disclosure, will be described. The device MD is configured to be held in position by a tissue portion 610 of a patient. The device MD comprises a first portion MD’ configured to be placed on a first side 612 of the tissue portion 610, the first portion MD’ having a first cross-sectional area in a first plane and comprising a first surface configured to face and/or engage a first tissue surface of the first side 612 of the tissue portion 610. The device MD further comprises a second portion MD” configured to be placed on a second side 618 of the tissue portion 610, the second side 618 opposing the first side 612, the second portion MD” having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side 618 of the tissue portion 610. The device MD further comprises a connecting portion MD-2 configured to be placed through a hole in the tissue portion 610 extending between the first and second sides 612, 618 of the tissue portion 610. The connecting portion MD-2 is configured to connect the first portion MD’ to the second portion MD” .

[01065] The connecting portion MD-2 and the second portion MD” are configured to form a unit having a central axis C2 extending from a first end 650 of said unit to a second end 651 of said unit, the first end 650 being proximal to the first portion MD’ and the second end 651 being distal to the first portion MD’. The first end 650 may generally be defined as the interface between the connecting portion 1 42 and the first portion MD’.

[01066] A physical footprint of the unit perpendicular to the central axis C2 decreases continuously or stepwise from the first end 650 to the second end 651 of said unit. Here, the physical footprint 652 is smaller than the physical footprint 653 which is more proximal to the first end 650, the physical footprint 653 in turn being smaller than the physical footprint 654 which is even more proximal to the first end 650. The illustrated footprints 652, 653, 654 may be cross-sectional areas which are determined in a plane perpendicular to the central axis C2. The footprints 652, 653, 654 may also be seen as the extension of the unit in a plane perpendicular to the central axis C2.

[01067] In embodiments where the unit comprises one or more bends or one or more angled sections, the physical footprint shall preferably decrease continuously or stepwise from the first end 650 to the second end 651 of the unit also along such bends or angled sections.

[01068] By decreasing the physical footprint along the central axis C2, removal of the device MD may be facilitated. In particular, the device 10 may more easily slide out of scar tissue which has formed around the implanted device MD.

[01069] The connecting portion MD-2 and the second portion MD” may be configured to reversibly connect to each other to form the unit. Such a connection may be a snap-fit connection, a magnetic type connection, a threaded connection, or a combination thereof, as described in other parts of the present disclosure. An irreversible connection between the connecting portion MD-2 and the second portion MD” is also possible. In this sense, the term “irreversible” shall be understood as a connection which cannot be disengaged without damage or irreversible damage. It is also possible that the connecting portion MD-2 and the second portion MD” are formed as a single body forming the unit. In such cases there are no seal or interface between the connecting portion MD-2 and the second portion MD”.

[01070] The unit here comprises an angled section forming a bend in the unit. The bend being about 90° as measured from the first end 650 to the second end 651. Hereby, a secure position is achieved, and a smaller vertical footprint, i.e. the space occupied by the device in a direction inwards to the center of the patient, may be achieved. The bend may be between 15° and 165°, such as between 30° and 150°, such as between 45° and 135°, such as substantially 90°.

POP RIVET II - ELECTRO SUBCUTANEOUS CONTROL

[01071] Referring now to Figs. 53A-53C, an implantable energized medical device which may incorporate one or several of the features described in conjunction with Figs. 1-52, and which may be referred to as a remote unit in other parts of the present disclosure, will be described.

[01072] The device MD is configured to be held in position by a tissue portion 610 of a patient. The device MD comprises a first portion MD’ configured to be placed on a first side 612 of the tissue portion 610, the first portion MD’ having a first cross-sectional area in a first plane and comprising a first surface configured to face and/or engage a first tissue surface of the first side 612 of the tissue portion 610. The device MD further comprises a second portion MD” configured to be placed on a second side 618 of the tissue portion 610, the second side 618 opposing the first side 612, the second portion MD” having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side 618 of the tissue portion 610. The device MD further comprises a connecting portion MD-2 configured to be placed through a hole in the tissue portion 610 extending between the first and second sides 612, 618 of the tissue portion 610. The connecting portion MD-2 is configured to connect the first portion MD’ to the second portion MD”.

[01073] The device MD further comprises a hermetic seal arrangement, which may cover the first portion MD’, the connecting portion MD-2 and the second portion MD”, as visualized by hermetic seal arrangement 656a. Such hermetic seal arrangement may for example be achieved by a housing made of a metal, such as titanium. The hermetic seal arrangement may also cover only the connecting portion MD-2 and the second portion MD”, as visualized by hermetic seal arrangement 656b. Such hermetic seal arrangement may be achieved by the flexible structure 655 being sealed with regard to the first portion MD’, and further wherein the flexible structure 655 is either joined with the second portion MD” in a sealing manner, or formed as an integral unit with the second portion MD”.

[01074] Any entry to the connecting portion MD-2 and/or the second portion MD”, may be achieved by means of a sealed entry (not shown). Such sealed entry can for example be achieved by a portion of an outside of connecting portion MD-2 and/or the second portion MD” comprising a ceramic portion integrated in, or brazed to, the material of the connecting portion MD-2 and/or the second portion MD” respectively. In such cases, the material of the connecting portion MD-2 and/or the second portion MD” is preferably a metal, such as titanium. At least one metallic lead or conduit may travel through the sealed entry for transferring energy, information or fluid respectively from an outside of the device MD, also known as the wet side, to an inside of the device MD. The at least one metallic lead may in turn be integrated in, or brazed to, the ceramic portion. Thus, the at least one metallic lead can pass the sealed entry without being further insulated, such that the sealed entry can enable the transfer of electrical energy, information, or fluid, through a wall of titanium and ceramics, such that the connecting portion MD-2 and/or the second portion MD” can be hermetically enclosed by the hermetical seal arrangement which reduces the risk of any fluid diffusing into the device MD, and in particular into the connecting portion MD-2 and/or the second portion MD”.

[01075] Here, the connecting portion MD-2 comprises a flexible structure 655 enabling the connecting portion MD-2 to flex. As can be seen in Fig. 53B, the connecting portion MD-2 may flex to accommodate for the thickness of the tissue portion 610, in this particular case the second portion MD” is flexing downwards and away from the first portion MD’. However, the flexible structure 655 may be configured to allow flexing in any and all directions. In some embodiments, the flexible structure 655 may be configured to allow roll, pitch, and/or upwards and downwards movement with regard to the first portion MD’ and/or second portion MD”. As can be seen in Fig. 53C, the connecting portion MD-2 may flex to accommodate for the thickness of the tissue portion 610, in this particular case the first portion MD’ is flexing downwards and towards the second portion MD”.

[01076] The flexible structure 655 here comprises a bellows, which may be annularly fixated by means of soldering or welding to the first portion MD’ and/or the second portion MD”. The bellows may be a metallic bellows, and more specifically may be a titanium bellows. The flexible structure 655 may thus be flexible by means of elasticity of the metal or the titanium. Metals are generally dense which is advantageous as fluids do not easily diffuse through the metal. This reduces the risk that gas or fluid diffuses into the device MD.

[01077] The bellows of the flexible structure 655 may assume a relaxed state, i.e. where the structure is not biased. In such relaxed state the flexible structure 655 may have a length LI as measured from the first portion MD’ to the second portion MD”. Once the flexible structure 655 is compressed, the length of the flexible structure 655 may decrease to a length L2. Conversely, if the flexible structure 655 is pulled, the length of the flexible structure 655 may increase to L3, being larger than both LI. Depending on the corrugated structure of the bellows, e.g. the dimensions of the corrugations and their frequency along the length of the bellows, different degrees of flexibility may be achieved.

[01078] The bellows comprise lowered portions and elevated portions. The lowered portions and elevated portions enable at least one of compression, expansion and flexing of the bellows. By compressing or expanding one side of the bellows, flexing of the first portion MD’ or second portion MD” may be achieved.

[01079] If the bellows is made from a metal, the metal may be welded to form the corrugations of the bellows. Furthermore, the bellows, or the flexible structure 655, may form part of the hermetic seal arrangement.

[01080] The flexible structure 655 may have a substantially cylindrical shape, as illustrated in Figs. 53A-53C. Such shape may provide for that flexing is available in all directions with little to no variation in resistance depending on the flexing direction.

[01081] Referring now to Figs. 54A-54D, an implantable energized medical device similar to the one described in conjunction with Figs. 53A-53C, and which may incorporate one or several of the features described in conjunction with Figs. 1-52, and which may be referred to as a remote unit in other parts of the present disclosure, will be described. In particular, it is shown how the device MD may be inserted into a hole 611 in a tissue portion 610 of a patient. [01082] Owing to the flexible structure 652 of the connecting portion MD-2, the first portion MD’ and second portion MD” can be separated to increase the distance between respective ends 657,659 of the first portion MD’ and second portion MD” . Hereby, the second portion MD” can be inserted into the hole 611 in the tissue portion 610 without being hindered by the first portion MD’ abutting the tissue portion 610, as shown in Fig. 54B. Once a sufficiently large portion of the second portion MD” has been inserted through the hole 611, the device MD can be rotated to achieve the desired position in the tissue portion 610.

[01083] Referring now to Figs. 55A-55F, an implantable energized medical device which may incorporate one or several of the features described in conjunction with Figs. 1-53C, and which may be referred to as a remote unit in other parts of the present disclosure, will be described. It should be noted that Figs. 55A-55F are schematic.

[01084] In each of the embodiments illustrated in Figs. 55A-55F, the device MD comprises a first portion MD’, a connecting portion MD-2, and a second portion MD”. The device MD is placed in a hole in a tissue portion 610. The device MD comprises an electric motor 661 wherein at least part of the electric motor is arranged within the connecting portion MD-2. The connecting portion MD-2 may be defined by an imaginary boundary 663 defined by the first surface 614 of the first portion MD’ extending through the connecting portion MD-2. Here, the imaginary boundary 663 lines up with the first side 612 of the tissue portion 610. The connecting portion MD-2 may be further defined by an imaginary boundary 667 defined by the second surface 620 of the second portion MD” extending through the connecting portion MD-2. Here, the imaginary boundary 667 lines up with the second side 618 of the tissue portion 610.

[01085] Furthermore, in each of the illustrated embodiments of Figs. 55A-55F, the electric motor 661 is preferably oriented such that its longest dimension aligns with a longest dimension of the device MD, in this case being a dimension extending from the first portion MD’ to the second portion MD” as indicated by the reference sign LD.

[01086] Referring first to Fig. 55A, the electric motor 661 is fully arranged within the connecting portion MD-2.

[01087] In Fig. 55B, the electric motor 661 is arranged such that it extends through the connecting portion into the first portion MD’, past the imaginary boundary 663, and such that it extends through the connecting portion into the second portion MD”, past the imaginary boundary 667. [01088] In Fig. 55C, the electric motor 661 is arranged such that it is contained within the imaginary boundary 663, in the connecting portion MD-2, and such that it extends through the connecting portion into the second portion MD”, past the imaginary boundary 667.

[01089] In Fig. 55D, a gear arrangement 669 is operatively connected to the electric motor 661. The gear arrangement may be located in the second portion MD” or the connecting portion MD-2. The electric motor 661 may extend into the second portion MD”, past the imaginary boundary 667, as illustrated, or it may be located within the connecting portion MD-2 within the imaginary boundary 667. The gear arrangement 669 is configured to transfer mechanical force from the electric motor to an implantable body engaging portion (not shown) being external to the device MD, or to an actuating element in e.g. a pump (not shown). The gear arrangement 669 may be a worm drive, as illustrated. The gear arrangement 669 may further be configured to transfer movement from the electrical motor 661 to a different plane or axis than what is provided by the electric motor 661 itself. In the illustrated embodiment, the gear arrangement 669 transfers movement from the electrical motor 661 to a new axis being substantially perpendicular to the axis provided by the electric motor 661.

[01090] In Fig. 55E, an embodiment similar to the one described in conjunction with Fig. 55D is shown. Here, a gear arrangement 669 is operatively connected to an electric motor 661. The electric motor 661 is arranged such that it is contained within the connecting portion MD-2, within the imaginary boundaries 663 and 667. However, the gear arrangement 669 is arranged in the second portion MD”.

[01091] In Fig. 55F, a gear arrangement 669 is operatively connected to the electric motor 661. The gear arrangement 669 as well as the electric motor 661 is arranged such that they are contained within the connecting portion MD-2, within the imaginary boundaries 663, 667.

[01092] Without reference to any particular figure, it is herein further disclosed that the implantable energized medical device MD may comprise the first portion configured to be placed on a first side of the tissue portion, the first portion comprising a first surface configured to face a first tissue surface of the first side of the tissue portion, the first portion being further configured to connect, directly or indirectly, to a second portion, as disclosed in other parts of the present disclosure, placed on a second side of the tissue portion opposing the first side, wherein the first portion comprises an internal wireless energy transmitter configured to transmit energy wirelessly to the second portion. Such first portion may be configured to connect to the second portion via a connecting portion as disclosed in other parts of the present disclosure. The connecting portion may form part of such device MD, and may be integrally formed with the first portion, or may be a separate component with regard to the first portion, wherein the connecting portion is configured to connect to the first portion. In other words, one embodiment of the device MD may consist of the first portion only, omitting the second portion and optionally omitting the connecting portion.

[01093] Fig. 56 shows a cross-sectional view of an implantable energized medical device, which may incorporate one or several of the features described in conjunction with Figs. 1-55F, and which may be referred to as a remote unit in other parts of the present disclosure.

[01094] The second portion MD” of the device MD comprises or forms a reservoir 671 for holding a fluid, and device MD further comprises a sealed container C configured to protrude into the reservoir 671. An actuator A is connected to the sealed container C, the actuator A being configured to expand or retract the sealed container C to change the volume of the sealed container C for pumping fluid to or from the reservoir 671.

[01095] The reservoir 671 is configured to hold the fluid to be pumped. The fluid is preferably a biocompatible incompressible liquid, such as a saline solution, but could in the alternative be an oilbased liquid, such as a silicone oil, or a gas. The sealed container C is configured to protrude into the reservoir 671, such that a wall of the sealed container forms a portion of a wall enclosing the reservoir 671. The sealed container C comprises a first movable wall portion 672 forming a portion of the wall of the reservoir 671. The movable wall portion 672 being a portion of the sealed container C protruding into the reservoir 671. The actuator A is directly or indirectly connected to the first movable wall portion 672, for moving the movable wall portion 672, for altering a volume of the sealed container C and a volume of the reservoir 671, for pumping the fluid to or from the reservoir 671.

[01096] The sealed container C may comprise a first portion (as shown) and a second portion (not shown), where movement of the first movable wall portion 672 causes movement of a second movable wall portion, altering a volume of the second portion of the sealed container C, such that the volume change of the sealed container C is less than the volume change of the reservoir 671, when the volume of the reservoir 671 is altered for pumping fluid to or from the reservoir 671. When the volume of the reservoir 671 is reduced and expanded, the reservoir 671 functions as a pump for moving fluid to and from a body engaging portion, i.e. an additional implant in the patient’s body

[01097] The first and second portions of the sealed container may be mirrored and identical, and as such, in a relaxed state, have the same volume. The pressure in the sealed container remains substantially the same all the time as the volume of the sealed container C remains substantially the same when the volume of the reservoir 671 is altered for pumping fluid to or from the reservoir 671.

[01098] In the embodiment shown in Fig. 56, the sealed container C is annular, and the center of the sealed container C is annularly fixated to outer portions of the reservoir 671. As the actuator moves the first movable wall portion 672 causing the sealed container C to expand, a second movable wall portion, if present, moves the same distance, contracting the second portion of the sealed container C, such that the volume in the sealed container remains the same when the volume of the reservoir 671 is altered for pumping fluid to or from the reservoir 671. The sealed container C is substantially rigid in directions other than the length extension LE of the sealed container C, such that the diameter of the sealed container is substantially constant and the volume of the sealed container only changes as a result of the first and second movable wall portions moving in the direction of the length extension of the sealed container C.

[01099] In the embodiment shown in Fig. 56, the sealed container C comprises a titanium bellows, and the titanium bellows is annularly fixated by means of soldering or welding to the to reservoir or second portion MD”.

[01100] In the embodiment shown in Fig. 56, the volume of the sealed container C is altered less than 10% when the volume of the reservoir is altered for pumping fluid to or from the reservoir 671. In particular, the volume of the sealed container C may be altered less than 5% when the volume of the reservoir 671 is altered for pumping fluid to or from the reservoir 671.

[01101] In the embodiment shown in Fig. 56, the walls of the sealed container C comprises lowered portions and elevated portions. The lowered portions and elevated portions enable at least one of compression and expansion of the sealed container C. In particular, in the embodiment shown in Fig. 56 the sealed container C comprises a bellows enabling the contraction and expansion of the sealed container C, by means of the elasticity of the bellows making the bellows flexible. In particular, in the embodiment shown in Fig. 56, the bellows is a metal bellows, in particular a titanium bellows. The sealed container C in the form of a titanium bellows is thus flexible by means of the elasticity of the titanium.

[Oi l 02] As the sealed container C is a titanium bellows 452, at least a portion of the first movable wall portion 672 being in contact with the fluid in the reservoir 671 comprises metal, namely the titanium. Metals are generally dense which is advantageous as fluids do not diffuse through the metal as easy. This reduces the risk that gas diffuses from the sealed container C or that fluids diffuse into the sealed container C. In the embodiment shown in Fig. 56, the entire wall enclosing the sealed container C is made from metal, in particular titanium. In alternative embodiments it is however conceivable that a portion of the wall of the sealed container C is made from a flexible or elastic polymer material, such as a silicone -based material or a polyurethane -based material. In embodiments in which the sealed container has a wall made from composite of metallic or non-metallic materials, the non-metallic materials could be provided as a layer or a coating applied or sprayed onto the metal. In some embodiments, at least 50% of the area of the wall enclosing the sealed container C comprises metal and in alternative embodiments at least 80% of the area of the wall enclosing the sealed container C comprises metal, and in yet alternative embodiments, at least 90% of the area of the wall enclosing the sealed container C comprises metal.

[01103] The sealed container C may be configured to enclose a gas, such as helium or air. More specifically, the sealed container C may be configured to enclose a gas having a pressure exceeding standard atmospheric pressure (atm), i.e. 101,325 Pa. The sealed container C in the embodiment of Fig. 56 is hermetically enclosed by a metallic layer such that the gas enclosed in the sealed container C is hermetically enclosed by a metallic layer.

[01104] The device MD may further comprise a fluid conduit 673 for connecting the reservoir 671 to a body engaging portion 676 of an implant configured for receiving the fluid pumped from the reservoir 671. The body engaging portion 676 is here an implantable constriction device in a state in which the implantable constriction device is constricting a luminary organ U and thereby restricts the flow of fluid through the luminary organ U. The implantable constriction device comprises a surrounding structure 677 having a periphery surrounding the luminary organ U when implanted. The surrounding structure 677 comprises two support elements 678a, 678b connected to each other for forming the surrounding structure 677. The first support element 678a is configured to support a first operable hydraulic constriction element 679. The first operable hydraulic constriction element 679 is configured to constrict the luminary organ U for restricting the flow of fluid therethrough and configured to release the constriction of the luminary organ U upon request. The first and second support elements 678a, 678b each comprises a curvature adapted for the curvature of the luminary organ U such that the implantable constriction device fits snuggly around the luminary organ U such that the distance that the operable hydraulic constriction elements 679 needs to expand to constrict the luminary organ U is kept at a minimum.

[01105] All foreign matter implanted into the human body inevitably causes an inflammatory response. In short, the process starts with the implanted medical device immediately and spontaneously acquiring a layer of host proteins. The blood protein -modified surface enables cells to attach to the surface enabling monocytes and macrophages to interact on the surface of the medical implant. The macrophages secrete proteins that modulate fibrosis and in turn developing the fibrosis capsule around the foreign body. In practice, a fibrosis capsule is a dense layer of excess fibrous connective tissue. On a medical device implanted in the abdomen, the fibrotic capsule typically grows to a thickness of about 0,5mm - 2mm, and is substantially inelastic and dense.

[01106] Fluid is conducted from the reservoir 671 to the operable hydraulic constriction element 679 such that the implantable constriction device constricts the luminary organ U and thereby restricts a flow of fluid through the luminary organ U. As a first portion of the sealed container C is expanded and the second portion of the sealed container, if present, is compressed, the volume of the sealed container C remains the same throughout the shift, and as such, the actuator A does not need to work against a changing pressure in the sealed container C. The volume of the reservoir 671 when the sealed container C is in its most expanded state may be less than 50% of the volume of the reservoir 671 when the sealed container C is in its most compressed state.

[01107] The actuator A may comprise an electrical motor M configured to convert electrical energy to a rotating mechanical force. The motor M may be connected to a transmission configured to receive mechanical force and reduce the speed and increase the force of the received mechanical force. In the embodiment of Fig. 56, the transmission is in the form of a gear arrangement G configured to increase the torque of the mechanical force created by the electrical motor M and to deliver a force with a higher torque. Consequently, low torque may be provided by the motor M, i.e. a relatively small force with high angular velocity, which is transferred to the gear arrangement G to achieve a relatively large force with low angular velocity. The gear arrangement is in turn connected to a further transmission configured to transform the received rotating mechanical force into a liner mechanical force. The further transmission comprises a shaft 674 connected to the force output of the gear arrangement G. The shaft comprises outer threads 674t adapted to engage inner threads of a nut portion 675 in the form of a hollow shaft having inner threads, such that the interaction between the threaded shaft 674, 674t and the threaded inner portion of the nut portion 675 transforms the radially rotating force generated by the motor M and the gear system G, to a linear force acting in the axial direction of the shaft 674. The nut portion 675 is fixated to, or integrated with, the first movable wall portion 672 of the sealed container C.

[01108] The sealed container C may further comprise a first and a second connecting member for connecting the first movable wall portion 672 to the second movable wall portion (not shown), such that the second movable wall portion moves in synchronization with the first movable wall portion 672, as the operation device operates the first movable wall portion 672. The first and second connecting members could be metal rods, such as titanium rods welded or soldered to the inner surfaces of the first and second movable wall portions respectively.

[01109] The actuator A is further arranged within the sealed container C, thus being protected from fluids in the reservoir 671 by means of the hermetic property of the sealed container C.

[01110] The reservoir 671 may have an oval cross-section, more specifically an elliptic crosssection, and even more specifically a circular cross-section. Having a circular cross-section enables the reservoir 671 to have the same cross-sectional shape as the sealed container C, which may also have an oval cross-section, more specifically an elliptic cross-section, and even more specifically a circular cross-section, which means that the distance between the wall of the bellows of the sealed container C can be made really small for reducing the space occupied by the device MD in the body of the patient.

[01111] The sealed container C may further comprise a sealed entry in the form of a portion of the wall of the sealed container C comprising a ceramic portion integrated in, or brazed to, the metal or titanium of the sealed container C. At least one metallic lead may travel through the sealed entry for transferring electrical energy or information from within the sealed container C to the environment outside the sealed container C, also known as the wet side. The at least one metallic lead may in turn be integrated in, or brazed to, the ceramic portion. Thus, the at least one metallic lead can pass the sealed entry without being further insulated, such that the sealed entry can enable the transfer of electrical energy or information through a wall of titanium and ceramics, such that the sealed container C can be hermetically enclosed by titanium and ceramics which reduces the risk of any fluid diffusing into the sealed container C.

[Oi l 12] As shown in Fig. 56, the device MD may further comprise an injection port 681 configured to receive a needle or other means for transferring fluid to or from the device MD, in particular to or from the reservoir 671. The injection port 681 is connected to an internal conduit 682 which is fluidly connected to the reservoir 671 via a port 683. The injection port 681 may comprise a membrane configured to form a seal around the needle or other means for transferring fluid when penetrated.

[Oi l 13] Referring now to Figs. 57A-57N and 57P-57Q, embodiments of a system comprising an implantable energized medical device, which may incorporate one or several of the features described in conjunction with Figs. 1-56, and which may be referred to as a remote unit in other parts of the present disclosure.

[Oi l 14] Each system depicted in Figs. 57A-57P comprises an implantable energized medical device MD configured to be held in position by a tissue portion 610 of a patient, the device MD comprising: a first portion MD’, a second portion MD”, and a connecting portion MD-2, as described elsewhere in the present disclosure. The system may further comprise at least one of the following components: an implantable energy storage unit 304, an implantable reservoir 107 configured to hold a fluid, a body engaging implant 676 configured to at least one of stretch, contract, expand, stimulate and exert a force on body tissue or a body organ, an implantable pump 106 configured to transfer fluid to and from the implantable reservoir and the body engaging implant respectively via a conduit, and an implantable electric motor 661 connected to the implantable energy storage unit 304, the implantable electric motor 661 being configured to operate the implantable pump 106. The embodiments differ mainly in the arrangement and location of the components, in particular whether the components are arranged within the device, i.e. in the first portion MD’, connecting portion MD-2 and/or second portion MD”, or whether they are arranged external to the device, i.e. outside of the first portion MD’, connecting portion MD-2 and/or second portion MD”.

[01115] As illustrated, the implantable pump 106 may be connected to the implantable reservoir 107 via a fluid conduit.

[01116] The expression “arranged externally” shall in this context be understood as a component being configured to be located outside of the device MD. Furthermore, such component may be configured to be implanted in a location in the patient’s body which is remote to the location of the implanted device MD.

[01117] Furthermore, each system comprises an internal component 685 arranged in the device MD, wherein the internal component 685 may have capabilities of at least one of receiving wireless energy, transmitting wireless energy, receiving communication signals, and transmitting communication signals. The internal component 685, although here illustrated as a single unit, may comprise several units.

[01118] The illustrated embodiments are purely schematic, and lines connecting components may symbolize one or several metallic leads for transferring energy and/or for transferring communication signals (such may be the case for lines between the implantable energy storage unit 304 and the implantable electric motor 661). They may also symbolize a shaft or magnetic coupling configured to transfer force or movement (such may be the case for lines between the implantable electric motor 661 and the implantable pump 106). It shall also be noted that the lines connecting components does not necessarily imply that the components are physical separated and connected by e.g. metallic leads or shafts. They may instead simply be seen as an indication that the components are connected electrically or mechanically. For example, in the case of the implantable electric motor 661 and the implantable pump 106, these two components, although illustrated as being separate and connected by a line, may form part of a single unit which integrates the implantable electric motor 661 with the implantable pump 106 to achieve the functionality of a pump. Furthermore, the implantable pump 106 may form part of the implantable reservoir 107, and in particular the implantable pump 106 may be arranged at least partly inside or in connection with the implantable reservoir 107.

[01119] Furthermore, the location of the components in relation to the device MD, internally and externally, as well as the length of the illustrated lines and conduits, shall not be seen as limited by the illustrated embodiments. In contrast, for example, the length of lines and conduits may be shorter or longer than depicted. Similarly, illustrated components may be located closer to or further away from each other, and/or closer to or further away from the device MD, and/or in other locations or portions of the device MD. Furthermore, the entrance and exit of lines or conduits with regard to the device MD are schematic and only exemplary. [01120] Furthermore, although not shown in the illustrated embodiments, a conduit in fluid connection with the reservoir may be arranged internally and/or externally to the device MD for introducing and/or removing fluid from the reservoir. The conduit may be connected to an injection port in the device MD.

[01121] A gear arrangement may be included in the system, preferably arranged in proximity of the electric motor 661. The gear arrangement, if present, is operatively connected to the electric motor and configured to reduce the velocity and increase the force of movement generated by the electric motor 661. Thus, if the electric motor 661 is arranged externally with the regard to the device MD, the gear arrangement may be arranged externally as well, or internally, i.e. within the device MD, and vice versa.

[01122] An advantage of having one or more components externally arranged to the device MD is that load distribution may be improved. This is particularly important since one of the objects of the device MD is to achieve and maintain a secure placement in the patient’s body. By distributing weight to other parts of the patient’s body, the risk of detachment of the device MD from its implanted position may be decreased. Furthermore, it may be advantageous to distribute heat generation from one or more of the components to particular parts or regions or several parts or regions of the patient’s body.

[01123] Referring first to Fig. 57A, the system comprises, externally arranged with regard to the device MD, an implantable energy storage unit 304, an implantable electric motor 661, an implantable reservoir 107, and an implantable pump 106.

[01124] Referring now to Fig. 57B, the system comprises, externally arranged with regard to the device MD, an implantable electric motor 661, an implantable reservoir 107, and an implantable pump 106. Furthermore, the system comprises an implantable energy storage unit 304 arranged in the device MD.

[01125] Referring now to Fig. 57C, the system comprises, externally arranged with regard to the device MD, an implantable energy storage unit 304, an implantable reservoir 107, and an implantable pump 106. Furthermore, the system comprises an implantable electric motor 661 arranged in the device MD.

[01126] Referring now to Fig. 57D, the system comprises, externally arranged with regard to the device MD, an implantable energy storage unit 304, an implantable electric motor 661, and an implantable pump 106. Furthermore, the system comprises an implantable reservoir 107 arranged in the device MD. [01127] Referring now to Fig. 57E, the system comprises, externally arranged with regard to the device MD, an implantable energy storage unit 304, an implantable electric motor 661, and an implantable reservoir 107. Furthermore, the system comprises an implantable pump 106 arranged in the device 106.

[01128] Referring now to Fig. 57F, the system comprises, externally arranged with regard to the device MD, an implantable energy storage unit 304 and an implantable electric motor 661. It should be noted that this embodiment does not necessarily comprise an implantable reservoir 107 nor an implantable pump 106. The implantable electric motor 661 is here operatively connected to the body engaging implant 676.

[01129] Referring now to Fig. 57G, the system comprises, externally arranged with regard to the device MD, an implantable reservoir 107 and an implantable pump 106. Furthermore, the system comprises an implantable energy storage unit 304 and an implantable electric motor 661, arranged in the device 106.

[01130] Referring now to Fig. 57H, the system comprises, externally arranged with regard to the device MD, an implantable energy storage unit 304 and an implantable pump 106. Furthermore, the system comprises an implantable electric motor 661 and an implantable reservoir 107, arranged in the device MD.

[01131] Referring now to Fig. 571, the system comprises, externally arranged with regard to the device MD, an implantable energy storage unit 304 and an implantable electric motor 661. Furthermore, the system comprises an implantable reservoir 107 and an implantable pump 106, arranged in the device MD.

[01132] Referring now to Fig. 57J, the system comprises, externally arranged with regard to the device MD, an implantable electric motor 661 and an implantable reservoir 107. Furthermore, the system comprises an implantable energy storage unit 304 and an implantable pump 106, arranged in the device MD.

[01133] Referring now to Fig. 57K, the system comprises, externally arranged with regard to the device MD, an implantable energy storage unit 304. Furthermore, the system comprises an implantable electric motor 661 arranged in the device MD. It should be noted that this embodiment does not necessarily comprise an implantable reservoir 107 nor an implantable pump 106. The implantable electric motor 661 is here operatively connected to the body engaging implant 676.

[01134] Referring now to Fig. 57L, the system comprises, externally arranged with regard to the device MD, an implantable pump 106. The system further comprises an implantable energy storage unit 304, an implantable electric motor 661, and an implantable reservoir 107, arranged in the device MD.

[01135] Referring now to Fig. 57M, the system comprises, externally arranged with regard to the device MD, an implantable energy storage unit 304. The system further comprises an implantable pump 106, an implantable electric motor 661, and an implantable reservoir 107, arranged in the device MD.

[01136] Referring now to Fig. 57N, the system comprises, externally arranged with regard to the device MD, an implantable electric motor 661. The system further comprises an implantable energy storage unit 304, an implantable pump 106, and an implantable reservoir 107, arranged in the device MD.

[01137] Referring now to Fig. 57P, the system comprises, externally arranged with regard to the device MD, an implantable reservoir 107. The system further comprises an implantable energy storage unit 304, an implantable electric motor 661, an implantable pump 106, arranged in the device MD.

[01138] Referring now to Fig. 57Q, the system comprises, externally arranged with regard to the device MD, and an implantable electric motor 661. Furthermore, the system comprises an implantable energy storage unit 304 arranged in the device MD. It should be noted that this embodiment does not necessarily comprise an implantable reservoir 107 nor an implantable pump 106. The implantable electric motor 661 is here operatively connected to the body engaging implant 676.

[01139] Referring now to Fig. 58A, an implantable energized medical device which may incorporate one or several of the features described in conjunction with Figs. 1-57Q, and which may be referred to as a remote unit in other parts of the present disclosure, will be described. The device MD is configured to be held in position by a tissue portion of a patient. The device MD comprises a first portion MD’ configured to be placed on a first side of the tissue portion, the first portion MD’ having a first cross-sectional area in a first plane and comprising a first surface configured to face and/or engage a first tissue surface of the first side of the tissue portion. The device MD further comprises a second portion MD” configured to be placed on a second side of the tissue portion, the second side opposing the first side, the second portion MD” having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion. The device MD further comprises a connecting portion MD-2 configured to be placed through a hole in the tissue portion extending between the first and second sides of the tissue portion. The connecting portion MD-2 is configured to connect the first portion MD’ to the second portion MD”. [01140] The device MD here comprises an internal component 685 arranged in the device MD, wherein the internal component 685 may have capabilities of at least one of receiving wireless energy, transmitting wireless energy, receiving communication signals, and transmitting communication signals. The internal component 685, although here illustrated as a single unit, may comprise several units.

[01141] The second portion MD” is here hermetically sealed by means of an outer wall 686 of the second portion comprising a metal, such as titanium. The second portion MD” may further comprise an internal component 684 having capabilities of at least one of receiving wireless energy, receiving wired energy, receiving communication signals, and transmitting communication signals. Such internal component 684 may comprise an electric motor, a pump, or the like.

[01142] An outer wall of the first portion MD’ may comprise or consist of a polymer material.

Accordingly, fluid will likely be able to permeate through the outer wall of the first portion MD’ over time when the device MD is implanted. In order to protect components of the second portion MD”, a hermetic seal is formed with respect to the connecting portion MD-2 and with respect to the first portion MD’.

[01143] Furthermore, in order to achieve wired communication or energy transfer between the second portion MD’ ’ and the connecting portion MD-2, the outer wall 686 of the second portion MD” may comprise a ceramic portion 687 integrated in, or brazed to, the outer wall 686. The ceramic portion 687 may in turn comprise at least one metallic lead 691 travelling through the ceramic portion 687 for transferring electrical energy or information from within the second portion MD” to an outside of the second portion MD” and/or from the outside of the second portion MD”, such as from the connecting portion MD-2, to an inside of the second portion MD”. The outside of the second portion MD”, being outside of the hermetic seal, is commonly referred to as the “wet” side. The at least one metallic lead 691 may in turn be integrated in, or brazed to, the ceramic portion 687, such that the at least one metallic lead 687 can pass the ceramic portion 687 without being further insulated.

[01144] Similarly, the connecting portion MD-2 may comprise an outer wall comprising a metal, such as titanium. Such outer wall of the connecting portion MD-2 may form a hermetic seal. Furthermore, the outer wall of the connecting portion MD-2 may comprise a ceramic portion integrated in, or brazed to, the titanium (not shown). At least one metallic lead may travel through the ceramic portion for transferring electrical energy or information from within the connecting portion to an outside of the connecting portion and/or from the outside of the connecting portion to an inside of the connecting portion. The least one metallic lead may be integrated in, or brazed to, the ceramic portion of the connecting portion, such that the at least one metallic lead can pass said ceramic portion without being further insulated. [01145] The at least one metallic lead 691 may connect, or extend to form, an internal lead 698. Such internal lead 698 may be connected to the internal component 684, as illustrated.

[01146] Accordingly, when the connecting portion MD-2 and the second portion MD” engage, the at least one metallic lead 691 will engage with a corresponding metallic lead 647 of the connecting portion to form a connection for transferring wired energy and/or wired communication signals.

Owing to the integrated ceramic portion 687, the transfer of such wired energy and/or wired communication signals can be achieved through the boundary of the second portion MD” without breaking the hermetic seal.

[01147] Referring now to Fig. 58B, a device MD similar to the one described in conjunction with Fig. 58A is illustrated. However, here, no ceramic port is necessary since the internal component 685 located in the first portion MD’ and the internal component 684 located in the second portion MD” are configured to transmit and/or receive wireless energy and/or wireless communication signals. Thus, the outer wall 686 of the second portion MD”, forming a hermetic seal, need not be penetrated.

[01148] Referring now to Figs. 59A and 59B, an implantable energized medical device which may incorporate one or several of the features described in conjunction with Figs. 1-58B, and which may be referred to as a remote unit in other parts of the present disclosure, will be described.

[01149] The device MD is configured to be held in position by a tissue portion 610 of a patient. The device MD comprises a first portion MD’ configured to be placed on a first side of the tissue portion 610, the first portion MD’ having a first cross-sectional area in a first plane and comprising a first surface configured to face and/or engage a first tissue surface of the first side of the tissue portion 610. The device MD further comprises a second portion MD” configured to be placed on a second side of the tissue portion 610, the second side opposing the first side, the second portion MD” having a second cross-sectional area in a second plane and comprising a second surface configured to engage a second tissue surface of the second side of the tissue portion 610. The device MD further comprises a connecting portion MD-2 configured to be placed through a hole in the tissue portion 610 extending between the first and second sides of the tissue portion. The connecting portion MD-2 is configured to connect the first portion MD’ to the second portion MD”.

[01150] As illustrated in Fig. 59A, the first portion MD’ is configured to be placed subcutaneously, which is also evident from its implanted position relative to the surface of the skin 699 of the patient.

[01151] Furthermore, the first portion may comprise a connecting interface arrangement 641 configured to transfer wired energy and/or wired communication signals and/or fluid to an additional implant in the patient. The connecting interface arrangement 641 is here illustrated as a single unit, it is however to be understood that the connecting interface arrangement 641 may include one or several connecting interface units at different locations on the device MD. In particular, a connecting interface for fluid may require a separate connecting interface unit, or port, and a connecting interface for wired energy or communication signals may require another separate connecting interface unit.

[01152] A lead, wire or fluid conduit 643 may form part of the device MD. Such components may also form part of a system which includes the device MD. The lead or wire 643 is configured to connect to the connecting interface arrangement 641 for transferring wired energy and/or wired communication signals. Similarly, the fluid conduit 643 is configured to connect to the connecting interface arrangement 641 for transferring fluid to and from the device MD and a body engaging implant implanted in another part of the patient’s body (not shown), and/or a reservoir implanted in another part of the patient’s body (not shown), and/or a pump implanted in another part of the patient’s body (not shown).

[01153] By flipping the device MD so that the first portion MD’ and the second portion MD” switch places, i.e. so that the second portion MD” is instead located closest to the surface of the skin 699, a wire, lead and/or fluid conduit 643 may run below the tissue portion 610 as opposed to above the tissue portion 610. Whether to run a lead, wire or fluid conduit below the tissue portion 610 or above the tissue portion 610 may be chosen depending on where the lead, wire or fluid conduit shall connect to an additional implant, where such additional implant is located, and/or how such additional implant is implanted. Thus, both the first portion MD’ and the second portion MD” may be configured to be placed subcutaneously, i.e. closest to the surface of the skin 699 relative to the tissue portion 610, such that the device MD can be placed with either of the first portion MD’ and the second portion MD” on side of the tissue portion 610 being closest to the surface of the skin 699.

[01154] The connecting interface arrangement 641 may alternatively or additionally be arranged at the second portion MD”, as shown in Fig. 59B. Thus, a lead, wire or fluid conduit may run above the tissue portion 610 even when the first portion portion MD’ is implanted below the tissue portion 610. Similarly, by flipping the device MD as shown in Fig 59B, the first portion MD’ will be located above the tissue portion 610 and closest to the surface of the skin 699, and the second portion MD” will be located below the tissue portion. Thus, a lead, wire or fluid conduit may run below the tissue portion 610 in this configuration.

[01155] The terms “above” and “below” in this context shall be understood as directional references where closer to the surface of the skin is “higher” or “above”, and further towards the center of the patient is “lower” or “below”. [01156] A height Hl of the first portion MD’ may be 15 mm or less, such as 10 mm or less, such as 7 mm or less, such as 5 mm or less. The height Hl may be a maximum height of the first portion MD’, i.e. the height Hl may be defined as the height at the location where the first portion MD’ has the largest height. Likewise, a height H2 of the second portion MD” may be 15 mm or less, such as 10 mm or less, such as 7 mm or less, such as 5 mm or less. The height H2 may be a maximum height of the second portion MD”, i.e. the height H2 may be defined as the height at the location where the first portion MD” has the largest height.

[01157] A length LI of the first portion MD’ and a length L2 of the second portion MD” may differ no more than 30%, such as no more than 15%, such as no more than 5%, such as no more than 1%, such as wherein the length LI of the first portion MD’ and the length L2 of the second portion MD” are substantially equal, as illustrated.

[01158] Similarly, a width (not shown, measured in a direction extending inwards or outwards of the illustrated plane) W1 of the first portion MD’ and a width W2 of the second portion MD” may differ no more than 30%, such as no more than 15%, such as no more than 5%, such as no more than 1%, such as wherein the width W1 of the first portion MD’ and the width W2 of the second portion MD” are substantially equal.

[01159] Similarly, a height Hl of the first portion MD’ and a height H2 of the second portion MD” may differ no more than 30%, such as no more than 15%, such as no more than 5%, such as no more than 1%, such as wherein the height Hl of the first portion MD’ and the height H2 of the second portion MD” are substantially equal, as illustrated.

INCLINED NEEDLE

[01160] Fig. 60A illustrates schematically a variant of the overall system according to the first general aspect as shown in Fig. 3, as will be explained further hereinafter, i.e. in relation to a system in which the infusion needle is laterally moved between successive injection cycles. However, the following teaching regarding this variant is analogously applicable to the overall system according to the second general aspect as shown in Fig. 4 where a plurality of infusion needles is provided which are not laterally movable. The following teaching is even applicable to corresponding systems with only one infusion needle that is not laterally movable at all, i.e. with only a single injection sisite. According to this variant, the infusion needle 11 does not extend vertically from the housing 12 but is inclined at an angle a relative to the outer wall of the housing or, more specifically, relative to the outer surface of the housing’s outer wall.

[01161] This is shown in more detail in Fig. 61, where the outer wall of the housing 12 is formed from the penetration area 14. The penetration area 14 has an outer surface 14A forming the outer surface of the outer wall of the housing 12, and such outer surface extends in a first direction (in Fig. 61 in the plane of the drawing from left to right or right to left). The configuration is such that a longitudinal vessel V, such as a vein or an artery, can be placed adjacent to said outer surface so that its central axis Av extends in parallel to the outer surface 14A, more specifically in parallel to the first direction into which the outer surface 14A extends. By arranging the infusion needle 11 in the plane defined by the extending direction of the outer surface 14A (said first direction) and central axis Av of the longitudinal vessel V, the advancing and retraction directions of the infusion needle are inclined relative to the central axis Av of the vessel V and, thus, secure piercing of the vessel V by the needle 11 can be improved as the danger of piercing all the way through and out of the rear wall of the vessel V is reduced.

[01162] As can be seen in Fig. 60A, a holder 20 is arranged below the penetration area 14 and configured to hold the vessel V in position when the infusion needle 11 is being advanced to extend from the penetration area 14 into the vessel V. The holder 20 is configured to hold the vessel V in a position in which the central axis Av thereof extends in parallel to the above-mentioned direction of extension of the outer surface 14A (said first direction).

[01163] In one embodiment (not shown) the holder 20 may be open on its front side or rear side so that the vessel V can be pushed sideways into the holder 20. However, in the embodiment shown in Fig. 60A, the holder 20 comprises a moveable lid 21 which is configured so as to open and close the holder 20 for placing and holding a section of the vessel V inside the holder 20. This way, the vessel V is held about its entire circumference. In Fig. 60A, the lid 21 is arranged on the lower side of the holder 20 and is moveable about a rotational axis so as to open and close the holder. Alternatively, the lid 21 may be arranged on the front side or rear side of the holder 20. There may be provided a snap fit to hold the lid 21 in its closed position. The hinge about which the lid 21 is swivable may be realized as a film hinge or any other type of hinge. Furthermore, instead of being swivable about the rotational axis, the movable lid 21 may be completely removable from the holder 20. The height of the holder 20 should be slightly smaller than the diameter of the vessel V to be held, whereas the width of the holder 20 should be somewhat larger than this so that the vessel has sufficient space inside the holder 20 but is in contact with the outer surface of the housing 12.

[01164] Fig. 60B illustrates the variant of Fig. 60A with a curved surface 12A of the housing 12. The curved surface reduces the risk that the infusion needle 11, after penetrating a wall of a vessel arranged along the curved surface 12A, further penetrates the opposite wall of the vessel upon further advancement of the infusion needle 11. This becomes clearer in context with an embodiment in which, different to what is shown in Fig. 60B, the infusion needle is not laterally movable. In that case, to which this variant is applicable as well, the tip end of the infusion needle 11 may enter into the vessel just about where the outer surface of the housing 12 enters into the curved surface 12A and whereafter the outer surface of the housing 12 further extends in about the angled direction of the inclined infusion needle 11.

[01165] Fig. 60C illustrates the variant of Fig. 60A with a plurality of infusion needles. Thus, while Fig. 60A illustrates an embodiment with a laterally movable infusion needle 11, the embodiment shown in Fig. 60C has a plurality of infusion needles 11 arranged side by side so that an injection site can be changed by injecting the substance through a respective one of the plurality of infusion needles 11. More specifically, the embodiment shown in Fig. 60C has a curved surface 12A similar to the embodiment of Fig. 60B, but it may likewise have a straight outer surface of the housing 12 as shown in Fig. 60A.

[01166] Fig. 60D illustrates the variant of Fig. 60A with a curved needle. Here, the curved needle is arranged such that its tip end 11C penetrates the penetration area 14 at an angle a. The infusion needle 11 has a radius of curvature r and is rotatable about an axis of rotation 1 IE. In order to rotate the infusion needle 11 about the axis of rotation 1 IE, it is preferably mounted to a needle arm 1 IF which, in turn, is rotatable about the axis of rotation 1 IE. This way, upon rotating the infusion needle 11 about the axis of rotation 1 IE, the tip end 11C pierces through the penetration area 14 at the angle a and further pierces a vessel arranged next to the penetration area 14 at an angle which is somewhat smaller than the angle a, and such angle becomes smaller and smaller upon further advancement of the infusion needle 11.

[01167] Preferably, the curved infusion needle 11 is laterally displaceable, as indicated by a horizontal arrow in Fig. 60D, so as to change the injection site. Such lateral displacement is in a direction perpendicular to the axis of rotation 1 IE. Alternatively or additionally, the needle may be laterally displaceable in a different direction, in particular in a direction parallel to the axis of rotationl IE. However, the principle as described in relation to Fig. 60D is likewise applicable in embodiments in which the infusion needle 11 is not laterally displaceable.

[01168] Fig. 60E illustrates the variant of Fig. 60A with a curved surface 12A of the housing 12 and a curved infusion needle 11. Thus, this embodiment basically corresponds to the embodiment of Fig. 60D except that the outer surface of the housing 12 has a curved surface 12A. The curved surface 12A is curved in a direction which reduces the risk that the tip end 11C of the infusion needle 11, after entering through a vessel wall, pierces through the opposite vessel wall upon further advancement of the infusion needle 11. In other words, the curved surface 12A is curved in about the same direction as the infusion needle 11.

SHORT DISTANCE OF NEEDLE INJECTION PORT [01169] Figs. 62A and 62B show a front portion of the infusion needle shown in Fig. 61 in a top view and a cross-sectional side view respectively. While the tip of the needle 11 is designed as a beveled tip with the tip end being offset of the needle’s central axis 1 IB, the design and arrangement of the needle’s injection port 11A is equally suitable for infusion needles having a pointed tip with the tip end e. g. lying on the central axis 1 IB of the infusion needle 11. More specifically, the injection port 11A is arranged close to the tip end 11C of the infusion needle 11 at a distance “a” which is less than 2 mm, preferably less than 1 mm and most preferably between 0.5 and 1 mm. The distance “a” is measured from the tip end 11C to the point of the wall of the injection port 11A which is closest to the tip end 11C, as shown in Fig. 62A. The closer the injection port 11A is relative to the tip end 11C, the higher is the chance that the injection port comes to he inside the vessel V without the infusion needle 11 piercing all the way through the vessel V. In this regard, it is further advantageous to keep the size of the injection port 11A small, at least in respect of its extension in the longitudinal direction of the infusion needle 11. More specifically, the cross-sectional extension of the injection port 11 A in the longitudinal direction of the infusion needle 11 should not be more than 0.5 mm.

[01170] More preferably, the injection port 11A has a larger extension “b” in a direction transverse to the longitudinal direction of the infusion needle 11 as compared to its extension “c” in the longitudinal direction of the infusion needle 11. For instance, the injection port 11A may have a rectangular or an oval cross section, as shown in Fig. 62A. This way, the cross-sectional area of the injection port 11A can be increased without compromising its short dimension in the longitudinal direction of the injection needle 11 of preferably less than 0.5 mm.

NEEDLE INJECTION PORT WITH ROUNDED OR BEVELED EDGE

[01171] In a preferred embodiment the injection port 11A on the side surface of the infusion needle 11 has a rounded or beveled edge at a transition between the injection port 11A and the side surface of the infusion needle 11. The cross-sectional view of the infusion needle 11 as shown in Fig. 62B illustrates the injection port 11A with a rounded edge. The rounded or beveled edge of the injection port 11A is provided at least on the opposite sides of the injection port 11A along the advancing and retracting directions of the infusion needle 11 as shown in Fig. 62B. In other words, a hypothetical connecting line between said opposite sides of the injection port 11A would extend along the advancing and retracting directions of the infusion needle 11. Preferably, the edge at the transition between the injection port 11A and the side surface of the infusion needle 11 is rounded or beveled along the entire circumference of the injection port 11A.

PENETRATION AREA WITH PRE-CONFIGURED PASSAGES [01172] Fig. 63 to 58 illustrate different embodiments in which the penetration area 14 includes pre-configured openings 14A through which the infusion needle or needles 11 can penetrate and extend out off when being advanced.

NEEDLE IN TUBE

[01173] In Fig. 63, the penetration area 14 is provided with tubes in which the infusion needles 11 are arranged, the needles having their injection ports arranged on a side surface thereof, i. e. the front of the needles is closed. The inner surfaces of the tube and the outer surfaces of the infusion needle are liquid-tightly sealed against each other so that ingress of fluid, such as blood, through the tube and into the injection port 11A is securely prevented. The tubes may be formed integrally with the material of the penetration area 14 so that the walls of the tubes are formed from such material, which may be an elastic polymer, such as silicone. Alternatively, the tubes within which the infusion needles 11 are arranged may be individual tubes arranged in the penetration area 14. In particular, such individual tubes may be formed from a ceramic material or the entire penetration area 14 may be formed from the ceramic material, wherein preferably also the infusion needles 11 or at least their outer surface is made from ceramic material. In either case, as can be seen from Fig. 63, the inner diameter of the inner surface of the tubes and the outer diameter of the outer surface of the infusion needles 11 match each other so as to obtain such liquid-tight seal which prevents fluid ingress through the tubes and further into the injection port 11A. Fig. 63 also illustrated the lid 21 of the holder 20 mentioned previously, which holds the vessel V in place so that the vessel V cannot escape when the needle 11 is advanced from the penetration area 14 into the vessel V.

PRE-CONFIGURED ELASTIC OPENING

[01174] Fig. 64 shows a different alternative of a penetration area with pre-configured passages 14A. Here, the passages 14A have a length extending in the Y-direction all the way through the penetration area 14 and a width extending in the Z-direction, so as to form a slot. The passage is normally closed due to resilient forces generated by the elasticity of the material of the penetration area 14, which may be an elastomer, such as silicone. Moreover, the passage 14A opens automatically when an infusion needle 11 is advanced into and through the passage. After an injection cycle, when the needle 11 has returned to its retracted position, the passage 14A closes automatically again due to the elastic forces generated by the elastic material of the penetration area 14. Preferably, the passage 14A has a widened entrance section 14B, as shown in Fig. 64. In such entrance section, the passage 14A is normally open for the infusion needle 11 to easily enter into the passage 14A.

[01175] Fig. 65 illustrates a different embodiment which is suitable in context with the second general concept illustrated in Fig. 4 and which comprises a plurality of infusion needles 11 which only need to be advanced and retracted for an injection cycle but do not need to be laterally moved between successive injection cycles. In this case, since lateral movement of the infusion needles 11 is not a requirement, the front end sections of the infusion needles 11 reside inside the passages 14A when the infusion needles 11 are in their respective retracted positions. Thus, a widened entrance section 14B as described in relation to Fig. 51 can be dispensed with, but may be provided nevertheless, as such entrance section may be helpful when the entire system is being assembled.

[01176] Fig. 66 illustrates a further alternative embodiment with pre -configured passages 14A being provided and having a widthwise extension so as to form a slot which extends all the way through the penetration area 14. Again, the penetration area 14 is made of an elastic material, preferably an elastomer, such as silicone. In order to open the slot so that the infusion needle 11 may enter into the slot, pressure is exerted on opposite sides of the elastic material, more specifically, in opposite directions of the slot’s widthwise extension, so as to open the passage 14A for the at least one infusion needle 11 when the infusion needle 11 is being advanced. This may be achieved in many different ways, one of which being illustrated in Fig. 66. Here, two prongs 22A of a fork 22 are lowered so as to take at least an upper section of the penetration area 14 between them. The further the prongs 22A are lowered, the more is the elastic material of the penetration area 14 being compressed, thereby causing a respective one of pre-configured passages 14A to open gradually. The infusion needle 11 is advanced either simultaneously with the lowering of the fork 22 or individually thereafter. Further advancement of the infusion needle 11 may occur independently from any movement of the fork 22. This arrangement is suitable not only for the first general concept according to Fig. 3 but particularly for the second general concept according to Fig. 4 since both the fork 22 and the needle 11 may be moved together laterally between successive injection cycles when the fork 22 and infusion needle 21 are in their retracted positions.

NEEDLE WITH STYLET

[01177] Fig. 67 illustrates the principle of injecting a substance using an infusion needle 11 which comprises a retractable stylet 99. Although the infusion needle 11 is shown as being inclined, it does not need to be inclined according to this principle. That is, according to this principle, the stylet 99 extends inside the infusion needle 11 and is moveable within the hollow body thereof between an advanced position and a retracted position. In the advanced position, the stylet is so far advanced inside the hollow body of the infusion needle 11 that it closes the injection port 11A, which in this case is not provided on a side surface of the infusion needle 11 but in a front side of the tip end 11C thereof. This has the advantage that fibrosis is prevented from growing into the infusion needle 11 when the infusion needle is implanted in a patient. In the retracted position, the stylet 99 is so far retracted inside the hollow body of the infusion needle 11 that a pathway is open for the substance, which is to be injected, to flow through the hollow body of the infusion needle 11 out of the injection port 11A. In this regard, a feeding port 1 ID may be provided in a sidewall of the hollow body of the infusion needle 11 in order to allow for the substance, which is to be injected, to be fed through the feeding port 1 ID into the hollow body of the infusion needle 11. Any body fluid entering the infusion needle 11 after termination of the injection cycle may be pushed out of the infusion needle 11 by reinserting the stylet 99 into the infusion needle 11 up to the tip end 11C of the infusion needle 11.

[01178] Since the stylet 99 extends all the way through the infusion needle 11 up to the front of its tip end 11C, the risk that the infusion needle 11 cuts out material from the penetration area 14 and carries such material into the patient’s body upon advancement of the infusion needle 11 is substantially reduced. However, the major advantage is that the stylet 99 prevents fibrosis from growing into the infusion needle 11. This offers the opportunity not to retract the infusion needle 11 entirely from the patient’s body after termination of an injection cycle. Rather, the tip end 11C of the infusion needle 11 may remain extended from the housing 12 when the infusion needle 11 is in its fully retracted position. Any fibrosis growing on and around the housing, including on and around the tip end 11C of the infusion needle 11, may be pierced by the tip end 11C of the infusion needle 11 when the infusion needle 11 is advanced again for carrying out the next infusion cycle.

[01179] In order to avoid that the tip end 11C of the infusion needle 11 causes damage to the patient’s tissue when it extends from the housing 12 in the infusion needle’s retracted position, one or more walls 12B provided on the outer surface of the housing 12 may protect the tip end 11C of the infusion needle 11, as illustrated in the embodiment shown in Fig. 67.

[01180] Fig. 68 illustrates the principle as shown in Fig. 67, wherein a tip end 99C of the stylet 99 extends from the tip end 11C of the infusion needle 11 when the stylet 99 is in its advanced position. The tip end 99C of the stylet 99 is sharp for piercing through tissue of the patient when the infusion needle 11 is being advanced into the patient’s tissue. In turn, the tip end 11C of the infusion needle 11 is blunt.

[01181] Fig. 69 illustrates the principle as shown in Fig. 67, wherein the infusion needle 11 with the stylet 99 extends from the penetration area 14 which, in this case, is laterally displaceable along with the infusion needle 11. Thus, not only the infusion needle 11 is laterally displaceable, but also the penetration area 14 in the housing’s outer wall, more specifically the septum through which the infusion needle 11 extends, is moveable in a lateral direction along with the infusion needle 11 when the infusion needle 11 is displaced laterally. This allows for variation of the injection site by lateral displacement of both the infusion needle 11 and the penetration area 14.

[01182] In the embodiment shown in Fig. 69, lateral movement of the penetration area 14 is achieved by dividing the housing 12 in sections which are interconnected by a flexible wall section 12C, such as a bellows, wherein the penetration area 14 is disposed in one of those housing sections. As shown in Fig. 69, the housing section with the penetration area 14 may be completely surrounded by the flexible wall section 12C and may be guided (not shown) in a lateral direction together with the infusion needle 11 whenever the injection site is to be changed. Any fibrosis that might have built up on and around the tip end 11 A of the infusion needle 11 would move along with the displaceable housing section when the injection site is changed. This way, there is no need to entirely retract the infusion needle 11 back into the housing 12 after an injection cycle.

[01183] Fig. 70 illustrates the variant of Fig. 60E with the curved infusion needle 11 which, in addition, includes a stylet 99. The stylet 99 is curved in the same plane and with the same radius r of curvature as the infusion needle 11. Similar to the infusion needle 11 being mounted to the needle arm 1 IF, the stylet 99 is mounted to a stylet arm 99F. The needle arm 1 IF and stylet arm 99F are rotatable about a common axis of rotation 1 IE. Not shown in the principle embodiments of Figs. 60D and 62 but shown in a different embodiment hereinafter, a conduit may be connected to the needle arm 1 IF for supplying an infusion liquid or drug to the needle. Such conduit may be flexible so as to enable the conduit to follow the movement of the needle arm 1 IF. Alternatively, the conduit may be arranged at the common axis of rotation 1 IE, in which case the conduit does not need to be flexible.

[Oi l 84] A drive unit, which is likewise not specifically shown in the principle embodiment of Fig. 70, is provided for carrying out at least the following steps in sequence: advancing the infusion needle 11 and stylet 99 by rotating the needle arm 1 IF jointly with the stylet 99F about the common axis of rotation 1 IE in the advancing direction, retracting the stylet 99 inside the infusion needle 11 towards its retracted position by rotating the stylet arm 99F about the common axis of rotation 1 IE in the retraction direction, and

[01185] - retracting the infusion needle 11 by rotating the needle arm 11F about the common axis of rotation 1 1 E in the retraction direction.Preferably, the drive unit is further configured to advance the stylet 99 inside the infusion needle 11 before retracting the infusion needle 11, namely by rotating the stylet arm 99F about the common axis of rotation 1 IE in the advancing direction. Thus, the drug is injected into the patient after the infusion needle 11 has been advanced into the patient and after the stylet 99 has been retracted from the advanced infusion needle 11, and the infusion needle 11 is preferably retracted from the patient’s body only after the stylet 99 has been re-inserted into the infusion needle 11.

[01186] Again, as in the embodiment described above in relation to Fig. 60D, the entire drive unit, including the needle arm 1 IF and stylet arm 99F, may be displacably arranged inside the housing 12 in order to allow for changing the injection site, as indicated by the horizontal arrow in Fig. 70. [Oi l 87] Fig. 71 A to 7 ID illustrate a first principle of a mechanism for rotating the needle arm

I IF and stylet arm 99F, here involving a biasing element 41 and a releasable holder 42. The biasing element 41 is, in this example, a torsion spring, which has one of its ends attached to the stylet arm 99F and its other end attached to a base, which may be the bottom of the housing 12 or the bottom of a carriage which is movably mounted in the housing 12. The torsion spring 41 urges the stylet arm 99F away from such base. The needle arm 1 IF with the infusion needle 11 attached thereto is connected to the stylet arm 99F so that it is likewise urged away from such base due to the biasing force of the torsion spring 41, as is shown in Fig. 71 A. The stylet 99 attached to the stylet arm 99F is positioned inside the infusion needle 11 in the state shown. The needle arm 1 IF has a feeding port 1 ID to which a flexible conduit may be connected for feeding a substance, which is to be injected, to the infusion needle 11.

[01188] In order to advance the infusion needle 11 into the patient’s body, the stylet arm 99F is rotated against the biasing force of the torsion spring 41, as indicated by the arrow in Fig. 71A. As the infusion needle 11 is advanced, the torsion spring 41 is charged. The advanced state of the infusion needle 11 is shown in Fig. 7 IB, albeit from the opposite side in order to better illustrate the releasable holder 42 and a release 43 with which the releasable holder 42 cooperates. That is, the release 43 is arranged so as to release the holder 42 from the needle arm 1 IF at the time when the infusion needle

I I is about to reach its fully advanced position, such that the stylet arm 99F can move away from the needle arm 1 IF due to the biasing force of the torsion spring 41. This state is shown in Fig. 71C.

[01189] More specifically, the releasable holder 42 comprises a flexible hook by which the needle arm 1 IF and stylet 99F are hooked together when the stylet arm 99F rotates jointly with the needle arm 1 IF about the common axis of rotation 1 IE in the advancing direction (Fig. 71 A), whereas the release 43 is a deflector configured to deflect the hook sideways so as to unhook the flexible hook when the infusion needle 11 reaches its advanced position. Thus, the flexible hook and the deflector together form a releasable snap connection. Here, the deflector is wedge-shaped.

[01190] Fig. 72 illustrates the mechanism of Figs. 71A to 71D implemented in an overall system according to a first embodiment of the first principle. As can be seen, the needle arm 1 IF and stylet arm 99F are installed on a carriage 46 which is slidably movable within the housing 12. An indexing shaft 44 extends from the housing 12 and cooperates with the carriage 46 in such a way that movement, here rotation, of the indexing shaft 44 causes the carriage 46 to accordingly move inside the housing 12. Instead of the indexing shaft 44, one or more drive cables as disclosed in respect of other embodiments described above, may be employed to displace the carriage 46 inside the housing 12. [01191] In addition, a drive cable 45 extends from the housing 12 and cooperates with the stylet arm 99F and needle arm 1 IF by means of a worm gear. The worm gear engages a worm wheel which is arranged on the axis of rotation 1 IE and connected to the needle arm 1 IF. Accordingly, when the needle arm 1 IF is retracted from the patient and through the penetration area 14 back into the housing 12 by means of the drive shaft 45, the torsion spring 41 (the end of which is shown detached from the stylet arm 99F in Fig. 72 for illustrative purposes, but should in fact be attached thereto) is charged and the releasable holder 42 in the form of the flexible hook is snap-fitted behind the wedge-shaped deflector, thereby securely holding the needle arm 1 IF close to the stylet arm 99F against the biasing force of the torsion spring 41, as shown in Fig. 7 ID.

[01192] Figs. 73A and 73B illustrate the mechanism of Figs. 71A to 71D implemented in an overall system according to a second embodiment of the first principle. The second embodiment differs in size from the first embodiment shown in Fig. 72, meaning that the second embodiment is thinner (about 11 mm as compared to 18 mm) but higher (about 45 mm as compared to 35 mm) than the first embodiment. The reduction of the thickness is achieved by placing each machine element on a separate shaft. Accordingly, the worm wheel is no longer arranged on the common axis of rotation 1 IE but is arranged on a separate shaft 1 IE’ above the common axis of rotation 1 IE. The worm wheel on the shaft 1 IE’ and the needle arm 1 IF arranged on the common axis of rotation 1 IE cooperate with each other by two respective sector gears which are thin as compared to the worm wheel. Furthermore, as can also be seen from Fig. 73B, the torsion spring 41 is mounted on a third shaft 1 IE” and likewise cooperates with the stylet arm 99F via respective sector gears, one sector gear arranged on the third shaft 1 IE” and the other sector gear integrated on the back of the stylet arm 99F.

[01193] Figs. 74A to 74D illustrate a second principle of a mechanism for rotating a needle arm 1 IF and a stylet arm 99F, here involving at least one biasing element and a clutch. In this case, the needle arm 1 IF and the stylet arm 99F, which are mounted on the common axis of rotation 1 IE, are not held together but are loosely mounted so as to be rotatable about the common axis of rotation 1 IE. A first biasing element in the form of a torsion spring (not shown in Fig. 66) exhibits a biasing force on the stylet arm 99F and urges the stylet arm 99F jointly with the needle arm 1 IF about the common axis of rotation 1 IE in the advancing direction, as indicated in Fig. 74A by the larger, upper arrow. A second biasing element in the form of a second torsion spring (also not shown in Fig. 66) may be provided and act in the same way on the needle arm 1 IF as the first torsion spring acts on the stylet arm 99F. In the retracted position which is shown in Fig. 74A, the stylet arm 99F and needle arm 1 IF are held in position against such biasing forces as long as rotation of the two arms is prevented, i.e. as long as the worm wheel 47 does not turn. In order to advance the infusion needle 11 into and through the penetration area 14, the worm wheel 47 is rotated accordingly (in the counter-clockwise direction in Fig. 74A). The biasing force of the first torsion spring acting on the stylet arm 99F may be sufficient to move and insert the infusion needle into the patient, thereby overcoming the counteracting forces (indicated by the left-most arrow in Fig. 74A) created by the piercing of the penetration area 14 and the patient’s tissue, but the biasing force of the second torsion spring acting on the needle arm 1 IF may help to overcome such counter forces.

[01194] Fig. 74B shows the state in which the infusion needle 11 has been advanced through the penetration area 14 into the patient’s body and shows the situation where the stylet 99 connected to the stylet arm 99F begins to being retracted from the infusion needle 11. In order to do so, the clutch, which will be described in detail further below in relation to Figs. 75 A to 75 C, needs to be shifted so that it engages solely the stylet arm 99F. More specifically, in the state shown in Fig. 74A, the position of the clutch is such that it engages the needle arm 1 IF (or the needle arm 1 IF and the stylet arm 99F together) so as to prevent the two arms from rotating toward their advanced positions as long as the worm wheel is not turned (counter-clockwise in Fig. 74A). Then, once the two arms have reached their advanced positions in which the infusion needle 11 is inserted in the patient’s body, the worm wheel 47 is further turned counter-clockwise so as to bring the clutch into a position in which it detaches from the needle arm 1 IF and attaches solely to the stylet arm 99F. Thereafter, as shown in Fig. 74B, the worm wheel is turned clockwise, thereby rotating the stylet arm 99F toward its retracted position against the biasing force of the first torsion spring acting on the stylet arm 99F and against frictional forces (indicated by the left-most arrow in Fig. 74B) caused by the stylet 99 being retracted from the infusion needle 11. The second torsion spring acting on the needle arm 1 IF prevents that such frictional forces cause the infusion needle 11 to be retracted from the patient’s body when the stylet 99 is being retracted from the infusion needle 11 .

[01195] Fig. 74C shows the state in which the stylet 99 is to be re-inserted into the needle 11 by means of the stylet arm 99F. This is achieved again by means of the biasing force of the first torsion spring acting on the stylet arm 99F, which biasing force causes the stylet arm 99F to rotate once the worm wheel 47 is turned clockwise, as indicated by the respective arrows in Fig. 74C. Again, such movement is counter-acted by frictional forces between the stylet 99 and the needle 11, as indicated by the left-most arrow in Fig. 74C.

[01196] Finally, in order to retract the infusion needle 11 with the stylet 99 inserted therein from the patient’s body and backward through the penetration area 14, the clutch needs first to be shifted to a position in which it engages again with the needle arm 1 IF (or with both the needle arm 1 IF and the stylet arm 99F). This is achieved at the end of the insertion step described in relation to Fig. 74C, namely by turning the worm wheel further in the clockwise direction, thereby shifting the clutch. After such shifting, the clutch engages with the needle arm 1 IF. As shown in Fig. 74D, by rotating the worm wheel 47 in the counter-clockwise direction against the biasing forces of the first and second torsion springs as well as against frictional forces acting between the needle 11 and the penetration area 14 (left-most arrow in Fig. 74D), both the needle arm 1 IF and the stylet arm 99F are rotated toward their retracted positions, thereby retracting the infusion needle 11.

[01197] Figs. 75A to 75C illustrate the function of the clutch. Fig. 75A is an explosion view of the worm wheel 47, the stylet arm 99F, the needle arm 1 IF and a clutch element 48 connecting the worm wheel 47 with the stylet arm 99F, on the one hand, and with the needle arm 1 IF, on the other hand. All of these components are arranged on the common axis of rotation 1 IE.

[01198] Fig. 75B shows the clutch element 48 and its engagement surface 48A by which the clutch element 48 engages with a corresponding engagement surface of the stylet arm 99F and needle arm 1 IF. The engagement surfaces each include two ramps.

[01199] Fig. 47C illustrates how the ramps of the two engagement surfaces cooperate with each other in order to shift the clutch between a first state in which the clutch element engages with the needle arm 1 IF and a second state in which the clutch element 48 engages with the stylet arm 99F. Thus, by turning the clutch element 48 using the worm wheel 47, the ramps of the engagement surfaces slide along each other, thereby lifting the clutch element 48 against a spring force, which spring force urges the clutch element 48 into a respective engagement state once the ramps have passed each other. This way, by rotating the clutch element 48 successively further, the clutch can be successively shifted between the first and second states.

[01200] Fig. 76 illustrates the mechanism of Figs. 74A to 74D implemented in an overall system. Again, the needle arm 1 IF and the stylet arm 99F are mounted on a moveable carriage 48 along with the worm wheel 47 so as to be displaceable inside the housing 12.

[01201] Fig. 77 illustrates a third principle of a mechanism for rotating a needle arm 1 IF and a stylet arm 99F, here involving a needle crank arm 11G and a stylet crank arm 99G. Fig. 77 is a top view into a housing 12, which in this embodiment is substantially circular. A carriage 48 which is likewise circular is accommodated in the housing 12 so as to be rotatable within the housing 12. The needle arm 1 IF and the stylet arm 99F are mounted on the carriage 48 so as to be rotatable about a common axis of rotation 1 IE. The infusion needle 11 is mounted to the needle arm 1 IF so that it can be advanced through the penetration area 14 which is provided on an outer circumference of the housing 12.

[01202] A needle crank arm 11G is connected with one end thereof to the needle arm 1 IF and with another end thereof to a needle guide pathway 11H. Accordingly, movement of the needle crank arm 11G along the needle guide pathway 11H and rotation of the needle arm 1 IF about the common axis of rotation 1 IE are interdependent. Similarly, the stylet crank arm 99G is connected with one end thereof to the stylet arm 99F and with another end thereof to a stylet guide pathway 99H such that, accordingly, movement of the stylet crank arm 99G along the stylet guide pathway 99H and rotation of the stylet arm 99F about the common axis of rotation 1 IE are interdependent. For instance, in the position of the needle arm 1 IE and stylet arm 99F as shown in Fig. 77, the stylet crank arm 99G may slide along the stylet guide pathway 99H so as to move the stylet arm 99F away from the needle arm 1 IF, thereby retracting the stylet 99 connected to the stylet arm 99F from the infusion needle 11 connected to the needle arm 1 IF. In turn, when, in the state as shown in Fig. 77, the needle crank arm 11G moves along the needle guide pathway 11H, the needle arm 1 IF is rotated towards its retracted position, thereby at the same time causing the stylet arm 99F to rotate about the common axis of rotation 1 IE toward its retracted position, respectively.

[01203] In order to coordinate such movements of the needle arm 1 IF and stylet arm 99F in an appropriate timely manner, a cam drive is provided so that first the needle arm 1 IF and the stylet arm 99F are jointly advanced, then the stylet arm 99F is rotated backwards so as to retract the stylet 99 from the needle 11, thereafter the stylet 99 is re-inserted back into the infusion needle 11 by rotating the stylet arm 99F toward its advanced position, and finally the needle arm 1 IF and stylet arm 99F are jointly rotated toward their respective retracted positions.

[01204] Fig. 78 illustrates the mechanism according to the third principle further, involving a cam drive. In this embodiment, the cam drive comprises a cam disk 49 as illustrated in the perspective view shown in Fig. 78. More specifically, Fig. 78 shows the housing 12 with the rotatably displaceable carriage 48 accommodated therein and the cam disk 49 arranged on top of it. The cam disk 49 comprises a needle cam pathway 11 J and a stylet cam pathway 99J. The needle crank arm 11G is connected to the needle cam pathway 11 J in such a way that rotation of the cam disk 49 causes the needle arm 1 IF to rotate about the common axis of rotation 1 IE due to the fact that the needle crank arm 11G is connected to the needle arm 1 IF and further guided in the needle guide pathway 11H described above. Similarly, the stylet crank arm 99G is connected to the stylet cam pathway 99 J in such a way that rotation of the cam disk 49 causes the stylet arm 99F to rotate about the common axis of rotation 1 IE due to the fact that the stylet crank arm 99G is connected to the stylet arm 99F and further guided in the stylet guide pathway 99H. The curves of the needle cam pathway 11 J and stylet cam pathway 99 J define for each point of time the exact positions of the needle arm 1 IF and stylet arm 99F, respectively, which will be described in further detail in relation to Figs. 79A to 79C.

[01205] Figs. 79A to 79C illustrate different stages of the mechanism according to the third principle involving the needle crank arm 11G , the stylet crank arm 99G and the cam disk 49. As can best be seen in Fig. 79B, which shows the state in which both the needle arm 1 IF and the stylet arm 99F are in their respective advanced positions, the stylet crank arm 99G is guided with one of its ends in both the stylet guide pathway 99H and the stylet cam pathway 99J and is connected with its respective other end to the stylet arm 99F. Similarly, one end of the needle crank arm 11G is guided both in the needle guide pathway 11H and the needle cam pathway 11 J while it is connected with its respective other end to the needle arm 1 IF (not visible in this view).

[01206] Figs. 79A to 79C illustrate the initial step, an intermediate step and the final step of an insertion cycle. For this purpose, the cam disk 49 is first rotated in the counter-clockwise direction as indicated by the arrow in Fig. 79A. Fig. 79A shows the initial state in which both the stylet 99 and the infusion needle 11 are in their respective retracted positions. In the intermediate state shown in Fig. 79B, i.e. after half of the insertion cycle, both the needle 11 and the stylet 99 are in their respectively advanced positions. By rotating the cam disk 49 further in the counter-clockwise direction so as to complete the insertion cycle, as shown in Fig. 79C, the infusion needle 11 remains in its advanced position, whereas the stylet 99 is retracted from the infusion needle 11. Then, by rotating the cam disk 49 in the reverse direction, i.e. in the clockwise direction, the movement of the needle 11 and stylet 99 follows the opposite sequence, i.e. the stylet 99 is re-inserted into the needle 11 (intermediate state shown in Fig. 79B), before both the needle 11 and the stylet 99 are retracted toward their initial state shown in Fig. 79A.

[01207] Fig. 80 illustrates the mechanism of Figs. 79A to 79C implemented in an overall system according to the third principle. More specifically, Fig. 80 is a cross sectional view through the housing 12 in which the carriage 48 is accommodated rotatably about a central axis. Fig. 80 further shows an enlarged detail of such cross sectional view. As can be seen, the stylet crank arm 99G has pins at one end thereof which extend in opposite directions, one end extending downwards into the stylet guide pathway 99H and one pin extending upwards into the stylet cam pathway 99 J.

[01208] Further shown in Fig. 80 are two bevel gears which cooperate with corresponding bearing races. One bevel gear connects to an indexing shaft which extends out of the housing 12 for remote actuation. The bevel gear of the indexing shaft cooperates with a bearing race on the bottom of the carriage 49 so that rotation of the indexing shaft causes the carriage 48 to turn about the central axis. This way, a penetration site of the infusion needle 11 through the penetration area 14 can be varied. The second bevel gear connects to a drive shaft extending from the housing 12 likewise for remote actuation. The second bevel gear connected to the drive shaft cooperates with a bearing race which is integrated into the cam disk 49 so as to rotate the cam disk 49 about the central axis in order to advance and retract the infusion needle 11 and the stylet 99 accordingly.

Preferred ASPECTS of the present disclosure are summarized in the following paragraphs:

FIRST ASPECT - Cross guide with needle cooperating member

1. An at least partly implantable system for injecting a substance into a patient’s body, comprising: a housing adapted for implantation inside the patient’s body, the housing having an outer wall with a penetration area, at least one infusion needle disposed in the housing, a drive unit arranged for advancing and retracting the at least one infusion needle in opposite advancing and retracting directions so that a tip end of the at least one infusion needle penetrates, upon advancement of the at least one infusion needle, said penetration area so as to allow for injecting the substance through said penetration area via the at least one infusion needle, and a needle cooperating member arranged to cooperate with the at least one infusion needle upon the advancing or retracting of the at least one infusion needle and further comprising a cross guide to which the needle cooperating member is coupled so as to be movable into different positions in a displacement direction which is different to the advancing and retracting directions. The system of aspect 1, wherein the drive unit comprises a first motor for advancing or retracting or both advancing and retracting the at least one infusion needle in opposite advancing and retracting directions and a second motor for displacing the needle cooperating member in the displacement direction. The system of aspect 1 or 2, wherein the cross guide is fixedly held between two opposing fixing points. The system of any one of the preceding aspects, wherein the cross guide comprises a shaft on which the needle cooperating member is slidably mounted. The system of any one of the preceding aspects, wherein the cross guide extends in a displacement direction that is perpendicular to the advancing and retracting directions of the at least one infusion needle or in a direction that is inclined relative to the advancing and retracting directions of the at least one infusion needle. The system of any one of the preceding aspects, comprising a translating frame arranged to move in the advancing and retracting directions, wherein the cross guide is fixed to the translating frame so as to move together with the translating frame. The system of any one of the preceding aspects, wherein the at least one infusion needle comprises an array of infusion needles and wherein the needle cooperating member is arranged to cooperate with a respective one infusion needle of the array of infusion needles at a time. The system of aspect 7, wherein the needle cooperating member is arranged for acting on the array of infusion needles so as to advance or retract, depending on its position relative to the cross guide, the respective one infusion needle. The system of aspect 8, wherein the needle cooperating member is separate from the array of infusion needles. The system of aspect 9, wherein, in a rest position, the needle cooperating member is disengaged from the array of infusion needles and, upon movement of the translating frame, it engages the respective one infusion needle. The system of any one of aspects 8 to 10, wherein the infusion needles of the array of infusion needles are mounted in a mounting block so as to be slidable in the advancing and retracting directions. The system of aspect 11, wherein the needle cooperating member is arranged to advance the respective one infusion needle by pushing it in the advancing direction. The system of any one of aspects 7 to 12, wherein the needle cooperating member comprises a needle driver part and a positioning part, wherein the needle driver part and the positioning part are arranged to disengage from each other when the translating frame moves in the advancing direction. The system of aspect 13, comprising a secondary cross guide member arranged in parallel to the cross guide, wherein the positioning part is movably, preferably slidably, mounted on the secondary cross guide member and the needle driver part is movably, preferably slidably, mounted on the cross guide. The system of aspect 14, wherein, when the positioning part and the needle driver part are engaged, the positioning part is moveable along the cross guide in the displacement direction, thereby moving the needle driver part along the secondary cross guide member also in the displacement direction into a desired position and, when the positioning part is moved in the advancing or retracting direction, the needle driver part and the positioning part disengage from each other. The system of any one of aspects 13 to 15, wherein a displacement cable for pulling the needle cooperating member along the cross guide in the displacement direction is connected to the positioning part of the needle cooperating member. The system of any one of aspects 1 to 6, wherein the at least one infusion needle comprises a single infusion needle, wherein the single infusion needle is attached to the needle cooperating member so as to be movable in the displacement direction together with the needle cooperating member. The system of aspect 17, wherein the single infusion needle is welded or potted to the needle cooperating member. The system of aspect 17 or 18, wherein the single infusion needle has a curved section, the curved section being attached to the needle cooperating member. The system of aspect 19, wherein the curved section is fixedly held in a correspondingly curved recess of the needle cooperating member. The system of any one of aspects 17 to 20, wherein a needle-reinforcing tube is placed around the single infusion needle. The system of any one of aspects 17 to 21, comprising a tubing for supplying the substance to the single infusion needle, wherein the tubing is connected to an end of the single infusion needle and looped inside the housing so as to allow the tubing a required range of motion. The system of any one of the preceding aspects, comprising a displacement cable or a displacement belt for pulling the needle cooperating member along the cross guide in the displacement direction. The system of aspect 23, comprising a tensioning spring providing a counter-force to a pulling force of the displacement cable acting on the needle cooperating member. The system of aspect 24, wherein the counter-force provided by the tensioning spring is strong enough to move the needle cooperating member in a direction opposite the displacement direction when there is no pulling force of the displacement cable acting on the needle cooperating member. The system of aspect 24 or 25, wherein the tensioning spring is a constant-force tensioning spring. The system of any one of aspects 24 to 26, wherein the tensioning spring comprises a metal band which winds on itself when it is not tensioned, wherein one end of the metal band is attached to a reel and another end of the metal band is connected to the needle cooperating member. The system of any one of aspects 24 to 27, wherein the tensioning spring provides a tensioning force of between 0.5 N and 2 N, preferably between 0.8 N and 1.2 N, most preferably about 1 N. The system of aspect 23, wherein the displacement cable or displacement belt is arranged for pulling the needle cooperating member along the cross guide in opposite first and second displacement directions. The system of aspect 29, comprising a first wheel having a first axis of rotation and a second wheel having a second axis of rotation in parallel to and spaced apart from the first axis of rotation, wherein the displacement cable or displacement belt winds around the first and second wheels. The system of aspect 30, wherein the displacement cable or displacement belt is endless. The system of aspect 31, wherein the displacement cable or displacement belt forms a loop extending from the first wheel to the second wheel, winding around the second wheel by at least 180°, extending back from the second wheel to the first wheel, and winding around the first wheel by at least 180°. The system of aspect 32, wherein the displacement cable or displacement belt winds around at least one of the first and second wheels by 180° and a number of additional complete revolutions. 34. The system of any one of aspects 30 to 33, comprising a tensioning element which creates a tensioning force on the displacement cable or displacement belt in a direction transverse to a longitudinal axis of the displacement cable or displacement belt.

35. The system of aspect 34, wherein a drive cable is arranged to rotate the first or second wheel and extends out of the housing.

36. The system of aspect 35, wherein the drive cable is connected to one of the first and second wheels and arranged to wind on and off the first or second wheel or around the first or second wheel.

37. The system of aspect 35, wherein at least one of the first and second wheels is mounted on a drive shaft so as to rotate by rotation of the drive shaft and the drive cable is connected to the drive shaft in order to drive the drive shaft.

38. The system of aspect 37, comprising a third wheel mounted on the drive shaft, wherein the drive cable winds on and off the third wheel or around the third wheel.

39. The system of any one of aspects 35 to 38, wherein, in the case where the drive cable is arranged to wind on and off the first or second wheel or on and off the third wheel, the drive cable is attached to the respective first, second or third wheel with one end of the drive cable so that the drive cable unwinds and a section of the drive cable moves out of the housing when the cable is being pulled in a first direction, wherein a tensioning spring is arranged so as to pull the drive cable into an opposite second direction back into the housing onto the respective first, second or third wheel.

40. The system of any one of aspects 35 to 38, wherein, in the case where the drive cable is arranged to wind around the first or second wheel or around the third wheel, the drive cable is arranged so that one section of the drive cable moves into the housing while another section of the drive cable moves out of the housing when the drive cable is being pulled.

41. The system of any one of the preceding aspects, comprising a first alignment structure arranged on the needle cooperating member and a second alignment structure arranged stationary so that the first and second alignment structures engage with each other and define different rest positions for the needle cooperating member when the needle cooperating member is moved along the cross guide into different positions.

42. The system of aspect 41, wherein the first alignment structure is a leaf spring and the second alignment structure comprises a plurality of stationary detents or protrusions arranged to cooperate with the leaf spring or, alternatively, the first alignment structure comprises a plurality of detents or protrusions and the second alignment structure comprises one or more stationary leaf springs arranged to cooperate with the detents or protrusions.

First Aspect combined with Second Aspect - Translating frame 43. The system of any one of aspects 1 to 42, comprising at least one linear bearing, preferably two parallel linear bearings, and a translating frame arranged to move along the at least one linear bearing in the advancing and retracting directions, wherein the cross guide is fixed to the translating frame.

44. The system of aspect 43, comprising at least one return spring arranged to urge the translating frame into a rest position.

45. The system of aspect 44, wherein the at least one return spring comprises a coil spring arranged around one of the at least one linear bearing or two coil springs arranged around respective ones of two parallel linear bearings.

First Aspect combined with Third Aspect - Cable with block-and-tackle setup

46. The system of any one of aspects 1 to 45, wherein the drive unit comprises an advancement cable which is arranged so that pulling the advancement cable causes the advancing or retracting of the at least one infusion needle.

47. The system of aspect 46, wherein the advancement cable is guided through a wall of the housing.

48. The system of aspect 46 or 47, wherein the advancement cable forms part of a block-and-tackle setup.

49. The system of any one of aspects 46 to 48, wherein, where the system comprises at least one linear bearing, preferably two linear bearings, and a translating frame arranged to move along the at least one linear bearing in the advancing and retracting directions so as to advance or retract or both advance and retract the at least one infusion needle by respective movement of the translating frame, the block-and-tackle setup comprises at least one first pulley, preferably two first pulleys, fixed to the translating frame so as to move together with the translating frame and at least one second pulley, preferably two second pulleys, fixed to the housing so as to be stationary.

50. The system of aspect 49, wherein one end of the advancement cable is fixed to the housing.

51. The system of aspect 49, wherein one end of the advancement cable is fixed to the translating frame.

First Aspect combined with Fourth Aspect - Combined advancement and displacement cable

52. The system of any one of aspects 1 to 51, wherein the drive unit comprises a combined advancement and displacement cable which is arranged so that pulling the advancement and displacement cable allows for both causing the advancing or retracting of the at least one infusion needle and causing displacement of the at least one infusion needle in a displacement direction which is different to the advancing and retracting directions. The system of aspect 52, comprising a first actuator attached to a first end of the advancement and displacement cable and a second actuator attached to a second end of the advancement and displacement cable, wherein the first actuator is arranged so as to allow pulling and moving the advancement and displacement cable in a first pulling direction and the second actuator is arranged so as to allow pulling and moving the advancement and displacement cable in a second pulling direction opposite to the first pulling direction. The system of aspect 53, wherein simultaneous actuation of the first and second actuators so as to move the advancement and displacement cable in opposite first and second pulling directions causes the advancing or retracting of the at least one infusion needle. The system of aspect 54, wherein, where the system comprises at least one linear bearing, preferably two linear bearings, and a translating frame arranged to move along the at least one linear bearing in the advancing and retracting directions so as to advance or retract or both advance and retract the at least one infusion needle by respective movement of the translating frame, movement of the advancement and displacement cable in opposite first and second pulling directions causes the translating frame to move along the at least one linear bearing. The system of aspect 55, comprising at least two first pulleys fixed to the housing so as to be stationary, wherein the advancement and displacement cable is guided over one of the two first pulleys, further to the translating frame and further over the other one of the two first pulleys. The system of aspect 55 or 56, comprising at least one return spring arranged to urge the translating frame into a rest position. The system of aspect 57, wherein the at least one return spring comprises a coil spring arranged around one of the at least one linear bearing or two coil springs arranged around respective ones of the at least one linear bearing. The system of aspect 53, wherein actuation of any one of the first and second actuators so as to move the advancement and displacement cable in the first or second pulling direction, while the respective other one of the first and second actuators is not caused to move the advancement and displacement cable, causes the displacement of the at least one infusion needle in the displacement direction. The system of aspect 59, wherein, where the system comprises a needle cooperating member to which the at least one infusion needle is attached and a cross guide to which the needle cooperating member is coupled, the advancement and displacement cable is connected to the needle cooperating member so as to pull and move the needle cooperating member along the cross guide into different positions in the displacement direction. The system of aspect 60, comprising at least two second pulleys fixed to the translating frame on opposed sides of the needle cooperating member, wherein the advancement and displacement cable is guided over the two second pulleys . 62. The system of aspect 60 or 61, wherein the advancement and displacement cable has a central portion thereof fixedly connected to the needle cooperating member.

63. The system of aspect 60 or 61, wherein the advancement and displacement cable comprises two separate cable sections, each cable section having one end thereof connected to the needle cooperating member.

64. The system of any one of the aspects 52 to 63, wherein the at least one infusion needle comprises only a single infusion needle.

65. The system of aspect 64, wherein the single infusion needle is welded or potted to the needle cooperation member.

66. The system of aspect 64 or 65, wherein the single infusion needle has a curved section, the curved section being attached to the needle cooperating member.

67. The system of aspect 66, wherein the curved section is fixedly held in a recess of the needle cooperating member.

68. The system of any one of aspects 64 to 67, wherein a needle-reinforcing tube is placed around the at least one infusion needle.

69. The system of aspect 68, comprising a tubing for supplying the substance to the single infusion needle, wherein the tubing is connected to an end of the single infusion needle and looped inside the housing so as to allow the tubing a required range of motion.

70. The system of any one of aspects 52 to 69, comprising two motors which are arranged for, in cooperation, advancing or retracting the at least one infusion needle in the advancing or retracting direction and, individually, displacing the needle cooperating member in respectively opposite displacement directions.

First Aspect combined with Fifth Aspect - Infusion needle with lateral feeding port

71. The system of any one of aspects 1 to 51 , wherein the at least one infusion needle has a tubular needle body with a tip end, an injection port arranged at the tip end so as to allow for injecting the substance via the at least one infusion needle, a feeding port arranged distant from the tip end so as to allow for receiving the substance to be injected and a needle lumen inside the tubular needle body connecting the injection port with the feeding port, wherein the feeding port is a side port which is arranged on a side of the tubular needle body.

72. The system of aspect 71, wherein the at least one infusion needle comprises a plurality of infusion needles.

73. The system of aspect 72, wherein the infusion needles of the plurality of infusion needles are spaced apart from each other by a distance of between 1 mm and 2 mm.

74. The system of aspect 73 wherein the infusion needles of the plurality of infusion needles are spaced apart from each other by a distance of 1.5 mm. 75. The system of any one of aspects 71 to 74, comprising an internal reservoir inside the housing, the internal reservoir being arranged for holding the substance to be injected, wherein, when the at least one infusion needle is in an advanced position in which it penetrates the penetration area, the feeding port is positioned inside the internal reservoir and the injection port is positioned outside the housing.

76. The system of aspect 75, wherein the penetration area comprises a septum and wherein the internal reservoir is arranged within the septum such that, when the at least one infusion needle is in a retracted position, the feeding port is outside the internal reservoir and inside the septum.

77. The system of aspect 75, wherein the penetration area comprises a septum and wherein the internal reservoir is arranged within the septum such that, when the at least one infusion needle is in a retracted position, the feeding port is inside the internal reservoir.

78. The system of aspect 76 or 77, wherein, when the at least one infusion needle is in the retracted position, the injection port is inside the septum.

79. The system of aspect 78, wherein, when the at least one infusion needle is in the retracted position, the injection port is inside the septum and outside the internal reservoir.

80. The system of aspect 78, wherein, when the at least one infusion needle is in the retracted position, the injection port is inside the septum and inside the internal reservoir.

81. The system of any one of aspects 75 to 80, wherein, where the system comprises at least one linear bearing and a translating frame arranged to move along the at least one linear bearing in the advancing and retracting directions so as to advance or retract or both advance and retract the at least one infusion needle by respective movement of the translating frame, a supply lumen for supplying the substance to be injected to the internal reservoir is provided so as to run along an inner lumen of the at least one linear bearing.

82. The system of any one of aspects 71 to 81, wherein the injection port is a side port arranged on a side of the tubular needle body.

SECOND ASPECT - Translating frame

1. An at least partly implantable system for injecting a substance into a patient’s body, comprising: a housing adapted for implantation inside the patient’s body, the housing having an outer wall with a penetration area, at least one infusion needle disposed in the housing, opposite advancing and retracting directions so that a tip end of the at least one infusion needle penetrates, upon advancement of the at least one infusion needle, said penetration area so as to allow for injecting the substance through said penetration area via the at least one infusion needle, and two linear bearings arranged in parallel and a translating frame connecting the two linear bearings and arranged to move along the two linear bearings in the advancing and retracting directions of the at least one infusion needle so as to advance or retract or both advance and retract the at least one infusion needle by movement of the translating frame.

2. The system according to aspect 1, wherein the two linear bearings take the form of two parallel shafts to which the translating frame is slidably mounted.

3. The system according to aspect 1 or 2, further comprising at least one return spring arranged to urge the translating frame into a rest position.

4. The system according to aspect 3, wherein the at least one return spring comprises a coil spring arranged around one of the at least one parallel linear bearing or two coil springs arranged around respective ones of two parallel linear bearings.

Second Aspect combined with First Aspect - Cross guide with needle cooperating member

5. The system according to any one of aspects 1 to 4, comprising a needle cooperating member arranged to cooperate with the at least one infusion needle upon the advancing or retracting of the at least one infusion needle and further comprising a cross guide to which the needle cooperating member is coupled so as to be movable into different positions in a displacement direction which is different to the advancing and retracting directions.

6. The system of aspect 5, wherein the drive unit comprises a first motor for advancing or retracting or both advancing and retracting the at least one infusion needle in opposite advancing and retracting directions and a second motor for displacing the needle cooperating member in the displacement direction.

7. The system of aspect 5 or 6, wherein the cross guide is fixedly held between two opposing fixing points.

8. The system of any one of aspects 5 to 7, wherein the cross guide comprises a shaft on which the needle cooperating member is slidably mounted.

9. The system of any one of aspects 5 to 8, wherein the cross guide extends in a displacement direction that is perpendicular to the advancing and retracting directions of the at least one infusion needle or in a direction that is inclined relative to the advancing and retracting directions of the at least one infusion needle.

10. The system of any one of aspects 5 to 9, comprising a translating frame arranged to move in the advancing and retracting directions, wherein the cross guide is fixed to the translating frame so as to move together with the translating frame.

11. The system of any one of aspects 5 to 10, wherein the at least one infusion needle comprises an array of infusion needles and wherein the needle cooperating member is arranged to cooperate with a respective one infusion needle of the array of infusion needles at a time.

12. The system of aspect 11, wherein the needle cooperating member is arranged for acting on the array of infusion needles so as to advance or retract, depending on its position relative to the cross guide, the respective one infusion needle. The system of aspect 12, wherein the needle cooperating member is separate from the array of infusion needles. The system of aspect 13, wherein, in a rest position, the needle cooperating member is disengaged from the array of infusion needles and, upon movement of the translating frame, it engages the respective one infusion needle. The system of any one of aspects 11 to 14, wherein the infusion needles of the array of infusion needles are mounted in a mounting block so as to be slidable in the advancing and retracting directions. The system of aspect 15, wherein the needle cooperating member is arranged to advance the respective one infusion needle by pushing it in the advancing direction. The system of any one of aspects 11 to 16, wherein the needle cooperating member comprises a needle driver part and a positioning part, wherein the needle driver part and the positioning part are arranged to disengage from each other when the translating frame moves in the advancing direction. The system of aspect 17, comprising a secondary cross guide member arranged in parallel to the cross guide, wherein the positioning part is movably, preferably slidably, mounted on the secondary cross guide member and the needle driver part is movably, preferably slidably, mounted on the cross guide. The system of aspect 18, wherein, when the positioning part and the needle driver part are engaged, the positioning part is moveable along the cross guide in the displacement direction, thereby moving the needle driver part along the secondary cross guide member also in the displacement direction into a desired position and, when the positioning part is moved in the advancing or retracting direction, the needle driver part and the positioning part disengage from each other. The system of any one of aspects 17 to 19, wherein a displacement cable for pulling the needle cooperating member along the cross guide in the displacement direction is connected to the positioning part of the needle cooperating member. The system of any one of aspects 5 to 10, wherein the at least one infusion needle comprises a single infusion needle, wherein the single infusion needle is attached to the needle cooperating member so as to be movable in the displacement direction together with the needle cooperating member. The system of aspect 21, wherein the single infusion needle is welded or potted to the needle cooperating member. The system of aspect 21 or 22, wherein the single infusion needle has a curved section, the curved section being attached to the needle cooperating member. The system of aspect 23, wherein the curved section is fixedly held in a correspondingly curved recess of the needle cooperating member. The system of any one of aspects 21 to 24, wherein a needle-reinforcing tube is placed around the single infusion needle. The system of any one of aspects 21 to 25, comprising a tubing for supplying the substance to the single infusion needle, wherein the tubing is connected to an end of the single infusion needle and looped inside the housing so as to allow the tubing a required range of motion. The system of any one of aspects 5 to 26, comprising a displacement cable or a displacement belt for pulling the needle cooperating member along the cross guide in the displacement direction. The system of aspect 27, comprising a tensioning spring providing a counter-force to a pulling force of the displacement cable acting on the needle cooperating member. The system of aspect 28, wherein the counter-force provided by the tensioning spring is strong enough to move the needle cooperating member in a direction opposite the displacement direction when there is no pulling force of the displacement cable acting on the needle cooperating member. The system of aspect 28 or 29, wherein the tensioning spring is a constant-force tensioning spring. The system of any one of aspects 28 to 30, wherein the tensioning spring comprises a metal band which winds on itself when it is not tensioned, wherein one end of the metal band is attached to a reel and another end of the metal band is connected to the needle cooperating member. The system of any one of aspects 28 to 31, wherein the tensioning spring provides a tensioning force of between 0.5 N and 2 N, preferably between 0.8 N and 1.2 N, most preferably about 1 N. The system of aspect 32, wherein the displacement cable or displacement belt is arranged for pulling the needle cooperating member along the cross guide in opposite first and second displacement directions. The system of aspect 33, comprising a first wheel having a first axis of rotation and a second wheel having a second axis of rotation in parallel to and spaced apart from the first axis of rotation, wherein the displacement cable or displacement belt winds around the first and second wheels. The system of aspect 34, wherein the displacement cable or displacement belt is endless. The system of aspect 35, wherein the displacement cable or displacement belt forms a loop extending from the first wheel to the second wheel, winding around the second wheel by at least 180°, extending back from the second wheel to the first wheel, and winding around the first wheel by at least 180°. The system of aspect 36, wherein the displacement cable or displacement belt winds around at least one of the first and second wheels by 180° and a number of additional complete revolutions. The system of any one of aspects 34 to 37, comprising a tensioning element which creates a tensioning force on the displacement cable or displacement belt in a direction transverse to a longitudinal axis of the displacement cable or displacement belt. The system of aspect 38, wherein a drive cable is arranged to rotate the first or second wheel and extends out of the housing. The system of aspect 39, wherein the drive cable is connected to one of the first and second wheels and arranged to wind on and off the first or second wheel or around the first or second wheel. The system of aspect 39, wherein at least one of the first and second wheels is mounted on a drive shaft so as to rotate by rotation of the drive shaft and the drive cable is connected to the drive shaft in order to drive the drive shaft. The system of aspect 41, comprising a third wheel mounted on the drive shaft, wherein the drive cable winds on and off the third wheel or around the third wheel. The system of any one of aspects 39 to 42, wherein, in the case where the drive cable is arranged to wind on and off the first or second wheel or on and off the third wheel, the drive cable is attached to the respective first, second or third wheel with one end of the drive cable so that the drive cable unwinds and a section of the drive cable moves out of the housing when the cable is being pulled in a first direction, wherein a tensioning spring is arranged so as to pull the drive cable into an opposite second direction back into the housing onto the respective first, second or third wheel. The system of any one of aspects 39 to 42, wherein, in the case where the drive cable is arranged to wind around the first or second wheel or around the third wheel, the drive cable is arranged so that one section of the drive cable moves into the housing while another section of the drive cable moves out of the housing when the drive cable is being pulled. The system of any one of aspects 5 to 44, comprising a first alignment structure arranged on the needle cooperating member and a second alignment structure arranged stationary so that the first and second alignment structures engage with each other and define different rest positions for the needle cooperating member when the needle cooperating member is moved along the cross guide into different positions. The system of aspect 45, wherein the first alignment structure is a leaf spring and the second alignment structure comprises a plurality of stationary detents or protrusions arranged to cooperate with the leaf spring or, alternatively, the first alignment structure comprises a plurality of detents or protrusions and the second alignment structure comprises one or more stationary leaf springs arranged to cooperate with the detents or protrusions. Second Aspect combined with Third Aspect - Cable with block-and-tackle setup

47. The system of any one of aspects 1 to 46, wherein the drive unit comprises an advancement cable, wherein pulling the advancement cable causes the advancing or retracting of the at least one infusion needle, wherein the advancement cable forms part of a block-and-tackle setup.

48. The system of aspect 47, wherein the advancement cable is guided through a wall of the housing.

49. The system of aspect 47 or 48, comprising at least one linear bearing, preferably two linear bearings arranged in parallel, and a translating frame arranged to move along the at least one linear bearing in the advancing and retracting directions of the at least one infusion needle so as to advance or retract or both advance and retract the at least one infusion needle by movement of the translating frame, wherein the block-and-tackle setup comprises at least one first pulley, preferably two first pulleys, fixed to the translating frame so as to move together with the translating frame and at least one second pulley, preferably two second pulleys, fixed to the housing so as to be stationary.

50. The system of aspect 49, wherein one end of the advancement cable is fixed to the housing.

51. The system of aspect 49, wherein one end of the advancement cable is fixed to the translating frame.

Second Aspect combined with Fourth Aspect - Combined advancement and displacement cable

52. The system of any one of aspects 1 to 51, wherein the drive unit comprises a combined advancement and displacement cable which is arranged so that pulling the advancement and displacement cable allows for both causing the advancing or retracting of the at least one infusion needle and causing displacement of the at least one infusion needle in a displacement direction which is different to the advancing and retracting directions.

53. The system of aspect 52, comprising a first actuator attached to a first end of the advancement and displacement cable and a second actuator attached to a second end of the advancement and displacement cable, wherein the first actuator is arranged so as to allow pulling and moving the advancement and displacement cable in a first pulling direction and the second actuator is arranged so as to allow pulling and moving the advancement and displacement cable in a second pulling direction opposite to the first pulling direction.

54. The system of aspect 53, wherein simultaneous actuation of the first and second actuators so as to move the advancement and displacement cable in opposite first and second pulling directions causes the advancing or retracting of the at least one infusion needle.

55. The system of aspect 54, comprising at least one linear bearing, preferably two parallel linear bearings, and a translating frame arranged to move along the at least one linear bearing in the advancing and retracting directions, wherein movement of the advancement and displacement cable in opposite first and second pulling directions causes the translating frame to move along the at least one linear bearing. The system of aspect 55, comprising at least two first pulleys fixed to the housing so as to be stationary, wherein the advancement and displacement cable is guided over one of the two first pulleys, further to the translating frame and further over the other one of the two first pulleys. The system of aspect 55 or 56, further comprising at least one return spring arranged to urge the translating frame into a rest position. The system of aspect 57, wherein the at least one return spring comprises a coil spring arranged around one of the at least one linear bearing or two coil springs arranged around respective ones of the at least one linear bearing. The system of any one of aspects 53 to 58, wherein actuation of any one of the first and second actuators so as to move the advancement and displacement cable in the first or second pulling direction, while the respective other one of the first and second actuators is not caused to move the advancement and displacement cable, causes the displacement of the at least one infusion needle in the displacement direction. The system of aspect 59, comprising a needle cooperating member to which the at least one infusion needle is attached and a cross guide to which the needle cooperating member is coupled, wherein the advancement and displacement cable is connected to the needle cooperating member so as to pull and move the needle cooperating member along the cross guide into different positions in the displacement direction. The system of aspect 60, comprising at least two second pulleys fixed to the translating frame on opposed sides of the needle cooperating member, wherein the advancement and displacement cable is guided over the two second pulleys. The system of aspect 60, wherein the advancement and displacement cable has a central portion thereof fixedly connected to the needle cooperating member. The system of aspect 60, wherein the advancement and displacement cable comprises two separate cable sections, each cable section having one end thereof connected to the needle cooperating member. The system of any one of aspects 52 to 65, wherein the at least one infusion needle comprises only a single infusion needle. The system of any one of aspects 60 to 63, wherein the single infusion needle is welded or potted to the needle cooperation member. The system of any one of aspects 60 to 64, wherein a needle-reinforcing tube is placed around the single infusion needle. The system of aspect 66, wherein the single infusion needle has a curved section, the curved section being attached to the needle cooperating member. 68. The system of aspect 67, wherein the curved section is fixedly held in a recess of the needle cooperating member.

69. The system of any one of aspects 66 to 68, comprising a tubing for supplying the substance to the single infusion needle, wherein the tubing is connected to an end of the single infusion needle and looped inside the housing so as to allow the tubing a required range of motion.

70. The system of any one of aspects 52 to 69, comprising two motors which are arranged for, in cooperation, advancing or retracting the at least one infusion needle in the advancing or retracting direction and, individually, displacing the needle cooperating member in respectively opposite displacement directions.

Second Aspect combined with Fifth Aspect - Infusion needle with lateral feeding port

71. The system of any one of aspects 1 to 51 , wherein the at least one infusion needle has a tubular needle body with a tip end, an injection port arranged at the tip end so as to allow for injecting the substance via the at least one infusion needle, a feeding port arranged distant from the tip end so as to allow for receiving the substance to be injected and a needle lumen inside the tubular needle body connecting the injection port with the feeding port, wherein the feeding port is a side port which is arranged on a side of the tubular needle body.

72. The system of aspect 71, wherein the at least one infusion needle comprises a plurality of infusion needles.

73. The system of aspect 72, wherein the infusion needles of the plurality of infusion needles are spaced apart from each other by a distance of between 1 mm and 2 mm.

74. The system of aspect 73, wherein the infusion needles of the plurality of infusion needles are spaced apart from each other by a distance of 1.5 mm.

75. The system of any one of aspects 71 to 73, comprising an internal reservoir inside the housing, the internal reservoir being arranged for holding the substance to be injected, wherein, when the at least one infusion needle is in an advanced position in which it penetrates the penetration area, the feeding port is positioned inside the internal reservoir and the injection port is positioned outside the housing.

76. The system of aspect 75, wherein the penetration area comprises a septum and wherein the internal reservoir is arranged within the septum such that, when the at least one infusion needle is in a retracted position, the feeding port is outside the internal reservoir and inside the septum.

77. The system of aspect 75, wherein the penetration area comprises a septum and wherein the internal reservoir is arranged within the septum such that, when the at least one infusion needle is in a retracted position, the feeding port is inside the internal reservoir.

78. The system of aspect 76 or 77, wherein, when the at least one infusion needle is in the retracted position, the injection port is inside the septum. 79. The system of aspect 78, wherein, when the at least one infusion needle is in the retracted position, the injection port is inside the septum and outside the internal reservoir.

80. The system of aspect 78, wherein, when the at least one infusion needle is in the retracted position, the injection port is inside the septum and inside the internal reservoir.

81. The system of any one of aspects 75 to 80, wherein, where the system comprises at least one linear bearing and a translating frame arranged to move along the at least one linear bearing in the advancing and retracting directions so as to advance or retract or both advance and retract the at least one infusion needle by respective movement of the translating frame, a supply lumen for supplying the substance to be injected to the internal reservoir is provided so as to run along an inner lumen of the at least one linear bearing.

82. The system of aspect 81, wherein the injection port is a side port arranged on a side of the tubular needle body.

THIRD ASPECT - Cable with block-and-tackle setup

1. An at least partly implantable system for injecting a substance into a patient’s body, comprising: a housing adapted for implantation inside the patient’s body, the housing having an outer wall with a penetration area, at least one infusion needle disposed in the housing, and a drive unit arranged for advancing and retracting the at least one infusion needle in opposite advancing and retracting directions so that a tip end of the at least one infusion needle penetrates, upon advancement of the at least one infusion needle, said penetration area so as to allow for injecting the substance through said penetration area via the at least one infusion needle, wherein the drive unit comprises an advancement cable, wherein pulling the advancement cable causes the advancing or retracting of the at least one infusion needle, wherein the advancement cable forms part of a block-and-tackle setup.

2. The system of aspect 1, wherein the advancement cable is guided through a wall of the housing.

3. The system of aspect 1 or 2, comprising at least one linear bearing, preferably two linear bearings arranged in parallel, and a translating frame arranged to move along the at least one linear bearing in the advancing and retracting directions of the at least one infusion needle so as to advance or retract or both advance and retract the at least one infusion needle by movement of the translating frame, wherein the block-and-tackle setup comprises at least one first pulley, preferably two first pulleys, fixed to the translating frame so as to move together with the translating frame and at least one second pulley, preferably two second pulleys, fixed to the housing so as to be stationary.

4. The system of aspect 3, wherein one end of the advancement cable is fixed to the housing.

5. The system of aspect 3, wherein one end of the advancement cable is fixed to the translating frame. Third Aspect combined with Second Aspect - Translating frame

6. The system of any one of aspects 1 to 5, comprising at least one linear bearing, preferably two linear bearings arranged in parallel, and a translating frame connecting the two linear bearings and arranged to move along the two linear bearings in the advancing and retracting directions of the at least one infusion needle so as to advance or retract or both advance and retract the at least one infusion needle by movement of the translating frame.

7. The system according to aspect 6, wherein the two linear bearings take the form of two parallel shafts to which the translating frame is slidably mounted.

8. The system according to aspect 6 or 7, further comprising at least one return spring arranged to urge the translating frame into a rest position.

9. The system according to aspect 8, wherein the at least one return spring comprises a coil spring arranged around one of the at least one parallel linear bearing or two coil springs arranged around respective ones of two parallel linear bearings.

Third Aspect combined with First Aspect - Cross guide with needle cooperating member

10. The system according to any one of aspects 1 to 9, comprising a needle cooperating member arranged to cooperate with the at least one infusion needle upon the advancing or retracting of the at least one infusion needle and further comprising a cross guide to which the needle cooperating member is coupled so as to be movable into different positions in a displacement direction which is different to the advancing and retracting directions.

11. The system of aspect 10, wherein the drive unit comprises a first motor for advancing or retracting or both advancing and retracting the at least one infusion needle in opposite advancing and retracting directions and a second motor for displacing the needle cooperating member in the displacement direction.

12. The system of aspect 10 or 11, wherein the cross guide is fixedly held between two opposing fixing points.

13. The system of any one of aspects 10 to 12, wherein the cross guide comprises a shaft on which the needle cooperating member is slidably mounted.

14. The system of any one of aspects 10 to 13, wherein the cross guide extends in a displacement direction that is perpendicular to the advancing and retracting directions of the at least one infusion needle or in a direction that is inclined relative to the advancing and retracting directions of the at least one infusion needle.

15. The system of any one of aspects 10 to 14, comprising a translating frame arranged to move in the advancing and retracting directions, wherein the cross guide is fixed to the translating frame so as to move together with the translating frame. The system of any one of aspects 10 to 15, wherein the at least one infusion needle comprises an array of infusion needles and wherein the needle cooperating member is arranged to cooperate with a respective one infusion needle of the array of infusion needles at a time. The system of aspect 16, wherein the needle cooperating member is arranged for acting on the array of infusion needles so as to advance or retract, depending on its position relative to the cross guide, the respective one infusion needle. The system of aspect 17, wherein the needle cooperating member is separate from the array of infusion needles. The system of aspect 18, wherein, in a rest position, the needle cooperating member is disengaged from the array of infusion needles and, upon movement of the translating frame, it engages the respective one infusion needles. The system of any one of aspects 16 to 19, wherein the infusion needles of the array of infusion needles are mounted in a mounting block so as to be slidable in the advancing and retracting directions. The system of aspect 20, wherein the needle cooperating member is arranged to advance the respective one infusion needle by pushing it in the advancing direction. The system of any one of aspects 16 to 21, wherein the needle cooperating member comprises a needle driver part and a positioning part, wherein the needle driver part and the positioning part are arranged to disengage from each other when the translating frame moves in the advancing direction. The system of aspect 22, comprising a secondary cross guide member arranged in parallel to the cross guide, wherein the positioning part is movably, preferably slidably, mounted on the secondary cross guide member and the needle driver part is movably, preferably slidably, mounted on the cross guide. The system of aspect 23, wherein, when the positioning part and the needle driver part are engaged, the positioning part is movable along the cross guide in the displacement direction, thereby moving the needle driver part along the secondary cross guide member also in the displacement direction into a desired position and, when the positioning part is moved in the advancing or retracting direction, the needle driver part and the positioning part disengage from each other. The system of any one of aspects 22 to 24, wherein a displacement cable for pulling the needle cooperating member along the cross guide in the displacement direction is connected to the positioning part of the needle cooperating member. The system of any one of aspects 10 to 15, wherein the at least one infusion needle comprises a single infusion needle, wherein the single infusion needle is attached to the needle cooperating member so as to be movable in the displacement direction together with the needle cooperating member. The system of aspect 26, wherein the single infusion needle is welded or potted to the needle cooperating member. The system of aspect 26 or 27, wherein the single infusion needle has a curved section, the curved section being attached to the needle cooperating member. The system of aspect 28, wherein the curved section is fixedly held in a correspondingly curved recess of the needle cooperating member. The system of any one of aspects 26 to 29, wherein a needle-reinforcing tube is placed around the single infusion needle. The system of any one of aspects 26 to 29, comprising a tubing for supplying the substance to the single infusion needle, wherein the tubing is connected to an end of the single infusion needle and looped inside the housing so as to allow the tubing a required range of motion. The system of any one of aspects 10 to 31, comprising a displacement cable or a displacement belt for pulling the needle cooperating member along the cross guide in the displacement direction. The system of aspect 32, comprising a tensioning spring providing a counter-force to a pulling force of the displacement cable acting on the needle cooperating member. The system of aspect 33, wherein the counter-force provided by the tensioning spring is strong enough to move the needle cooperating member in a direction opposite the displacement direction when there is no pulling force of the displacement cable acting on the needle cooperating member. The system of aspect 33 or 34, wherein the tensioning spring is a constant-force tensioning spring. The system of any one of aspects 33 to 35, wherein the tensioning spring comprises a metal band which winds on itself when it is not tensioned, wherein one end of the metal band is attached to a reel and another end of the metal band is connected to the needle cooperating member. The system of any one of aspects 33 to 36, wherein the tensioning spring provides a tensioning force of between 0.5 N and 2 N, preferably between 0.8 N and 1.2 N, most preferably about 1 N. The system of aspect 37, wherein the displacement cable or displacement belt is arranged for pulling the needle cooperating member along the cross guide in opposite first and second displacement directions. The system of aspect 38, comprising a first wheel having a first axis of rotation and a second wheel having a second axis of rotation in parallel to and spaced apart from the first axis of rotation, wherein the displacement cable or displacement belt winds around the first and second wheels. The system of aspect 39, wherein the displacement cable or displacement belt is endless. The system of aspect 40, wherein the displacement cable or displacement belt forms a loop extending from the first wheel to the second wheel, winding around the second wheel by at least 180°, extending back from the second wheel to the first wheel, and winding around the first wheel by at least 180°. The system of aspect 41, wherein the displacement cable or displacement belt winds around at least one of the first and second wheels by 180° and a number of additional complete revolutions. The system of any one of aspects 39 to 42, comprising a tensioning element which creates a tensioning force on the displacement cable or displacement belt in a direction transverse to a longitudinal axis of the displacement cable or displacement belt. The system of aspect 43, wherein a drive cable is arranged to rotate the first or second wheel and extends out of the housing. The system of aspect 45, wherein the drive cable is connected to one of the first and second wheels and arranged to wind on and off the first or second wheel or around the first or second wheel. The system of aspect 46, wherein at least one of the first and second wheels is mounted on a drive shaft so as to rotate by rotation of the drive shaft and the drive cable is connected to the drive shaft in order to drive the drive shaft. The system of aspect 47, comprising a third wheel mounted on the drive shaft, wherein the drive cable winds on and off the third wheel or around the third wheel. The system of any one of aspects 44 to 47, wherein, in the case where the drive cable is arranged to wind on and off the first or second wheel or on and off the third wheel, the drive cable is attached to the respective first, second or third wheel with one end of the drive cable so that the drive cable unwinds and a section of the drive cable moves out of the housing when the cable is being pulled in a first direction, wherein a tensioning spring is arranged so as to pull the drive cable into an opposite second direction back into the housing onto the respective first, second or third wheel. The system of any one of aspects 44 to 47, wherein, in the case where the drive cable is arranged to wind around the first or second wheel or around the third wheel, the drive cable is arranged so that one section of the drive cable moves into the housing while another section of the drive cable moves out of the housing when the drive cable is being pulled. The system of any one of aspects 10 to 49, comprising a first alignment structure arranged on the needle cooperating member and a second alignment structure arranged stationary so that the first and second alignment structures engage with each other and define different rest positions for the needle cooperating member when the needle cooperating member is moved along the cross guide into different positions. 51. The system of aspect 50, wherein the first alignment structure is a leaf spring and the second alignment structure comprises a plurality of stationary detents or protrusions arranged to cooperate with the leaf spring or, alternatively, the first alignment structure comprises a plurality of detents or protrusions and the second alignment structure comprises one or more stationary leaf springs arranged to cooperate with the detents or protrusions.

Third Aspect combined with Fourth Aspect - Combined advancement and displacement cable

52. The system of any one of aspects 1 to 51, wherein the drive unit comprises a combined advancement and displacement cable which is arranged so that pulling the advancement and displacement cable allows for both causing the advancing or retracting of the at least one infusion needle and causing displacement of the at least one infusion needle in a displacement direction which is different from the advancing and retracting directions.

53. The system of aspect 52, comprising a first actuator attached to a first end of the advancement and displacement cable and a second actuator attached to a second end of the advancement and displacement cable, wherein the first actuator is arranged so as to allow pulling and moving the advancement and displacement cable in a first pulling direction and the second actuator is arranged so as to allow pulling and moving the advancement and displacement cable in a second pulling direction opposite to the first pulling direction.

54. The system of aspect 53, wherein simultaneous actuation of the first and second actuators so as to move the advancement and displacement cable in opposite first and second pulling directions causes the advancing or retracting of the at least one infusion needle.

55. The system of aspect 54, comprising at least one linear bearing, preferably two parallel linear bearings, and a translating frame arranged to move along the at least one linear bearing in the advancing and retracting directions, wherein movement of the advancement and displacement cable in opposite first and second pulling directions causes the translating frame to move along the at least one linear bearing.

56. The system of aspect 55, comprising at least two first pulleys fixed to the housing so as to be stationary, wherein the advancement and displacement cable is guided over one of the two first pulleys, further to the translating frame and further over the other one of the two first pulleys.

57. The system of aspect 55 or 56, further comprising at least one return spring arranged to urge the translating frame into a rest position.

58. The system of aspect 57, wherein the at least one return spring comprises a coil spring arranged around one of the at least one linear bearing or two coil springs arranged around respective ones of the at least one linear bearing.

59. The system of any one of aspects 53 to 58, wherein actuation of any one of the first and second actuators so as to move the advancement and displacement cable in the first or second pulling direction, while the respective other one of the first and second actuators is not caused to move the advancement and displacement cable, causes the displacement of the at least one infusion needle in the displacement direction.

60. The system of aspect 59, comprising a needle cooperating member to which the at least one infusion needle is attached and a cross guide to which the needle cooperating member is coupled, wherein the advancement and displacement cable is connected to the needle cooperating member so as to pull and move the needle cooperating member along the cross guide into different positions in the displacement direction.

61. The system of aspect 60, comprising at least two second pulleys fixed to the translating frame on opposed sides of the needle cooperating member, wherein the advancement and displacement cable is guided over the two second pulleys.

62. The system of aspect 60, wherein the advancement and displacement cable has a central portion thereof fixedly connected to the needle cooperating member.

63. The system of aspect 60, wherein the advancement and displacement cable comprises two separate cable sections, each cable section having one end thereof connected to the needle cooperating member.

64. The system of any one of aspects 52 to 65, wherein the at least one infusion needle comprises only a single infusion needle.

65. The system of any one of aspects 60 to 63, wherein the single infusion needle is welded or potted to the needle cooperation member.

66. The system of any one of aspects 60 to 64, wherein a needle-reinforcing tube is placed around the single infusion needle.

67. The system of aspect 66, wherein the single infusion needle has a curved section, the curved section being attached to the needle cooperating member.

68. The system of aspect 67, wherein the curved section is fixedly held in a recess of the needle cooperating member.

69. The system of any one of aspects 66 to 68, comprising a tubing for supplying the substance to the single infusion needle, wherein the tubing is connected to an end of the single infusion needle and looped inside the housing so as to allow the tubing a required range of motion.

70. The system of any one of aspects 52 to 69, comprising two motors which are arranged for, in cooperation, advancing or retracting the at least one infusion needle in the advancing or retracting direction and, individually, displacing the needle cooperating member in respectively opposite displacement directions.

Third Aspect combined with Fifth Aspect - Infusion needle with lateral feeding port

71. The system of any one of aspects 1 to 51 , wherein the at least one infusion needle has a tubular needle body with a tip end, an injection port arranged at the tip end so as to allow for injecting the substance via the at least one infusion needle, a feeding port arranged distant from the tip end so as to allow for receiving the substance to be injected and a needle lumen inside the tubular needle body connecting the injection port with the feeding port, wherein the feeding port is a side port which is arranged on a side of the tubular needle body. The system of aspect 71, wherein the at least one infusion needle comprises a plurality of infusion needles. The system of aspect 72, wherein the infusion needles of the plurality of infusion needles are spaced apart from each other by a distance of between 1 mm and 2 mm. The system of aspect 73, wherein the infusion needles of the plurality of infusion needles are spaced apart from each other by a distance of 1.5 mm. The system of any one of aspects 71 to 73, comprising an internal reservoir inside the housing, the internal reservoir being arranged for holding the substance to be injected, wherein, when the at least one infusion needle is in an advanced position in which it penetrates the penetration area, the feeding port is positioned inside the internal reservoir and the injection port is positioned outside the housing. The system of aspect 75, wherein the penetration area comprises a septum and wherein the internal reservoir is arranged within the septum such that, when the at least one infusion needle is in a retracted position, the feeding port is outside the internal reservoir and inside the septum. The system of aspect 75, wherein the penetration area comprises a septum and wherein the internal reservoir is arranged within the septum such that, when the at least one infusion needle is in a retracted position, the feeding port is inside the internal reservoir. The system of aspect 76 or 77, wherein, when the at least one infusion needle is in the retracted position, the injection port is inside the septum. The system of aspect 78, wherein, when the at least one infusion needle is in the retracted position, the injection port is inside the septum and outside the internal reservoir. The system of aspect 78, wherein, when the at least one infusion needle is in the retracted position, the injection port is inside the septum and inside the internal reservoir. The system of any one of aspects 75 to 80, wherein, where the system comprises at least one linear bearing and a translating frame arranged to move along the at least one linear bearing in the advancing and retracting directions so as to advance or retract or both advance and retract the at least one infusion needle by respective movement of the translating frame, a supply lumen for supplying the substance to be injected to the internal reservoir is provided so as to run along an inner lumen of the at least one linear bearing. The system of any one of aspects 71 to 81, wherein the injection port is a side port arranged on a side of the tubular needle body. FOURTH ASPECT - Combined advancement and displacement cable

1. An at least partly implantable system for injecting a substance into a patient’s body, comprising: a housing adapted for implantation inside the patient’s body, the housing having an outer wall with a penetration area, at least one infusion needle disposed in the housing, and a drive unit arranged for advancing and retracting the at least one infusion needle in opposite advancing and retracting directions so that a tip end of the at least one infusion needle penetrates, upon advancement of the at least one infusion needle, said penetration area so as to allow for injecting the substance through said penetration area via the at least one infusion needle, wherein the drive unit comprises a combined advancement and displacement cable which is arranged so that pulling the advancement and displacement cable allows for both causing the advancing or retracting of the at least one infusion needle and causing displacement of the at least one infusion needle in a displacement direction which is different from the advancing and retracting directions.

2. The system of aspect 52, comprising a first actuator attached to a first end of the advancement and displacement cable and a second actuator attached to a second end of the advancement and displacement cable, wherein the first actuator is arranged so as to allow pulling and moving the advancement and displacement cable in a first pulling direction and the second actuator is arranged so as to allow pulling and moving the advancement and displacement cable in a second pulling direction opposite to the first pulling direction.

3. The system of aspect 53, wherein simultaneous actuation of the first and second actuators so as to move the advancement and displacement cable in opposite first and second pulling directions causes the advancing or retracting of the at least one infusion needle.

4. The system of aspect 54, comprising at least one linear bearing, preferably two parallel linear bearings, and a translating frame arranged to move along the at least one linear bearing in the advancing and retracting directions, wherein movement of the advancement and displacement cable in opposite first and second pulling directions causes the translating frame to move along the at least one linear bearing.

5. The system of aspect 55, comprising at least two first pulleys fixed to the housing so as to be stationary, wherein the advancement and displacement cable is guided over one of the two first pulleys, further to the translating frame and further over the other one of the two first pulleys.

6. The system of aspect 55 or 56, further comprising at least one return spring arranged to urge the translating frame into a rest position.

7. The system of aspect 57, wherein the at least one return spring comprises a coil spring arranged around one of the at least one linear bearing or two coil springs arranged around respective ones of the at least one linear bearing. 8. The system of any one of aspects 53 to 58, wherein actuation of any one of the first and second actuators so as to move the advancement and displacement cable in the first or second pulling direction, while the respective other one of the first and second actuators is not caused to move the advancement and displacement cable, causes the displacement of the at least one infusion needle in the displacement direction.

9. The system of aspect 59, comprising a needle cooperating member to which the at least one infusion needle is attached and a cross guide to which the needle cooperating member is coupled, wherein the advancement and displacement cable is connected to the needle cooperating member so as to pull and move the needle cooperating member along the cross guide into different positions in the displacement direction.

10. The system of aspect 60, comprising at least two second pulleys fixed to the translating frame on opposed sides of the needle cooperating member, wherein the advancement and displacement cable is guided over the two second pulleys.

11. The system of aspect 60, wherein the advancement and displacement cable has a central portion thereof fixedly connected to the needle cooperating member.

12. The system of aspect 60, wherein the advancement and displacement cable comprises two separate cable sections, each cable section having one end thereof connected to the needle cooperating member.

13. The system of any one of aspects 52 to 65, wherein the at least one infusion needle comprises only a single infusion needle.

14. The system of any one of aspects 60 to 63, wherein the single infusion needle is welded or potted to the needle cooperation member.

15. The system of any one of aspects 60 to 64, wherein a needle-reinforcing tube is placed around the single infusion needle.

16. The system of aspect 66, wherein the single infusion needle has a curved section, the curved section being attached to the needle cooperating member.

17. The system of aspect 67, wherein the curved section is fixedly held in a recess of the needle cooperating member.

18. The system of any one of aspects 66 to 68, comprising a tubing for supplying the substance to the single infusion needle, wherein the tubing is connected to an end of the single infusion needle and looped inside the housing so as to allow the tubing a required range of motion.

19. The system of any one of aspects 52 to 69, comprising two motors which are arranged for, in cooperation, advancing or retracting the at least one infusion needle in the advancing or retracting direction and, individually, displacing the needle cooperating member in respectively opposite displacement directions.

Fourth Aspect combined with Second Aspect - Translating frame 20. The system of any one of aspects 1 to 19, comprising at least one linear bearing, preferably two linear bearings arranged in parallel, and a translating frame connecting the two linear bearings and arranged to move along the two linear bearings in the advancing and retracting directions of the at least one infusion needle so as to advance or retract or both advance and retract the at least one infusion needle by movement of the translating frame.

21. The system according to aspect 20, wherein the two linear bearings take the form of two parallel shafts to which the translating frame is slidably mounted.

22. The system according to aspect 20 or 21, further comprising at least one return spring arranged to urge the translating frame into a rest position.

23. The system according to aspect 22, wherein the at least one return spring comprises a coil spring arranged around one of the at least one parallel linear bearing or two coil springs arranged around respective ones of two parallel linear bearings.

Fourth Aspect combined with First Aspect - Cross guide with needle cooperating member

24. The system according to any one of aspects 1 to 23, comprising a needle cooperating member arranged to cooperate with the at least one infusion needle upon the advancing or retracting of the at least one infusion needle and further comprising a cross guide to which the needle cooperating member is coupled so as to be movable into different positions in a displacement direction which is different from the advancing and retracting directions.

25. The system of aspect 24, wherein the cross guide is fixedly held between two opposing fixing points.

26. The system of aspect 24 or 25, wherein the cross guide comprises a shaft on which the needle cooperating member is slidably mounted.

27. The system of any one of aspects 24 to 26, wherein the cross guide extends in a displacement direction that is perpendicular to the advancing and retracting directions of the at least one infusion needle or in a direction that is inclined relative to the advancing and retracting directions of the at least one infusion needle.

28. The system of any one of aspects 24 to 27, comprising a translating frame arranged to move in the advancing and retracting directions, wherein the cross guide is fixed to the translating frame so as to move together with the translating frame.

29. The system of any one of aspects 24 to 28, wherein the at least one infusion needle comprises a single infusion needle, wherein the single infusion needle is attached to the needle cooperating member so as to be movable in the displacement direction together with the needle cooperating member.

30. The system of aspect 29, wherein the single infusion needle is welded or potted to the needle cooperating member. 31. The system of aspect 29 or 30, wherein the single infusion needle has a curved section, the curved section being attached to the needle cooperating member.

32. The system of aspect 31, wherein the curved section is fixedly held in a correspondingly curved recess of the needle cooperating member.

33. The system of any one of aspects 29 to 32, wherein a needle-reinforcing tube is placed around the single infusion needle.

34. The system of any one of aspects 29 to 33, comprising a tubing for supplying the substance to the single infusion needle, wherein the tubing is connected to an end of the single infusion needle and looped inside the housing so as to allow the tubing a required range of motion.

35. The system of any one of aspects 24 to 34, comprising a first alignment structure arranged on the needle cooperating member and a second alignment structure arranged stationary so that the first and second alignment structures engage with each other and define different rest positions for the needle cooperating member when the needle cooperating member is moved along the cross guide into different positions.

36. The system of aspect 35, wherein the first alignment structure is a leaf spring and the second alignment structure comprises a plurality of stationary detents or protrusions arranged to cooperate with the leaf spring or, alternatively, the first alignment structure comprises a plurality of detents or protrusions and the second alignment structure comprises one or more stationary leaf springs arranged to cooperate with the detents or protrusions.

Fourth Aspect combined with Third Aspect - Cable with block-and-tackle setup

47. The system of any one of aspects 1 to 46, wherein the drive unit comprises an advancement cable, wherein pulling the advancement cable causes the advancing or retracting of the at least one infusion needle, wherein the advancement cable forms part of a block-and-tackle setup.

48. The system of aspect 47, wherein the advancement cable is guided through a wall of the housing.

49. The system of aspect 47 or 48, comprising at least one linear bearing, preferably two linear bearings arranged in parallel, and a translating frame arranged to move along the at least one linear bearing in the advancing and retracting directions of the at least one infusion needle so as to advance or retract or both advance and retract the at least one infusion needle by movement of the translating frame, wherein the block-and-tackle setup comprises at least one first pulley, preferably two first pulleys, fixed to the translating frame so as to move together with the translating frame and at least one second pulley, preferably two second pulleys 133, fixed to the housing so as to be stationary.

50. The system of aspect 49, wherein one end of the advancement cable is fixed to the housing.

51. The system of aspect 49, wherein one end of the advancement cable is fixed to the translating frame. Fourth Aspect combined with Fifth Aspect - Infusion needle with lateral feeding port

52. The system of any one of aspects 1 to 51, wherein the at least one infusion needle has a tubular needle body with a tip end, an injection port arranged at the tip end so as to allow for injecting the substance via the at least one infusion needle, a feeding port arranged distant from the tip end so as to allow for receiving the substance to be injected and a needle lumen inside the tubular needle body connecting the injection port with the feeding port, wherein the feeding port is a side port which is arranged on a side of the tubular needle body.

53. The system of aspect 52, comprising an internal reservoir inside the housing, the internal reservoir being arranged for holding the substance to be injected, wherein, when the at least one infusion needle is in an advanced position in which it penetrates the penetration area, the feeding port is positioned inside the internal reservoir and the injection port is positioned outside the housing.

54. The system of aspect 53, wherein the penetration area comprises a septum and wherein the internal reservoir is arranged within the septum such that, when the at least one infusion needle is in a retracted position, the feeding port is outside the internal reservoir and inside the septum.

55. The system of any one of aspects 52 to 54, wherein, where the system comprises at least one linear bearing and a translating frame arranged to move along the at least one linear bearing in the advancing and retracting directions so as to advance or retract or both advance and retract the at least one infusion needle by respective movement of the translating frame, a supply lumen for supplying the substance to be injected to the internal reservoir is provided so as to run along an inner lumen of the at least one linear bearing.

56. The system of any one of aspects 52 to 55, wherein the injection port is a side port arranged on a side of the tubular needle body.

FIFTH ASPECT - Infusion needle with lateral feeding port

1. An at least partly implantable system for injecting a substance into a patient’s body, comprising: a housing adapted for implantation inside the patient’s body, the housing having an outer wall with a penetration area, at least one infusion needle disposed in the housing, and a drive unit arranged for advancing and retracting the at least one infusion needle in opposite advancing and retracting directions so that a tip end of the at least one infusion needle penetrates, upon advancement of the at least one infusion needle, said penetration area so as to allow for injecting the substance through said penetration area via the at least one infusion needle, wherein the at least one infusion needle has a tubular needle body with a tip end, an injection port arranged at the tip end so as to allow for injecting the substance via the at least one infusion needle, a feeding port arranged distant from the tip end so as to allow for receiving the substance to be injected and a needle lumen inside the tubular needle body connecting the injection port with the feeding port, wherein the feeding port is a side port which is arranged on a side of the tubular needle body.

2. The system of aspect 1, comprising an internal reservoir inside the housing, the internal reservoir being arranged for holding the substance to be injected, wherein, when the at least one infusion needle is in an advanced position in which it penetrates the penetration area, the feeding port is positioned inside the internal reservoir and the injection port is positioned outside the housing.

3. The system of aspect 2, wherein the penetration area comprises a septum and wherein the internal reservoir is arranged within the septum such that, when the at least one infusion needle is in a retracted position, the feeding port is outside the internal reservoir and inside the septum.

4. The system of aspect 2, wherein the penetration area comprises a septum and wherein the internal reservoir is arranged within the septum such that, when the at least one infusion needle is in a retracted position, the feeding port is inside the internal reservoir.

5. The system of aspect 3 or 4, wherein, when the at least one infusion needle is in the retracted position, the injection port is inside the septum.

6. The system of aspect 5, wherein, when the at least one infusion needle is in the retracted position, the injection port is inside the septum and outside the internal reservoir.

7. The system of aspect 5, wherein, when the at least one infusion needle is in the retracted position, the injection port is inside the septum and inside the internal reservoir.

8. The system of any one of aspects 2 to 7, wherein, where the system comprises at least one linear bearing and a translating frame arranged to move along the at least one linear bearing in the advancing and retracting directions so as to advance or retract or both advance and retract the at least one infusion needle by respective movement of the translating frame, a supply lumen for supplying the substance to be injected to the internal reservoir is provided so as to run along an inner lumen of the at least one linear bearing.

9. The system of any one of aspects 1 to 8, wherein the injection port is a side port arranged on a side of the tubular needle body.

Fifth Aspect combined with First Aspect - Cross guide with needle cooperating member

10. The system according to any one of aspects 1 to 9, comprising a needle cooperating member arranged to cooperate with the at least one infusion needle upon the advancing or retracting of the at least one infusion needle and further comprising a cross guide to which the needle cooperating member is coupled so as to be movable into different positions in a displacement direction which is different from the advancing and retracting directions. The system of aspect 10, wherein the drive unit comprises a first motor for advancing or retracting or both advancing and retracting the at least one infusion needle in opposite advancing and retracting directions and a second motor for displacing the needle cooperating member in the displacement direction. The system of aspect 10 or 11, wherein the cross guide is fixedly held between two opposing fixing points. The system of any one of aspects 10 to 12, wherein the cross guide comprises a shaft on which the needle cooperating member is slidably mounted. The system of any one of aspects 10 to 13, wherein the cross guide extends in a displacement direction that is perpendicular to the advancing and retracting directions of the at least one infusion needle or in a direction that is inclined relative to the advancing and retracting directions of the at least one infusion needle. The system of any one of aspects 10 to 14, comprising a translating frame arranged to move in the advancing and retracting directions, wherein the cross guide is fixed to the translating frame so as to move together with the translating frame. The system of any one of aspects 10 to 15, wherein the at least one infusion needle comprises an array of infusion needles and wherein the needle cooperating member is arranged to cooperate with a respective one infusion needle of the array of infusion needles at a time. The system of aspect 16, wherein the needle cooperating member is arranged for acting on the array of infusion needles so as to advance or retract, depending on its position relative to the cross guide, the respective one infusion needle. The system of aspect 17, wherein the needle cooperating member is separate from the array of infusion needles. The system of aspect 18, wherein, in a rest position, the needle cooperating member is disengaged from the array of infusion needles and, upon movement of the translating frame, it engages the respective one infusion needle. The system of any one of aspects 17 to 19, wherein the infusion needles of the array of infusion needles are mounted in a mounting block so as to be slidable in the advancing and retracting directions. The system of aspect 20, wherein the needle cooperating member is arranged to advance the respective one infusion needle by pushing it in the advancing direction. The system of any one of aspects 16 to 21, wherein the needle cooperating member comprises a needle driver part and a positioning part, wherein the needle driver part and the positioning part are arranged to disengage from each other when the translating frame moves in the advancing direction. The system of aspect 22, comprising a secondary cross guide member arranged in parallel to the cross guide, wherein the positioning part is movably, preferably slidably, mounted on the secondary cross guide member and the needle driver part is movably, preferably slidably, mounted on the cross guide. The system of aspect 23, wherein, when the positioning part and the needle driver part are engaged, the positioning part is movable along the cross guide in the displacement direction, thereby moving the needle driver part along the secondary cross guide member also in the displacement direction into a desired position and, when the positioning part is moved in the advancing or retracting direction, the needle driver part and the positioning part disengage from each other. The system of any one of aspects 22 to 24, wherein a displacement cable for pulling the needle cooperating member along the cross guide in the displacement direction is connected to the positioning part of the needle cooperating member. The system of aspect 25, comprising a tensioning spring providing a counter-force to a pulling force of the displacement cable acting on the needle cooperating member. The system of aspect 26, wherein the counter-force provided by the tensioning spring is strong enough to move the needle cooperating member in a direction opposite the displacement direction when there is no pulling force of the displacement cable acting on the needle cooperating member. The system of aspect 26 or 27, wherein the tensioning spring is a constant-force tensioning spring. The system of any one of aspects 26 to 28, wherein the tensioning spring comprises a metal band which winds on itself when it is not tensioned, wherein one end of the metal band is attached to a reel and another end of the metal band is connected to the needle cooperating member. The system of any one of aspects 26 to 29, wherein the tensioning spring provides a tensioning force of between 0.5 N and 2 N, preferably between 0.8 N and 1.2 N, most preferably about 1 N. The system of aspect 25, wherein the displacement cable is arranged for pulling the needle cooperating member along the cross guide in opposite first and second displacement directions. The system of aspect 31, comprising a first wheel having a first axis of rotation and a second wheel having a second axis of rotation in parallel to and spaced apart from the first axis of rotation, wherein the displacement cable or displacement belt winds around the first and second wheels. The system of aspect 32, wherein the displacement cable or displacement belt is endless. The system of aspect 33, wherein the displacement cable or displacement belt forms a loop extending from the first wheel to the second wheel, winding around the second wheel by at least 180°, extending back from the second wheel to the first wheel, and winding around the first wheel by at least 180°. The system of aspect 34, wherein the displacement cable or displacement belt winds around at least one of the first and second wheels by 180° and a number of additional complete revolutions. The system of any one of aspects 32 to 35, comprising a tensioning element which creates a tensioning force on the displacement cable or displacement belt in a direction transverse to a longitudinal axis of the displacement cable or displacement belt. The system of aspect 36, wherein a drive cable is arranged to rotate the first or second wheel and extends out of the housing. The system of aspect 37, wherein the drive cable is connected to one of the first and second wheels and arranged to wind on and off the first or second wheel or around the first or second wheel. The system of aspect 37, wherein at least one of the first and second wheels is mounted on a drive shaft so as to rotate by rotation of the drive shaft and the drive cable is connected to the drive shaft in order to drive the drive shaft. The system of aspect 39, comprising a third wheel mounted on the drive shaft, wherein the drive cable winds on and off the third wheel or around the third wheel. The system of any one of aspects 37 to 40, wherein, in the case where the drive cable is arranged to wind on and off the first or second wheel or on and off the third wheel, the drive cable is attachable to the respective first, second or third wheel with one end of the drive cable so that the drive cable unwinds and a section of the drive cable moves out of the housing when the cable is being pulled in a first direction, wherein a tensioning spring is arranged so as to pull the drive cable into an opposite second direction back into the housing onto the respective first, second or third wheel. The system of any one of aspects 37 to 40, wherein, in the case where the drive cable is arranged to wind around the first or second wheel or around the third wheel, the drive cable is arranged so that one section of the drive cable moves into the housing while another section of the drive cable moves out of the housing when the drive cable is being pulled. The system of any one of aspects 10 to 42, comprising a first alignment structure arranged on the needle cooperating member and a second alignment structure arranged stationary so that the first and second alignment structures engage with each other and define different rest positions for the needle cooperating member when the needle cooperating member is moved along the cross guide into different positions. The system of aspect 43, wherein the first alignment structure is a leaf spring and the second alignment structure comprises a plurality of stationary detents or protrusions arranged to cooperate with the leaf spring or, alternatively, the first alignment structure comprises a plurality of detents or protrusions and the second alignment structure comprises one or more stationary leaf springs arranged to cooperate with the detents or protrusions. Fifth Aspect combined with Second Aspect - Translating frame

45. The system of any one of aspects 1 to 44, comprising at least one linear bearing, preferably two linear bearings arranged in parallel, and a translating frame connecting the two linear bearings and arranged to move along the two linear bearings in the advancing and retracting directions of the at least one infusion needle so as to advance or retract or both advance and retract the at least one infusion needle by movement of the translating frame.

46. The system according to aspect 45, wherein the two linear bearings take the form of two parallel shafts to which the translating frame is slidably mounted.

47. The system according to aspect 45 or 46, further comprising at least one return spring arranged to urge the translating frame into a rest position.

48. The system according to aspect 47, wherein the at least one return spring comprises a coil spring arranged around one of the at least one parallel linear bearing or two coil springs arranged around respective ones of two parallel linear bearings.

Fifth Aspect combined with Third Aspect - Cable with block-and-tackle setup

49. The system of any one of aspects 1 to 48, wherein the drive unit comprises an advancement cable, wherein pulling the advancement cable causes the advancing or retracting of the at least one infusion needle, wherein the advancement cable forms part of a block-and-tackle setup.

50. The system of aspect 49, wherein the advancement cable is guided through a wall of the housing.

51. The system of aspect 49 or 50, comprising at least one linear bearing, preferably two linear bearings arranged in parallel, and a translating frame arranged to move along the at least one linear bearing in the advancing and retracting directions of the at least one infusion needle so as to advance or retract or both advance and retract the at least one infusion needle by movement of the translating frame, wherein the block-and-tackle setup comprises at least one first pulley, preferably two first pulleys, fixed to the translating frame so as to move together with the translating frame and at least one second pulley, preferably two second pulleys, fixed to the housing so as to be stationary.

52. The system of aspect 51, wherein one end of the advancement cable is fixed to the housing.

53. The system of aspect 52, wherein one end of the advancement cable is fixed to the translating frame.

FURTHER ASPECT combinable with any one of the other Aspects - Surface Coating

1. The system for injecting a substance into a patient’s body according to any one of the preceding and following aspects, comprising an outer surface (520) and a coating (530) arranged on the outer surface. 2. The system according to aspect 1, wherein the coating comprises at least one layer of a biomaterial.

3. The system according to aspect 2, wherein the biomaterial comprises at least one drug or substance with one or more of the following characteristics: an antithrombotic, an antibacterial and an antiplatelet characteristic.

4. The system according to aspect 2 or 3, wherein the biomaterial is fibrin-based.

5. The system according to any one of aspects 1 to 4, further comprising a second coating (530b) arranged on the first coating (530).

6. The system according to aspect 5, wherein the second coating is of a different biomaterial than said first coating.

7. The system according to aspect 6, wherein the first coating comprises a layer of perfluorocarbon chemically attached to the surface, and wherein the second coating comprises a liquid perfluorocarbon layer.

8. The system according to any one of aspects 1 to 7, wherein the coating comprises a drug encapsulated in a porous material.

9. The system according to any one of aspects 1 to 8, wherein the surface comprises a metal.

10. The system according to aspect 9, wherein the metal comprises at least one of the following, titanium, cobalt, nickel, copper, zinc, zirconium, molybdenum, tin or lead.

11. The system according to any one of aspects 1 to 10, wherein the surface comprises a micro pattern.

12. The system according to aspect 11, wherein the micro pattern is etched into the surface prior to insertion into the body.

13. The system according to aspect 11 or 12, further comprising a layer of a biomaterial coated on the micro pattern.

FURTHER ASPECT combinable with any one of the other Aspects - Communication General Communication Housing

1. An external device configured for communication with an implantable medical device implanted in a patient, the external device comprising: a display device, a housing unit configured to mechanically and disconnectably connect to the display device, the housing unit comprising: a first communication unit for receiving communication from the display device, and a second communication unit for wirelessly transmitting communication to the implantable medical device.

2. The external device according to aspect 1, wherein the external device comprises a handheld electronic device. The external device according to any one of aspects 1 and 2, wherein the external device is configured for communicating with the implantable medical device for changing an operational state of the implantable medical device. The external device according to any one of the preceding aspects, wherein the first communication unit is a wireless communication unit for wireless communication with the display device. The external device according to aspect 4, wherein: the first communication unit is configured to communicate wirelessly with the display device using a first communication frequency, the second communication unit is configured to communicate wirelessly with the implantable medical device using a second communication frequency, and the first and second communication frequencies are different. The external device according to any one of the preceding aspects, wherein the second communication unit is configured to communicate wirelessly with the implantable medical device using electromagnetic waves at a frequency below 100 kHz. The external device according to any one of the preceding aspects, wherein the second communication unit is configured to communicate wirelessly with the implantable medical device using electromagnetic waves at a frequency below 40 kHz. The external device according to any one of aspects 4 - 7, wherein the first communication unit is configured to communicate wirelessly with the display device using electromagnetic waves at a frequency above 100 kHz. The external device according to any one of the preceding aspects, wherein: the first communication unit is configured to communicate with the display device using a first communication protocol, the second communication unit is configured to communicate wirelessly with the implantable medical device using a second communication protocol, and the first and second communication protocols are different. The external device according to any one of aspects 3 - 9, wherein the housing unit comprises: a first antenna configured for wireless communication with the display device, and a second antenna configured for wireless communication with the implantable medical device. The external device according to any one of aspects 1 - 3, wherein the first communication unit is a wire-based communication unit for wire-based communication with the display device. The external device according to any one of the preceding aspects, wherein the display device comprises: a first communication unit for communication with the housing unit, and a second communication unit for wireless communication with a second external device. The external device according to aspect 12, wherein the second communication unit of the display device is configured for communicating with the second external device over the Internet. The external device according to any one of aspects 12 and 13, wherein the first communication unit of the display device is a wireless communication unit for wireless communication with the housing unit. The external device according to aspect 14, wherein: the first communication unit of the display device is configured to communicate wirelessly with the housing unit using a first communication frequency, the second communication unit of the display device is configured to communicate wirelessly with the second external device using a second communication frequency, and the first and second communication frequencies are different. The external device according to any one of aspects 14 and 15, wherein: the first communication unit of the display device is configured to communicate wirelessly with the housing unit using a first communication protocol, the second communication unit of the display device is configured to communicate wirelessly with the second external device using a second communication protocol, and the first and second communication protocols are different. The external device according to any one of aspects 14 - 16, wherein the display device comprises: a first antenna configured for wireless communication with the housing, and a second antenna configured for wireless communication with the second external device. The external device according to any one of aspects 12 - 13, wherein the first communication unit is a wire-based communication unit for wire-based communication with the housing unit. The external device according to any one of the preceding aspects, wherein the display device is configured to display a user interface to the patient. The external device according to any one of the preceding aspects, wherein the housing unit is configured to transmit information pertaining to the display of the user interface to the display device. The external device according to any one of aspects 19 and 20, wherein the display device is configured to: receive input pertaining to communication to or from the implantable medical device from the patient, and transmit communication based on the received input to the housing unit. The external device according to any one of aspects 19 - 21, wherein the display device comprises a touch screen configured to display the user interface and receive the input from the patient. The external device according to any one of the preceding aspects, wherein the housing unit is configured to display a user interface to the patient. The external device according to any one of the preceding aspects, wherein the first communication unit of the housing unit is configured to receive communication from the implantable medical device pertaining to input from the patient, and wirelessly transmit communication based on the received input to the implantable medical device, using the second communication unit. The external device according to any one of the preceding aspects, wherein the second communication unit of the housing unit is configured for wireless communication with the implantable medical device using a standard network protocol. The external device according to aspect 25, wherein the standard network protocol is selected from a list comprising:

RFID-type protocol, WLAN-type protocol, Bluetooth-type protocol, BLE-type protocol, NFC-type protocol, 3G/4G/5G-type protocol, and GSM-type protocol. The external device according to aspect 25, wherein the second communication unit of the housing unit comprises a Bluetooth transceiver. The external device according to any one of the preceding aspects, wherein the second communication unit of the housing unit is configured for wireless communication with the implantable medical device using a proprietary network protocol. The external device according to any one of aspects 25 - 27, wherein the second communication unit of the housing unit comprises a UWB transceiver. The external device according to any one of aspects 4 - 28, wherein the first communication unit of the housing unit is configured for wireless communication with the display device using a standard network protocol. The external device according to aspect 29, wherein the standard network protocol is an NFC type protocol. The external device according to any one of aspects 4 - 28, wherein the first communication unit of the housing unit is configured for wireless communication with the display device using a proprietary network protocol. The external device according to any one of aspects 4 - 31, wherein a communication range of the first communication unit of the housing unit is less than a communication range of the second communication unit of the housing unit. The external device according to any one of aspects 14 - 32, wherein a communication range of the first communication unit of the display device is less than a communication range of the second communication unit of the display device. The external device according to any one of the preceding aspects, wherein at least one of the housing unit and the display device is configured allow communication between the housing unit and the display device on the basis of a distance between the housing unit and the display device. The external device according to any one of the preceding aspects, wherein at least one of the housing unit and the display device is configured allow communication between the housing unit and the display device on the basis of the housing unit being mechanically connected to the display device. The external device according to any one of the preceding aspects, wherein the housing unit is configured allow communication between the housing unit and the implantable medical device on the basis of a distance between the housing unit and the implantable medical device. The external device according to any one of the preceding aspects, wherein the housing unit further comprises an encryption unit configured to encrypt communication received from the display device. The external device according to aspect 37, wherein the housing unit is further adapted to transmit the encrypted communication, using the second communication unit, to the implantable medical device. The external device according to any one of aspects 14 - 38, wherein the second communication unit of the display device is configured to be disabled to enable at least one of: communication between the display device and the housing unit, and communication between the housing unit and the implantable medical device. The external device according to any one of the preceding aspects, wherein the display device is a wearable device or a handset. The external device according to aspect 40, wherein the housing unit comprises a case for the wearable device or handset. The external device according to any one of the preceding aspects, wherein the implantable medical device is an implantable medical device configured to exert a force on a body portion of the patient. The external device according to any one of the preceding aspects, wherein the implantable medical device comprises an electrical motor and a controller (300) for controlling the electrical motor. The external device according to any one of aspects 1 - 41, wherein the implantable medical device comprises an energy consuming part. A housing unit configured for communication with an implantable medical device when implanted in a patient, the housing unit being configured to mechanically and disconnectably connect to a display device and comprising a first communication unit for receiving communication from the display device and second communication unit for wirelessly transmitting communication to the implantable medical device. The housing unit according to aspect 45, wherein the display device is a wearable device or a handset and the housing unit comprises a case for the wearable device or handset. The housing unit according to any one of aspects 45 - 46, wherein the first communication unit is a wireless communication unit for wireless communication with the display device. The housing unit according to aspect 47, wherein: the first communication unit is configured to communicate wirelessly with the display device using a first communication frequency, the second communication unit is configured to communicate wirelessly with the implantable medical device using a second communication frequency, and the first and second communication frequencies are different. The housing unit according to any one of aspects 45 - 48, wherein the second communication unit is configured to communicate wirelessly with the implantable medical device using electromagnetic waves at a frequency below 100 kHz. The housing unit according to any one of aspects 45 - 49, wherein the second communication unit is configured to communicate wirelessly with the implantable medical device using electromagnetic waves at a frequency below 40 kHz. The housing unit according to any one of aspects 47 - 50, wherein the first communication unit is configured to communicate wirelessly with the display device using electromagnetic waves at a frequency above 100 kHz. The housing unit according to any one of aspects 45 - 51, wherein: the first communication unit is configured to communicate wirelessly with the display device using a first communication protocol, the second communication unit is configured to communicate wirelessly with the implantable medical device using a second communication protocol, and the first and second communication protocols are different. The housing unit according to any one of aspects 47 - 52, wherein the housing unit comprises: a first antenna configured for wireless communication with the display device, and a second antenna configured for wireless communication with the implantable medical device. The housing unit according to any one of aspects 45 - 46, wherein the first communication unit is a wire-based communication unit for wire-based communication with the display device. The housing unit according to any one of aspects 45 - 54, wherein the housing unit is configured to transmit information pertaining to the display of a user interface to the display device. The housing unit according to any one of aspects 45 - 55, wherein the housing unit is configured to receive patient input from the display device. The housing unit according to any one of aspects 45 - 56, wherein the housing unit is configured to display a user interface to the patient. The housing unit according to any one of aspects 45 - 57, wherein the second communication unit is configured for wireless communication with the implantable medical device using a standard network protocol. The housing unit according to aspect 58, wherein the standard network protocol is one selected from a list comprising:

RFID-type protocol, WLAN-type protocol, Bluetooth-type protocol, BLE-type protocol, NFC-type protocol, 3G/4G/5G-type protocol, and GSM-type protocol. The housing unit according to aspect 58, wherein the second communication unit comprises a Bluetooth transceiver. The housing unit according to any one of aspects 45 - 57, wherein the second communication unit is configured for wireless communication with the implantable medical device using a proprietary network protocol. The housing unit according to any one of aspects 58 - 61, wherein the second communication unit of the housing unit comprises a UWB transceiver. The housing unit according to any one of aspects 47 - 62, wherein the first communication unit of the housing unit is configured for wireless communication with the display device using a standard network protocol. The housing unit according to aspect 63, wherein the standard network protocol is an NFC type protocol. The housing unit according to any one of aspects 47 - 62, wherein the first communication unit of the housing unit is configured for wireless communication with the display device using a proprietary network protocol. The housing unit according to any one of aspects 47 - 65, wherein a communication range of the first communication unit is less than a communication range of the second communication unit. The housing unit according to any one of aspects 45 - 66, wherein the housing unit is configured allow communication between the housing unit and the display device on the basis of a distance between the housing unit and the display device. The housing unit according to any one of aspects 45 - 67, wherein the housing unit is configured allow communication between the housing unit and the display device on the basis of the housing unit being mechanically connected to the display device. The housing unit according to any one of aspects 45 - 68, wherein the housing unit is configured allow communication between the housing unit and the implantable medical device on the basis of a distance between the housing unit and the implantable medical device. The housing unit according to any one of aspects 45 - 69, wherein the housing unit further comprises an encryption unit configured to encrypt communication received from the display device. The housing unit according to aspect 70, wherein the housing unit is further adapted to transmit the encrypted communication, using the second communication unit, to the implantable medical device. The housing unit according to aspects 45 - 71, wherein the minimum bounding box of the housing unit and the display device when mechanically connected, is no more than: 10 % wider, 10 % longer or 100 % higher, than the minimum bounding box of the display device. The housing unit according to aspects 45 - 72, wherein the housing unit comprises one or more switches configured to, when the housing is not mechanically connected to the display device, be used by the patient. The housing unit according to aspect 73, wherein the switches are at least partly covered by the display device, when the display device is mechanically connected to the housing unit. The housing unit according to any one of aspects 45 - 74, wherein at least a part of the housing unit is configured to bend to mechanically connect to the display device. The housing unit according to any one of aspects 45 - 75, wherein at least a part of the housing unit is configured to covers at least one side of the display device. The housing unit according to any one of aspects 45 - 76, wherein the housing unit is configured to clasp the display device. The housing unit according to any one of aspects 45 - 76, wherein the housing unit is configured to mechanically connect to the display unit by an attachment device mechanically connected to the housing unit and to the display device. The housing unit according to any one of aspects 45 - 76, wherein the housing unit comprises a magnet for magnetically attaching the housing unit to the display device. The housing unit according to any one of aspects 45 - 79, wherein the housing unit is configured to communicate with an implantable medical device configured to exert a force on a body portion of the patient. The external device according to any one of aspects 45 - 80, wherein the housing unit is configured to communicate with an implantable medical device comprising an electrical motor and a controller for controlling the electrical motor.

General Security Mode An implantable controller for an implantable medical device, the implantable controller comprising: a wireless transceiver for communicating wirelessly with an external device, a security module, and a central unit configured to be in communication with the wireless transceiver, the security module and the implantable medical device, wherein: the wireless transceiver is configured to receive communication from the external device including at least one instruction to the implantable medical device, and transmit the received communication to the central unit, the central unit is configured to send secure communication to the security module, derived from the received communication from the external device, and the security module is configured to at least one of: decrypt at least a portion of the secure communication, and verify the authenticity of the secure communication, and the security module is configured to transmit a response communication to the central unit, and wherein: the central unit is configured to communicate the at least one instruction to the implantable medical device, the at least one instruction being based on: the response communication, or a combination of the response communication and the received communication from the external device. The implantable controller according to aspect 1, wherein the security module comprises a set of rules for accepting communication from the central unit. The implantable controller according to aspect 2, wherein the wireless transceiver is configured to be placed in an off-mode, in which no wireless communication can be transmitted or received by the wireless transceiver, and wherein the set of rules comprises a rule stipulating that communication from the central unit is only accepted when the wireless transceiver is placed in the off-mode. The implantable controller according to aspect 4, wherein the set of rules comprises a rule stipulating that communication from the central unit is only accepted when the wireless transceiver has been placed in the off-mode for a specific time period. The implantable controller according to any one of the preceding aspects wherein the central unit is configured to verify a digital signature of the received communication from the external device. The implantable controller according to aspect 4, wherein the set of rules comprises a rule stipulating that communication from the central unit is only accepted when the digital signature of the received communication has been verified by the central unit. The implantable controller according to any one of the preceding aspects, wherein the central unit is configured to verify the size of the received communication from the external device. The implantable controller according to aspect 7, wherein the set of rules comprises a rule stipulating that communication from the central unit is only accepted when the size of the received communication has been verified by the central unit. The implantable controller according to any one of the preceding aspects, wherein: the wireless transceiver is configured to receive a message from the external device being encrypted with at least a first and second layer of encryption, the central unit is configured to decrypt a first layer of decryption and transmit at least a portion of the message comprising the second layer of encryption to the security model, and the security module is configured to decrypt the second layer of encryption and transmit a response communication to the central unit based on the portion of the message decrypted by the security module. The implantable controller according to aspect 9, wherein the central unit is configured to decrypt a portion of the message comprising a digital signature, such that the digital signature can be verified by the central unit. The implantable controller according to aspect 9, wherein the central unit is configured to decrypt a portion of the message comprising message size information, such that the message size can be verified by the central unit. The implantable controller according to aspect 9, wherein the central unit is configured to decrypt a first and second portion of the message, and wherein the first portion comprises a checksum for verifying the authenticity of the second portion. The implantable controller according to any one of aspects 9 - 12, wherein the response communication transmitted from the security module comprises a checksum, and wherein the central unit is configured to verify the authenticity of at least a portion of the message decrypted by the central unit using the received checksum. The implantable controller according to aspect 4, wherein the set of rules comprises a rule related to the rate of data transfer between the central unit and the security module. The implantable controller according to any one of aspects 9 - 14, wherein the security module is configured to decrypt a portion of the message comprising a digital signature, encrypted with the second layer of encryption, such that the digital signature can be verified by the security module. The implantable controller according to any one of aspects 4 - 15, wherein the central unit is only capable of decrypting a portion of the receive communication from the external device when the wireless transceiver is placed in the off-mode. The implantable controller according to any one of aspects 4 - 16, wherein the central unit is only capable of communicating the at least one instruction to the implantable medical device when the wireless transceiver is placed in the off-mode. The implantable controller according to any one of the preceding aspects, wherein the implantable controller is configured to: receive, using the wireless transceiver, a message from the external device comprising a first non-encrypted portion and a second encrypted portion, decrypt the encrypted portion, and use the decrypted portion to verify the authenticity of the non-encrypted portion. The implantable controller according to aspect 18, wherein the central unit is configured to: transmit the encrypted portion to the security module, receive a response communication from the security module, based on information contained in the encrypted portion being decrypted by the security module, and use the response communication to verify the authenticity of the non-encrypted portion. The implantable controller according to any one of aspects 18 - 19, wherein the non-encrypted portion comprises at least a portion of the at least one instruction to the implantable medical device. The implantable controller according to any one of the preceding aspects, wherein the implantable controller is configured to: receive, using the wireless transceiver, a message from the external device comprising information related to at least one of: a physiological parameter of the patient and a physical parameter of the implanted medical device, and use the received information to verify the authenticity of the message. The implantable controller according to aspect 21, wherein the physiological parameter of the patient comprises at least one of: a temperature, a heart rate and a saturation value. The implantable controller according to aspect 21 , wherein the physical parameter of the implanted medical device comprises at least one of: a current setting or value of the implanted medical device, a prior instruction sent to the implanted medical device or an ID of the implanted medical device. The implantable controller according to any one of aspects 21 - 23, wherein the portion of the message comprising the information is encrypted, and wherein the central unit is configured to transmit the encrypted portion to the security module and receive a response communication from the security module, based on the information having been decrypted by the security module. The implantable controller according to any one of the preceding aspects, wherein the security module comprises a hardware security module comprising at least one hardware -based key. The implantable controller according to aspect 25, wherein the hardware-based key corresponds to a hardware -based key in the external device. The implantable controller according to aspect 25, wherein the hardware-based key corresponds to a hardware -based key on a key-card connectable to the external device. The implantable controller according to any one of the preceding aspects, wherein the security module comprises a software security module comprising at least one software-based key. The implantable controller according to aspect 28, wherein the software -based key corresponds to a software -based key in the external device. The implantable controller according to aspect 28, wherein the software -based key corresponds to a software-based key on a key-card connectable to the external device. The implantable controller according to any one of the preceding aspects, wherein the security module comprises a combination of a software-based key and a hardware -based key. The implantable controller according to any one of the preceding aspects, wherein the security module comprises at least one cryptoprocessor. The implantable controller according to any one of the preceding aspects, wherein the wireless transceiver is configured to receive communication from a handheld external device. The implantable controller according to any one of the preceding aspects, wherein the at least one instruction to the implantable medical device comprises an instruction for changing an operational state of the implantable medical device. The implantable controller according to any one of the preceding aspects, wherein the wireless transceiver is configured to communicate wirelessly with the external device using electromagnetic waves at a frequency below 100 kHz. The implantable controller according to aspect 35, wherein the wireless transceiver is configured to communicate wirelessly with the external device using electromagnetic waves at a frequency below 40 kHz. The implantable controller according to any one of the preceding aspects, wherein: the wireless transceiver is configured to communicate wirelessly with the external device using a first communication protocol, the central unit is configured to communicate with the security module using a second communication protocol, and the first and second communication protocols are different. The implantable controller according to any one of the preceding aspects, wherein the wireless transceiver is configured to communicate wirelessly with the external device using a standard network protocol. The implantable controller according to aspect 38, wherein the standard network protocol is selected from a list comprising:

RFID- type protocol, WLAN- type protocol, Bluetooth- type protocol, BLE- type protocol, NFC- type protocol, 3G/4G/5G- type protocol, and GSM- type protocol. The implantable controller according to any one of aspects 1 - 37, wherein the wireless transceiver is configured to communicate wirelessly with the external device using a proprietary network protocol. The implantable controller according to any one of aspects 1 - 40, wherein the wireless transceiver comprises a UWB transceiver. The external device according to any one of the preceding aspects, wherein the security module and the central unit are comprised in a controller. The external device according to aspect 42, wherein the wireless transceiver is comprised in the controller. The external device according to any one of the preceding aspects, wherein the implantable medical device is an implantable medical device configured to exert a force on a body portion of the patient. The external device according to any one of the preceding aspects, wherein the implantable medical device comprises an electrical motor and wherein the controller is configured for controlling the electrical motor.

Variable lmpedance l An implantable medical device comprising a receiving unit comprising: at least one coil configured for receiving transcutaneously transferred energy, a measurement unit configured to measure a parameter related to the energy received by the coil, a variable impedance electrically connected to the coil, a switch placed between the variable impedance and the coil for switching off the electrical connection between the variable impedance and the coil, and a controller configured to: control the variable impedance for varying the impedance and thereby tune the coil based on the measured parameter and control the switch for switching off the electrical connection between the variable impedance and the coil in response to the measured parameter exceeding a threshold value. The implantable medical device according to aspect 1, wherein the controller is configured to vary the variable impedance in response to the measured parameter exceeding a threshold value. The implantable medical device according to any one of aspects 1 and 2, wherein the measurement unit is configured to measure a parameter related to the energy received by the coil over a time period. The implantable medical device according to any one of the preceding aspects, wherein the measurement unit is configured to measure a parameter related to a change in energy received by the coil. The implantable medical device according to any one of the preceding aspects, wherein the first switch is placed at a first end portion of the coil, and wherein the implantable medical device further comprises a second switch placed at a second end portion of the coil, such that the coil can be completely disconnected from other portions of the implantable medical device. The implantable medical device according to any one of the preceding aspects, wherein the receiving unit is configured to receive transcutaneously transferred energy in pulses according to a pulse pattern, and wherein the measurement unit is configured to measure a parameter related to the pulse pattern. The implantable medical device according to aspect 6, wherein the controller is configured to control the variable impedance in response to the pulse pattern deviating from a predefined pulse pattern. The implantable medical device according to aspect 6, wherein the controller is configured to control the switch for switching off the electrical connection between the variable impedance and the coil in response to the pulse pattern deviating from a predefined pulse pattern. The implantable medical device according to any one of the preceding aspects, wherein the measurement unit is configured to measure a temperature in the implantable medical device or in the body of the patient, and wherein the controller is configured to control the first and second switch in response to the measured temperature. The implantable medical device according to any one of the preceding aspects, wherein the variable impedance comprises a resistor and a capacitor. The implantable medical device according to any one of the preceding aspects, wherein the variable impedance comprises a resistor and an inductor. The implantable medical device according to any one of the preceding aspects, wherein the variable impedance comprises an inductor and a capacitor. The implantable medical device according to any one of the preceding aspects, wherein the variable impedance comprises a digitally tuned capacitor. The implantable medical device according to any one of the preceding aspects, wherein the variable impedance comprises a digital potentiometer. The implantable medical device according to any one of the preceding aspects, wherein the variable impedance comprises a variable inductor. The implantable medical device according to any one of the preceding aspects, wherein the variation of the impedance is configured to lower the active power that is received by the receiving unit. The implantable medical device according to any one of the preceding aspects, wherein the variable impedance is placed in series with the coil. The implantable medical device according to any one of aspects 1 - 16, wherein the variable impedance is placed parallel to the coil. The implantable medical device according to any one of the preceding aspects, further comprising an energy storage unit connected to the receiving unit, and wherein the energy storage unit is configured for storing energy received by the receiving unit. The implantable medical device according to any one of the preceding aspects, further comprising an energy consuming part. The implantable medical device according to aspect 20, wherein the energy consuming part of the implantable medical device is configured to exert a force on a body portion of the patient. The implantable medical device according to aspect 20, wherein the energy consuming part of the implantable medical device comprises an electrical motor and wherein the controller is configured for controlling the electrical motor.

Variable_Impedance_2 An implantable medical device comprising a receiving unit comprising: at least one coil configured for receiving transcutaneously transferred energy, a measurement unit configured to measure a parameter related to the energy received by the coil, a first switch is placed at a first end portion of the coil, a second switch placed at a second end portion of the coil, such that the coil can be completely disconnected from other portions of the implantable medical device, and a controller configured to control the first and second switch for completely disconnecting the coil from other portions of the implantable medical device on the basis of the measured parameter. The implantable medical device according to aspect 1, wherein the controller is configured to control the first and second switch in response to the measured parameter exceeding a threshold value. The implantable medical device according to any one of aspects 1 and 2, wherein the measurement unit is configured to measure a parameter related to the energy received by the coil over a time period. The implantable medical device according to any one of the preceding aspects, wherein the measurement unit is configured to measure a parameter related to a change in energy received by the coil. The implantable medical device according to any one of the preceding aspects, wherein the receiving unit is configured to receive transcutaneously transferred energy in pulses according to a pulse pattern, and wherein the measurement unit is configured to measure a parameter related to the pulse pattern. The implantable medical device according to aspect 5, wherein the controller is configured to control the first and second switch in response to the pulse pattern deviating from a predefined pulse pattern. The implantable medical device according to any one of the preceding aspects, wherein the measurement unit is configured to measure a temperature in the implantable medical device or in the body of the patient, and wherein the controller is configured to control the first and second switch in response to the measured temperature. The implantable medical device according to any one of the preceding aspects, further comprising an energy storage unit connected to the receiving unit, and wherein the energy storage unit is configured for storing energy received by the receiving unit. The implantable medical device according to any one of the preceding aspects, further comprising an energy consuming part. The implantable medical device according to aspect 9, wherein the energy consuming part of the implantable medical device is configured to exert a force on a body portion of the patient. The implantable medical device according to aspect 9, wherein the energy consuming part of the implantable medical device comprises an electrical motor and wherein the controller is configured for controlling the electrical motor.

Variable_Impedance_3 An implantable medical device comprising a receiving unit comprising: at least one coil configured for receiving transcutaneously transferred energy, a measurement unit configured to measure a parameter related to the energy received by the coil, and a controller, wherein: the receiving unit is configured to receive transcutaneously transferred energy in pulses according to a pulse pattern, and the measurement unit is configured to measure a parameter related to the pulse pattern, and the controller is configured to control the receiving unit in response to the pulse pattern of the received energy deviating from a predetermined pulse pattern. The implantable medical device according to aspect 1, further comprising at least one switch placed in series with the coil for switching of the coil, wherein the controller is configured to control the switch to switch of the coil in response to the pulse pattern of the received energy deviating from a predetermined pulse pattern. The implantable medical device according to aspect 1, further comprising a variable impedance electrically connected to the coil, for varying the impedance and thereby tuning the coil, and wherein the controller is configured to control the variable impedance in response to the pulse pattern of the received energy deviating from a predetermined pulse pattern. The implantable medical device according to any one of the preceding aspects, wherein the measurement unit is configured to measure a parameter related to the energy received by the coil over a time period. The implantable medical device according to any one of the preceding aspects, wherein the measurement unit is configured to measure a parameter related to a change in energy received by the coil. The implantable medical device according to any one of the preceding aspects, wherein the measurement unit is configured to measure a temperature in the implantable medical device or in the body of the patient, and wherein the controller is configured to control the first and second switch in response to the measured temperature. The implantable medical device according to any one of the preceding aspects, wherein the first switch is placed at a first end portion of the coil, and wherein the implantable medical device further comprises a second switch placed at a second end portion of the coil, such that the coil can be completely disconnected from other portions of the implantable medical device. The implantable medical device according to aspect 3, wherein the variable impedance comprises a resistor and a capacitor. The implantable medical device according to aspect 3, wherein the variable impedance comprises a resistor and an inductor. The implantable medical device according to aspect 3, wherein the variable impedance comprises an inductor and a capacitor. The implantable medical device according to aspect 3, wherein the variable impedance comprises a digitally tuned capacitor. 12. The implantable medical device according to aspect 3, wherein the variable impedance comprises a digital potentiometer.

13. The implantable medical device according to aspect 3, wherein the variable impedance comprises a variable inductor.

14. The implantable medical device according to any one of aspects 3 - 12, wherein the variation of the impedance is configured to lower the active power that is received by the receiving unit.

15. The implantable medical device according to any one of aspects 3 - 13, wherein the variable impedance is placed in series with the coil.

16. The implantable medical device according to any one of aspects 3 - 13, wherein the variable impedance is placed parallel to the coil.

17. The implantable medical device according to any one of the preceding aspects, further comprising an energy storage unit connected to the receiving unit, and wherein the energy storage unit is configured for storing energy received by the receiving unit.

18. The implantable medical device according to any one of the preceding aspects, further comprising an energy consuming part.

19. The implantable medical device according to aspect 18, wherein the energy consuming part of the implantable medical device is configured to exert a force on a body portion of the patient.

20. The implantable medical device according to aspect 18, wherein the energy consuming part of the implantable medical device comprises an electrical motor and wherein the controller is configured for controlling the electrical motor.

Data Packet Encryption - External Device

1. An external system for providing remote instructions to an implantable medical device, the external system being configured to: provide instructions to be transmitted to the implantable medical device, derive a checksum from the instructions, electronically sign the instructions and the checksum, and form a data packet from the instructions, the electronic signature and the checksum, wherein the external system comprises a wireless transmitter configured to wirelessly send the data packet to the implantable medical device.

2. The external system according to aspect 1, wherein the external system is further configured to encrypt the data packet at the external system.

3. The external system according to any one of aspects 1 and 2, wherein the wireless transmitter is part of a wireless transceiver comprised in the external system.

4. The external system according to any one of the preceding aspects, wherein the external system comprises a first external device and a second external device, and wherein the first external device is configured to transmit the data packet to the second external device, and wherein the second external device is configured to transmit the data packet wirelessly to the implantable medical device without changing the data packet. The external system according to any one of the preceding aspects, wherein the external system comprises a first external device and a second external device, and wherein the first external device is configured to transmit the data packet to the second external device, and wherein the second external device is configured to transmit the data packet wirelessly to the implantable medical device without full decryption of the data packet. The external system according to any one of the preceding aspects, wherein the external system is configured to transmit at least one instruction for altering the control program of the implantable medical device, to the implantable medical device. The external system according to any one of the preceding aspects, wherein the external system is configured to provide at least one instruction to the implantable medical device for altering at least one parameter for affecting the control of the implantable medical device. The external system according to aspect 7, wherein the external system is configured to provide at least one instruction for updating at least one parameter of the control program to a parameter value comprised in a set of parameter values stored in the implantable medical device. The external system according to any one of the preceding aspects, wherein the first external device is configured to send the data packet from the first external device to the second external device using a first network protocol and send the data packet from the second external device to the implantable medical device using a second network protocol. The external system according to any one of the preceding aspects, wherein the first external device is configured to send the data packet from the first external device to the second external device using wired communication and send the data packet from the second external device to the implantable medical device using wireless communication. The external system according to any one of aspects 1 - 9, wherein the first external device is configured to wirelessly send the data packet from the first external device to the second external device using a first network protocol, and wirelessly send the data packet from the second external device to the implantable medical device using a second network protocol. The external system according to any one of aspects 1 - 9 or 11, wherein the first external device is configured to wirelessly send the data packet from the first external device to the second external device using a first frequency band, and wirelessly send the data packet from the second external device to the implantable medical device using a second frequency band. The external system according to any one of the preceding aspects, wherein the first external device is configured to wirelessly send the data packet from the first external device to the second external device using a first wireless technology, and wirelessly send the data packet from the second external device to the implantable medical device using a second wireless technology. The external system according to any one of the preceding aspects, wherein the external system is configured to electronically sign the instructions at the external system using a key of the external system. The external system according to aspect 14, wherein the key is a non-extractable key. The external system according to any one of aspects 14 and 15, wherein the second external device is configured to perform a proof of possession operation comprising the steps of: transmitting, form the first external device to the second external device, a query based on a public key associated with the private of the external system, receiving, at the second external device, a response based on the possession of the private key in the first external device, and verifying that the response based on the possession of the private key matches the query based on a public key. The external system according to any one of the preceding aspects, wherein: the first external device is configured to form the data packet and electronically sign the instruction using a first private key, and the second external device is configured to: receive the data packet from the first external device, verify that the first external device is a trusted transmitter, in response to the verification, electronically sign the data packet using a second private key, and transmit the data packet from the second external device to the medical implant. The external system according to any one of the preceding aspects, wherein the checksum is configured to verify that no changes have been made to the bit stream forming the instructions. The external system according to any one of the preceding aspects, wherein the first external device is configured to at least one of: electronically sign the instructions and encrypt the data packet using a key placed on a key device external to the first external device. The external system according to any one of the preceding aspects, wherein the external system further comprises a key device configured to hold at least one private key. The external system according to aspect 20, wherein the key device comprises a wireless transmitter for wirelessly transmitting the at least one private key or a signal based on the private key, to the first external device. The external system according to any one of the preceding aspects, wherein the second external device is configured to at least one of: electronically sign the instructions and encrypt the data packet using a key placed on a key device external to the second external device. The external system according to any one of aspects 14 - 22, wherein the external system further comprises a second key device configured to hold at least one second private key. The external system according to aspect 23, wherein the second key device comprises a wireless transmitter for wirelessly transmitting the at least one private key or a signal based on the private key to the second external device. The external system according to aspect 14, further comprising a second key device comprising a wireless transmitter for wirelessly transmitting at least one second private key or a signal based on the second private key to the first external device. The external system according to any one of aspects 14 - 25, wherein at least one of the key device and the second key device comprises at least one of: a key card, a wearable device and a handset. The external system according to any one of the preceding aspects, wherein the first external device is configured to be unlocked by user credentials provided to the first external device. The external system according to aspect 27, wherein the first external device is configured to be unlocked by user credentials comprising a username and a password. The external system according to aspect 28, wherein the first external device is configured to be unlocked by user credentials comprising a PIN -code. The external system according to any one of aspects 27 - 29, wherein the first external device is configured to verify the user credentials by comparing the user credentials with user credentials stored in the first external device. The external system according to aspect 30, wherein the first external device is configured to verify the user credentials by comparing the user credentials with user credentials stored in the first external device by the manufacturer of the first external device. The external system according to any one of aspects 27 - 31, wherein the first external device is configured verify the user credentials by comparing the user credentials with user credentials stored as hardware or software in the first external device. The external system according to any one of aspects 27 - 32, wherein the first external device is configured verify the user credentials by communicating with a remote server. The external system according to any one of the preceding aspects, wherein the second external device is configured to be unlocked by user credentials provided to the second external device. The external system according to aspect 34, wherein the first external device is configured to be unlocked by user credentials comprising a username and a password. The external system according to aspect 34, wherein the first external device is configured to be unlocked by user credentials comprising a PIN -code. The external system according to aspect 36, wherein the second external device is configured to verify the user credentials by comparing the user credentials with user credentials stored in the second external device. The external system according to aspect 37, wherein the second external device is configured to verify the user credentials by comparing the user credentials with user credentials stored in the second external device by the manufacturer of the second external device. The external system according to any one of aspects 37 and 38, wherein the second external device is configured verify the user credentials by comparing the user credentials with user credentials stored as hardware or software in the second external device. The external system according to any one of aspects 37 - 39, wherein the second external device is configured verify the user credentials by communicating with a remote server. The external system according to any one of the preceding aspects, wherein the external system is configured to function without connection to the Internet. The external system according to any one of the preceding aspects, wherein the external system is configured to communicate with the implantable medical device independently of time. The external system according to any one of the preceding aspects 14 - 42, wherein the first and second private keys are different. The external system according to aspect 43, wherein the first and second private keys comprises at least one common element. The external system according to any one of aspects 14 - 44, wherein at least one first and second external device are configured to be unlocked by at least one of the first and second private key. The external system according to any one of the preceding aspects, wherein the external system comprises a central server, and wherein the central server is configured to form a data packet from the instructions, the electronic signature and the checksum and further configured to provide the formed data packet to the first external device. The external system according to aspect 46, wherein the central server can be accessed by at least one healthcare professional, such that the healthcare professional can provide input to the central server for forming the instructions to be sent to the implantable medical device. The external system according to aspect 46, wherein the central server can be accessed by at least one patient, such that the patient can provide input to the central server for verifying at least one of: the authenticity of the healthcare professional and the correctness of the instructions. The external system according to aspect 48, wherein the healthcare provider can electronically sign the instructions at the central server. The external system according to any one of aspects 48 and 49, wherein the patient can electronically sign the instructions at the central server. The external system according to any one of aspects 46 - 50, wherein the central server is configured to verify the authenticity of the first and second key and electronically sign the instructions using the first and second key. The external system according to any one of the preceding aspects, wherein the second key is a user key, and wherein the external system is configured to use the second key for at least one of: approving that communication is transmitted to the implantable medical device, and approving that a healthcare provider prepares an instruction to the implantable medical device. The external system according to aspect 52, wherein the approval step can be performed by first or second external device. The external system according to any one of aspects 14 - 53, wherein the first key is required to create an instruction to the implantable medical device and the second key is required to transmit the created instruction to the implantable medical device. The external system according to any one of aspects 2 - 54, wherein at least one of the first and second external device comprises an input button configured to be used for verifying user presence. The external system according to aspect 55, wherein the input button con be configured to replace at least one of: input of at least one key to at least one of the first and second external device, and input of credentials into at least one of the first and second external device. The external system according to aspect 55, wherein the input button is configured to replace the second key. The external system according to any one of the preceding aspects, wherein the external system is configured to transmit the data packet to the implantable medical device, and wherein the data packet comprises: at least one instruction signed by a first key and a public key including information about which root have created the public key. The external system according to any one of aspects 2 - 57, wherein at least one of the first and second external device is configured to enable communication with the implantable medical device based on at least one password being provided to at least one of the first and second external device. The external system according to aspect 58, wherein at least one of the first and second external device is configured to enable communication with the implantable medical device based on two passwords being provided to at least one of the first and second external device. The external system according to aspect 59, wherein at least one of the first and second external device is configured to enable communication with the implantable medical device based on one patient password and one healthcare provider passwords being provided to at least one of the first and second external device. The external system according to any one of the preceding aspects, wherein at least one of the first and second external devices are configured to perform a verification query operation with at least one of the first and second key device, the verification query operation comprising: transmitting, from the first or second external devices, a query comprising a computational challenge to at least one of the first and second key device, receiving, at the first or second external devices, a response based on the transmitted computational challenge, and verifying, at the first or second external devices, the received response.

62. The external system according to aspect 61, wherein at least one of the first and second external devices are configured to perform a verification query operation in the form of a proof of possession operation comprising: receiving a public key of at least one of the first and second key devices, the public key being associated with a private key of the first or second key device, transmitting, from at least one of the first and second external devices, a computational challenge to the first or second key device, based on the public key received from the first or second key device, receiving a response from the first or second key device based on the possession of the private key in the first or second key device, and verifying that the response based on the possession of the private key matches the query based on a public key.

Data Packet Encryption - Implant

1. A implantable medical device configured to receive remote instructions from an external system, the implantable medical device comprising: a wireless receiver configured to receive wirelessly transmitted data packets from the external system and a computing unit configured to: verify the electronic signature, and use a checksum provided in the data packet to verify the integrity of the instructions.

2. The implantable medical device according to aspect 1, wherein the computing unit is configured to decrypt the data packet.

3. The implantable medical device according to any one of aspects 1 and 2, wherein the computing unit is configured to use the checksum to verify that the bit stream making up the instructions is unchanged.

4. The implantable medical device according to any one of aspects 1 and 2, wherein the wireless receiver is part of a wireless transceiver.

5. The implantable medical device according to any one of aspects 1 - 4, wherein the computing unit comprises a memory unit configured to store electronic signatures, and wherein the computing unit is configured to verify the electronic signature my comparing the electronic signature with the electronic signatures stored in the memory unit. The implantable medical device according to any one of the preceding aspects, wherein the implantable medical device comprises a control program configured to control at least one function of the implantable medical device, and wherein computing unit is configured to alter the control program on the basis of the received instructions. The implantable medical device according to any one of the preceding aspects, wherein the implantable medical device comprises an internal computing unit configured to run a control program for controlling a function of the implantable medical device, wherein the control program comprises at least one adjustable parameter affecting the control of the implantable medical device, and wherein the method of providing remote instructions comprises providing instructions for altering the at least one parameter for affecting the control of the implantable medical device. The implantable medical device according to aspect 7, wherein the computing unit comprises a memory unit configured to store parameter values, and wherein the method further comprises the step of verifying that the instructions for altering the at least one parameter will result in the at least one parameter being updated to a parameter value comprised in the set of stored parameter values. The implantable medical device according to any one of the preceding aspects, wherein the implantable medical device comprises a central unit, comprising at least one of a wireless receiver and a wireless transceiver, and a security module connected to the central unit, wherein the implantable medical device is configured to transfer the data packet from the central unit to the security module and wherein the security module is configured to performing at least a portion of at least one of the decryption and the signature verification. The implantable medical device according to aspect 9, wherein the security module comprises a set of rules for accepting communication from the central unit, and wherein the security module is configured to verify compliance with the set of rules. The implantable medical device according to aspect 10, wherein wireless receiver or wireless transceiver is configured to be placed in an off-mode, in which no wireless communication can be received by the wireless transceiver, and wherein the set of rules comprises a rule stipulating that communication from the central unit is only accepted at the security module when the wireless transceiver is placed in the off-mode. The implantable medical device according to any one of the preceding aspects, wherein the implantable medical device is configured to at least one of decrypting the data packet and verifying the electronic signature using a private key of the implantable medical device. The implantable medical device according to any one of aspects 10 - 12, wherein the private key is a non-extractable key. The implantable medical device according to any one of aspects 10 - 13, wherein the implantable medical device is configured to perform a proof of possession operation comprising: transmitting, from the implantable medical device to the external system, a query based on a public key associated with the private key of the external system, receiving, at the implantable medical device, a response based on the possession of the private key in the external system, and verifying that the response based on the possession of the private key matches the query based on a public key. The implantable medical device according to any one of the preceding aspects, wherein the implantable medical device is configured to communicate with the external system independently of time. The implantable medical device according to any one of the preceding aspects, wherein the private key is provided in the implantable medical device by the manufacturer of the implantable medical device. The implantable medical device according to aspect 16, wherein the private key is stored as hardware or software in the implantable medical device. The implantable medical device according to any one of the preceding aspects 12 - 17, wherein the implantable medical device is configured to: verify a first electronic signature made using at least one of a first key and a second key, and verifying a second electronic signature made using at least one of a first key and a second key. The implantable medical device according to aspect 18, wherein at least one of the first and second keys is a private key. The implantable medical device according to aspect 18, wherein the first and second keys are different. The implantable medical device according to aspect 20, wherein the first and second keys comprises at least one common element. The implantable medical device according to any one of aspects 18 - 21, wherein the implantable medical device is configured to: verify a first electronic signature to allow communication from the external system to the implantable medical device, and verify a second electronic signature to allow an instruction received in the communication to alter the control program running on the implantable medical device. The implantable medical device according to aspect 22, wherein the first electronic signature is an electronic signature linked to the user of the implantable medical device and the second electronic signature is an electronic signature linked to a healthcare provider. The implantable medical device according to any one of aspects 12 - 23, wherein only a portion of the private key is needed to at least one of: decrypt the data packet and verify the electronic signature. The implantable medical device according to any one of aspects 12 - 23, wherein the implantable medical device trusts any external device holding the private key. The implantable medical device according to any one of the preceding aspects, wherein the implantable medical device is configured to receive the data packet comprising: at least one instruction signed by a private key of the external system, and a public key including information about which root have created the public key. The implantable medical device according to any one of the preceding aspects, wherein the implantable medical device is configured to accept communication from an external system based on at least one password being provided to the implantable medical device. The implantable medical device according to aspect 27, wherein the implantable medical device is configured to accept communication from an external system based on two passwords being provided to the implantable medical device. The implantable medical device according to aspect 28, wherein the implantable medical device is configured to accept communication from an external system based on one patient password and one healthcare provider passwords being provided to the implantable medical device.

Method of Communication A method of using the system for injecting a substance into a patient’s body according to any one of the preceding aspects, comprising a step of wireless communication between components of the system. The method according to aspect 1, comprising at least one of the following steps: encrypting the wireless communication from or to, or both from and to, a controller of the system, signing data transmitted by a controller via the wireless communication, and inputting authentication data of the patient to authenticate a user of the system. The method according to aspect 2, wherein the step of encrypting the wireless communication includes encryption with a public key and decryption with a private key. The method according to aspect 3, comprising the step of deriving the private key as a combined key by combining at least a first key and a second key. The method according to any one of aspects 2 to 4, wherein the step of signing the data transmitted by the controller via the wireless communication involves use of a private key, wherein the method comprises the further step of verifying the signed data using a public key. The method according to any one of aspects 2 to 5, comprising the step of obtaining authentication data of the patient. 7. The method according to aspect 6, wherein the step of obtaining authentication data of the patient includes obtaining such data using at least one of a fingerprint reader, a retina scanner, a camera, a graphical user interface for inputting a code, and a microphone.

8. The method according to any one of aspects 2 to 7, comprising the step of generating a sensation detectable by a sense of the patient and the step of authenticating a communication channel between two controllers of the system by inputting authentication data of the patient relating to the sensation.

9. The method according to aspect 8, wherein the step of authenticating the communication channel involves a step of verifying that the authentication data match data from a sensation generator relating to the sensation generated by the sensation generator.

10. The method according to aspect 8 or 9, wherein the step of generating a sensation detectable by the sense of the patient comprises generation of at least one of: a vibration, which includes or does not include a fixed-frequency mechanical vibration, a sound, which includes or does not include a superposition of fixed-frequency mechanical vibrations, a photonic signal, which includes or does not include a non-visible light pulse, such as an infrared pulse, a light signal, which includes or does not include a visual light pulse, an electrical signal, which includes or does not include an electrical current pulse, and a heat signal, which includes or does not include a thermal pulse.

Data Packet Encryption - Method

1. A method of providing remote instructions from an external system to an implantable medical device, the method comprising: deriving a checksum, at the external system, from the instructions to be sent to the implantable medical device, electronically signing the instructions and the checksum, at the external system, wherein: the instructions, the checksum and the electronic signature form a data packet, wirelessly sending the data packet to the implantable medical device, verifying the electronic signature, and using the checksum to verify the integrity of the instructions.

2. The method according to aspect 1, further comprising the steps of encrypting the data packet at the external system using a private key of the external system, and decrypting, at the implantable medical device, the data packet using a private key of the implantable medical device. The method according to any one of aspects 1 and 2, wherein the step of verifying the electronic signature comprises comparing the electronic signature with electronic signatures stored in the implantable medical device. The method according to any one of aspects 1 - 3, wherein the step of wirelessly sending the data packet to the implantable medical device comprises sending the data packet from a first external device to a second external device using wired communication and wirelessly sending the data packet from the second external device to the implantable medical device. The method according to any one of aspects 1 - 4, wherein the step of wirelessly sending the data packet to the implantable medical device comprises sending the data packet from a first external device to a second external device and further wirelessly sending the data packet from the second external device to the implantable medical device, and wherein the second external device transmits the data packet without changing the data packet. The method according to any one of aspects 1 - 5, wherein the step of wirelessly sending the data packet to the implantable medical device comprises sending the data packet from a first external device to a second external device and further wirelessly sending the data packet from the second external device to the implantable medical device, and wherein the second external device transmits the data packet without full decryption. The method according to any one of the preceding aspects, wherein the implantable medical device comprises a control program configured to control at least one function of the implantable medical device, and wherein the method further comprises altering the control program on the basis of the received instructions. The method according to any one of the preceding aspects, wherein the implantable medical device comprises an internal computing unit configured to run a control program for controlling a function of the implantable medical device, wherein the control program comprises at least one adjustable parameter affecting the control of the implantable medical device, and wherein the method of providing remote instructions comprises providing instructions for altering the at least one parameter for affecting the control of the implantable medical device. The method according to aspect 8, wherein the implantable medical device comprises a set of stored parameter values, and wherein the method further comprises the step of verifying that the instructions for altering the at least one parameter will result in the at least one parameter being updated to a parameter value comprised in the set of stored parameter values. The method according to any one of the preceding aspects, wherein the step of wirelessly sending the data packet to the implantable medical device comprises: wirelessly sending the data packet from a first external device to a second external device using a first network protocol, and wirelessly sending the data packet from the second external device to the implantable medical device using a second network protocol. The method according to any one of the preceding aspects, wherein the step of wirelessly sending the data packet to the implantable medical device comprises: wirelessly sending the data packet from a first external device to a second external device using a first frequency band, and wirelessly sending the data packet from the second external device to the implantable medical device using a second frequency band. The method according to any one of the preceding aspects, wherein the step of wirelessly sending the data packet to the implantable medical device comprises: wirelessly sending the data packet from a first external device to a second external device using a first wireless technology, and wirelessly sending the data packet from the second external device to the implantable medical device using a second wireless technology, wherein the first wireless technology has an effective range being one of: 2 times, 4 times, 8 times 20 times, 50 times or 100 times longer than the first wireless technology. The method according to any one of the preceding aspects, wherein the implantable medical device comprises a central unit, comprising a wireless transceiver, and a security module connected to the central unit, wherein the step of decrypting, at the implantable medical device, the data packet, comprises transferring the data packet from the central unit to the security module, and performing at least a portion of the decryption in the security module. The method according to aspect 13, wherein the security module comprises a set of rules for accepting communication from the central unit, and wherein the step of transferring the data packet from the receiving unit of the implant to the security module comprises verifying compliance with the set of rules. The method according to aspect 14, wherein wireless transceiver is configured to be placed in an off-mode, in which no wireless communication can be received by the wireless transceiver, and wherein the set of rules comprises a rule stipulating that communication from the central unit is only accepted at the security module when the wireless transceiver is placed in the off- mode. The method according to any one of the preceding aspects, wherein the step of electronically signing the instructions at the external system comprises electronically signing the instructions at the external system using a private key of the external system. The method according to aspect 16, wherein the private key is a non -extractable key. The method according to any one of aspects 16 and 17, wherein the step of verifying the electronic signature comprises performing a proof of possession operation comprising the steps of: transmitting, form the medical device to the external system, a query based on a public key associated with the private of the external system, receiving, at the medical device, a response based on the possession of the private key in the external system, and verifying that the response based on the possession of the private key matches the query based on a public key. The method according to any one of the preceding aspects, wherein the step of forming the data packet is performed at a first external device, and wherein the step of electronically signing the instructions comprises electronically signing the instruction using a first private key, and wherein the method further comprises: transmitting the data packet from the first external device to a second external device, verifying, at the second external device, that the transmitter is a trusted transmitter, in response to the verification, electronically signing the data packet using a second private key and transmitting the data packet from the second external device to the medical implant, and verifying, at the medical implant, the electronic signatures generated using the first and second private keys. The method according to any one of the preceding aspects, wherein the step of electronically signing the instructions and the checksum, at the external system, comprising signing the instructions and the checksum with the use of a key placed on a key device separate from at least one of the first and second external device. The method according to any one of the preceding aspects, wherein the step of electronically signing the instructions and the checksum, at the external system, comprising signing the instructions and the checksum with the use of a key placed on a key device comprising a wireless transmitter for wirelessly transmitting the at least one private key to at least one of the first and second external device. The method according to any one of aspects 20 and 21, wherein the step of electronically signing the instructions and the checksum, at the external system, further comprises signing the instructions and the checksum with the use of a second key placed on the key device or on a second key device, separate from at least one of the first and second external device. The method according to any one of aspects 21 and 22, wherein at least one of the key device and the second key device comprises at least one of: a key card, a wearable device and a handset. The method according to any one of the preceding aspects, further comprising the step of unlocking at least one of the first and second external device using user credentials provided to the first and/or second external device. The method according to aspect 24, wherein the step of unlocking at least one of the first and second external devices comprises unlocking at least one of the first and second external devices using a username and a password. The method according to aspect 24, wherein the step of unlocking at least one of the first and second external devices comprises unlocking at least one of the first and second external devices using a PIN-code. The method according to aspect 24, wherein the step of unlocking at least one of the first and second external devices comprises verifying, at the at least one first or second external devices, the user credentials by comparing the user credentials with user credentials stored in at least one of the first and second external devices. The method according to aspect 24, wherein the step of unlocking at least one of the first and second external devices comprises verifying, at the at least one first or second external devices, the user credentials by comparing the user credentials with user credentials stored in at least one of the first and second external devices by the manufacturer of at least one of the first and second external devices. The method according to any one of aspects 24 - 28, wherein the step of unlocking at least one of the first and second external devices comprises verifying, at the at least one first or second external devices, the user credentials by comparing the user credentials with user credentials stored as hardware or software in at least one of the first and second external devices. The method according to any one of aspects 24 - 29, wherein the step of unlocking at least one of the first and second external devices comprises verifying, at the at least one first or second external devices, the user credentials by communicating with a remote server. The method according to any one of the preceding aspects, wherein the method is performed without connection to the Internet. The method according to any one of the preceding aspects, wherein the method is configured to be performed independently of time. The method according to any one of the preceding aspects, wherein the first and second keys are different. The method according to any one of the preceding aspects, wherein at least one of the first and second keys are private. The method according to aspect 34, wherein the first and second private keys comprises at least one common element. The method according to any one of aspects 4 - 35, comprising unlocking at least one of the first and second external devices using at least one of the first and second private key. The method according to any one of the preceding aspects, wherein the step of electronically signing the instructions and the checksum is performed at a central server of the external system. The method according to aspect 37, further comprising: the central server being accessed by at least one healthcare professional, and the healthcare professional providing input to the central server for forming the instructions to be sent to the implantable medical device. The method according to aspect 37, further comprising the central server being accessed by at least one patient, such that the patient can provide input to the central server for verifying at least one of: the authenticity of the healthcare professional and the correctness of the instructions. The method according to aspect 38, further comprising the healthcare electronically signing the instructions at the central server. The method according to aspect 38, further comprising the patient electronically signing the instructions at the central server. The method according to any one of aspects 37 - 41, further comprising the steps of: verifying the authenticity of the first and second key at the central server, and electronically sign the instructions using the first and second key. The method according to any one of the preceding aspects, wherein the second key is a user key, and wherein the method comprises the steps of using the second key for at least one of: approving that communication is transmitted to the implantable medical device, and approving that a healthcare provider prepares an instruction to the implantable medical device. The method according to aspect 42, wherein the approval step can be performed by first or second external device. The method according to any one of aspects 4 - 43, wherein the first key is required to create an instruction to the implantable medical device and the second key is required to transmit the created instruction to the implantable medical device. The method according to any one of aspects 4 - 44, wherein at least one of the first and second external device comprises an input button, and wherein the method further comprises the step of pressing the button for verifying user presence. The method according to aspect 45, wherein the input button is placed on the second external device. The method according to any one of the preceding aspects, wherein the trental of the data packet comprises transmittal of: at least one instruction signed by a first key, and a public key including information about which root have created the public key. The method according to any one of aspects 4 - 47, further comprising enabling communication between the implantable medical device and at least one of the first and second medical device based on at least one password being provided to at least one of the first and second external device. 49. The method according to any one of aspects 4 - 47, further comprising enabling communication between the implantable medical device and at least one of the first and second medical device based on two passwords being provided to at least one of the first and second external device.

50. The method according to aspect 49, wherein the first password is a patient password and the second password is a healthcare provider passwords.

51. The method according to any one of the preceding aspects, further comprising at least one of the first and second external devices performing a verification query operation with at least one of the first and second key devices, the verification query operation comprising: transmitting, from the first or second external devices, a query comprising a computational challenge to at least one of the first and second key device, receiving, at the first or second external devices, a response based on the transmitted computational challenge, and verifying, at the first or second external devices, the received response.

52. The method according to aspect 51, wherein the verification query operation is in the form of a proof of possession operation comprising: receiving a public key of at least one of the first and second key devices, the public key being associated with a private key of the first or second key device, transmitting, from at least one of the first and second external devices, a computational challenge to the first or second key device, based on the public key received from the first or second key device, receiving a response from the first or second key device based on the possession of the private key in the first or second key device, and verifying that the response based on the possession of the private key matches the query based on a public key.

FURTHER ASPECT combinable with any one of the other Aspects - IMPLANTATAION

1. A method of implanting at least one component of the system for injecting a substance into a patient’s body according to any one of the preceding aspects, comprising the steps of: cutting the skin, dissecting free at least one area within the patient’s body, placing the housing accommodating the at least one infusion needle within said dissected area such that the tip end of the at least one infusion needle, when penetrating the housing's outer wall, can penetrate the patient’s tissue so as to allow for injecting a substance through said at least one penetration area via the at least one infusion needle, and closing at least the skin after implantation of at least parts of the system. 2. The method of aspect 1, further comprising the step of placing one or more of the following components of the system within the patient’s body remote from the housing accommodating the at least one infusion needle: at least part of the drive unit (D), a reservoir, a pump (P), at least one motor (M, M2) for actuation of one or more elements of the drive unit, the pump (P) or any other energy-consuming part of the system, energy storage means (A) for providing the at least one motor with energy, galvanic coupling elements between either an external energy source (E) or the energy storage means (A) and the motor (M, M2) for transmitting energy to the motor in contacting fashion, wireless coupling elements adapted to connect either the motor (M, M2) or the energy storage means (A) or both to an extracorporeal primary energy source for transmitting energy to either the motor or the energy storage means or both in non -contacting fashion, a control unit (Cl) for controlling the motor (M, M2), a data transmission interface for wirelessly transmitting data from an external data processing device (C2) to the control unit (Cl), a feedback sensor (F), wireless energy transforming means, an injection port for refilling the reservoir (Rl), and at least one tube for injecting thereinto a substance to be injected by means of the at least one injection needle.

FIRST INDEPENDENT NEW ASPECT combinable with all other aspects - SHORT DISTANCE OF NEEDLE INJECTION PORT

1. An at least partly implantable system for injecting a substance into a patient’s body, comprising: a housing adapted for implantation inside the patient’s body, the housing having an outer wall with a penetration area, at least one infusion needle disposed in the housing, and a drive unit arranged for advancing and retracting the at least one infusion needle in opposite advancing and retracting directions so that a tip end of the at least one infusion needle penetrates, upon advancement of the at least one infusion needle, said penetration area so as to allow for injecting the substance through said penetration area via the at least one infusion needle, wherein an injection port is provided on a side surface of the at least one infusion needle, said injection port being spaced apart from the tip end of the at least one infusion needle by less than 2 mm.

2. The system of aspect 1, wherein the injection port is spaced apart from the tip end of the at least one infusion needle by less than 1 mm.

3. The system of aspect 1 or 2, wherein the injection port is spaced apart from the tip end of the at least one infusion needle by between 0.5 and 1 mm.

4. The system of any one of aspects 1 to 3, wherein the injection port has an extension of not more than 0.5 mm in a longitudinal direction of the infusion needle.

5. The system of any one of aspects 1 to 4, wherein the injection port has an extension in a direction transverse to a longitudinal direction of the infusion needle which is greater than an extension of the injection port in the longitudinal direction of the infusion needle.

6. An infusion needle comprising an injection port on a side surface thereof, said injection port being spaced apart from a tip end of the at least one infusion needle by less than 2 mm.

7. The infusion needle of aspect 6, wherein the injection port is spaced apart from the tip end of the infusion needle by less than 1 mm.

8. The infusion needle of aspect 6 or 7, wherein the injection port is spaced apart from the tip end of the infusion needle by between 0.5 and 1 mm.

9. The infusion needle of any one of aspects 6 to 8, wherein the injection port has an extension of not more than 0.5 mm in a longitudinal direction of the infusion needle.

10. The infusion needle of any one of aspects 6 to 9, wherein the injection port has an extension in a direction transverse to a longitudinal direction of the infusion needle which is greater than an extension of the injection port in the longitudinal direction of the infusion needle.

SECOND INDEPENDENT NEW ASPECT combinable with all other aspects - INCLINED NEEDLE 1. An at least partly implantable system for injecting a substance into a patient’s body, comprising: a housing or casing adapted for implantation inside the patient’s body, the housing or casing having an outer wall with a penetration area, at least one infusion needle disposed in the housing or casing so as to penetrate the penetration area and configured for being advanced and retracted in opposite advancing and retraction directions between an advanced position and a retracted position, wherein the system is adapted to inject the substance into the patient’s body via the at least one infusion needle when the infusion needle is in the advanced position, and wherein injection of the substance into the patient’s body via the at least one infusion needle is not possible when the infusion needle is in the retracted position, wherein the infusion needle is inclined relative to the outer wall by an inclination angle in a range of 10° and 80°. 2. The system of aspect 1, comprising a drive unit arranged for advancing and retracting the at least one infusion needle in opposite advancing and retracting directions.

3. The system of aspect 1 or 2, wherein the tip end of the at least one infusion needle penetrates, upon advancement of the at least one infusion needle, said penetration area.

4. The system of aspect 1 or 2, wherein the tip end of the at least one infusion needle extends from the penetration area when the at least one infusion needle is in its retracted position.

5. The system of aspect 4, wherein protection walls are provided on the housing, preferably on opposite sides of the tip end of the at least one infusion needle, so as to prevent the tip end to get into contact with tissue of the patient when the at least one infusion needle is in its retracted position.

6. The system of any one of aspects 3 to 5, wherein the at least one infusion needle is laterally displaceable and wherein the penetration area in the housing’s outer wall comprises a septum through which the at least one infusion needle extends, wherein the septum is movable in a lateral direction along with the at least one infusion needle when the at least one infusion needle is displaced laterally.

7. The system of any one of aspects 1 to 6, wherein the outer wall of the housing has an outer surface extending in a first direction and configured so that a longitudinal vessel is placeable adjacent said outer surface such that a central axis of the longitudinal vessel extends in parallel to the first direction, and wherein the advancing and retraction directions of the at least one infusion needle are arranged in a plane defined by said first direction and said central axis of the longitudinal vessel and at the inclination angle in the a range of 10° and 80° relative to said first direction.

8. The system of aspect 7, wherein the first direction changes in a curve.

9. The system of aspect 7 or 8, comprising a holder configured to hold a vessel in position, when the at least one infusion needle is being advanced, such that the central axis of the vessel extends in parallel to said first direction of the outer surface of the housing’s outer wall.

10. The system of aspect 9, wherein the holder is configured to enclose a section of the longitudinal vessel so that the vessel cannot escape from the holder.

11. The system of aspect 9 or 10, wherein the holder comprises a movable lid configured to open and close the holder for placing and holding said section of the longitudinal vessel inside the holder.

12. The system of any one of aspects 1 to 11, wherein the inclination angle is in a range of 20° to 40°.

SUB-ASPECT OF SECOND INDEPENDENT NEW ASPECT- CURVED NEEDLE The system of any one of aspects 1 to 12, wherein at least a tip end section of the at least one infusion needle, which is a section including a tip end of the at least one infusion needle, is curved in a plane of curvature. The system of aspect 13, wherein advancement and retraction of the at least one infusion needle in the advancing and retraction directions comprises rotation of the tip end section of the at least one infusion needle about an axis of rotation which is vertical to the plane of curvature.

STYLET The system of aspect 13 or 14, wherein the infusion needle comprises: the tip end and a hollow body, wherein - preferably - a feeding port is provided in a side wall of the hollow body so as to allow for the substance to be fed through the feeding port into the hollow body and wherein an injection port is provided in a front side of the tip end through which the substance is dispensable to the outside of the infusion needle, and a stylet which is movable within the hollow body between an advanced position, in which the stylet is so far advanced inside the hollow body that it closes the injection port so as to prevent fibrosis from growing into the infusion needle when the infusion needle is implanted in a patient, and a retracted position, in which the stylet is so far retracted inside the hollow body that a pathway is open for the substance to flow - preferably from the feeding port and - through the hollow body out of the injection port. The system of aspect 15, wherein, in the advanced position of the stylet, the stylet extends from the tip end of the at least one infusion needle. The system of aspect 16, wherein a tip end of the stylet is sharp for piercing through tissue of the patient when the at least one infusion needle is being advanced. The system of aspect 17, wherein the tip end of the infusion needle is blunt.

NEEDLE ARM + STYLET ARM / MOVABLE CARRIAGE The system of any one of aspects 15 to 18, comprising a needle arm to which the infusion needle is mounted and a stylet arm to which the stylet is mounted, the needle arm and the stylet arm being rotatable about a common axis of rotation. The system of aspect 19, comprising a conduit connected to the needle arm for supplying the substance to the needle, wherein preferably the conduit is flexible so as to enable the conduit to follow movement of the needle arm. The system of aspect 19 or 20, comprising a drive unit for carrying out the following steps in sequence: advancing the infusion needle and stylet by rotating the needle arm jointly with the stylet arm about the common axis of rotation in the advancing direction, retracting the stylet inside the infusion needle towards its retracted position by rotating the stylet arm about the common axis of rotation in the retraction direction, retracting the infusion needle by rotating the needle arm about the common axis of rotation in the retraction direction. The system of claim 21, wherein the drive unit is configured to carry out the following step before retracting the infusion needle: advancing the stylet inside the infusion needle by rotating the stylet arm about the common axis of rotation in the advancing direction. The system of any one of aspects 19 to 22, comprising a first drive shaft extending from the housing or casing, the first drive shaft being configured to rotate the needle arm and the stylet arm about the common axis of rotation. The system of any one of aspects 19 to 23, wherein the needle arm and stylet arm are mounted on a carriage which is movable inside the housing or casing so as to laterally move the tip end of the at least one infusion needle between different lateral positions. The system of claim 24, comprising a second drive shaft extending from the housing or casing, the second drive shaft being configured to move the carriage inside the housing or casing so as to laterally move the tip end of the at least one infusion needle between different lateral positions.

RELEASABLE HOLDER The system of any one of aspects 21 to 25, wherein the drive unit comprises: a biasing element providing a biasing force which urges the needle arm and the stylet arm apart from each other, a releasable holder configured to hold the needle arm and stylet arm close to each other against the biasing force, and a release which is arranged to release the releasable holder, when the infusion needle reaches or has reached its advanced position, such that the stylet arm is moved apart from the needle arm due to the biasing force of the biasing element. The system of aspect 26, wherein the biasing element is a torque spring. The system of aspect 27, wherein the torque spring has a square or rectangular cross-section. The system of aspect 27 or 28, wherein one end of the torque spring is attached to the stylet arm and another end of the torque spring is attached to the needle arm. The system of aspect 27 or 28, wherein one end of the torque spring is attached to the stylet arm and another end of the torque spring is attached to the housing or casing or, where the needle arm and stylet arm are mounted on a carriage which is movable inside the housing or casing so as to laterally move the tip end of the at least one infusion needle between different lateral positions, to the carriage. The system of any one of aspects 26 to 30, wherein the releasable holder comprises a flexible hook by which the needle arm and stylet arm are hooked together when the stylet arm rotates jointly with the needle arm about the common axis of rotation in the advancing direction, and the release is a deflector configured to deflect the flexible hook sideways so as to unhook the flexible hook when the infusion needle reaches or has reached its advanced position.

CLUTCH The system of any one of aspects 21 to 25, wherein the drive unit comprises: at least one biasing element providing a biasing force which urges the stylet arm jointly with the needle arm about the common axis of rotation either in the advancing direction or in the retraction direction, and a clutch which is configured for selectively connecting the drive unit with at least one of: the stylet arm, the needle arm, and both the stylet arm and needle arm. The system of claim 32, wherein the at least one biasing element provides a biasing force which urges the stylet arm jointly with the needle arm about the common axis of rotation in the advancing direction, and wherein the clutch is configured for selectively connecting the drive unit either with the stylet arm, for retracting the stylet inside the infusion needle towards its retracted position by rotating the stylet arm about the common axis of rotation in the retraction direction, or with either the needle arm or both needle arm and the stylet arm, for retracting the infusion needle by rotating the needle arm about the common axis of rotation in the retraction direction. The system of aspect 33, wherein the at least one biasing element comprises a torque spring. The system of aspect 34, wherein the torque spring has a square or rectangular cross-section. The system of any one of aspects 33 to 35, wherein a biasing element is provided for each of the needle arm and the stylet arm.

CAM DRIVE The system of any one of aspects 21 to 25, wherein the drive unit comprises: a needle crank arm connected with one end thereof to the needle arm and with another end thereof to a needle guide pathway such that movement of the needle crank arm along the needle guide pathway and rotation of the needle arm about the common axis of rotation are interdependent, a stylet crank arm connected with one end thereof to the stylet arm and with another end thereof to a stylet guide pathway such that movement of the stylet crank arm along the stylet guide pathway and rotation of the stylet arm about the common axis of rotation are interdependent. 38. The system of aspect 37, wherein the drive unit further comprises at least one cam comprising a needle cam pathway and a stylet cam pathway, wherein the needle crank arm is connected to the needle cam pathway in such a way that movement of the cam causes the needle arm to rotate about the common axis of rotation, and a stylet crank arm is connected to the stylet cam pathway in such a way that rotation of the cam causes the stylet arm to rotate about the common axis of rotation.

39. The system of aspect 38, wherein the at least one cam is a cam disk which is rotatable about a central axis.

40. The system of aspect 39, wherein, where the needle arm and stylet arm are mounted on a carriage which is movable inside the housing or casing so as to laterally move the tip end of the at least one infusion needle between different lateral positions, the carriage is rotatably mounted inside the housing or casing.

THIRD INDEPENDENT NEW ASPECT combinable with all other aspects - NEEDLE IN TUBE

1. An at least partly implantable system for injecting a substance into a patient’s body, comprising: a housing adapted for implantation inside the patient’s body, the housing having an outer wall with a penetration area, at least one infusion needle disposed in the housing, and a drive unit arranged for advancing and retracting the at least one infusion needle in opposite advancing and retracting directions so that a tip end of the at least one infusion needle penetrates, upon advancement of the at least one infusion needle, said penetration area so as to allow for injecting the substance through said penetration area via the at least one infusion needle, wherein an injection port is provided on a side surface of the at least one infusion needle and wherein, when the at least one infusion needle is in a retracted position, the tip end of the at least one infusion needle is arranged in a tube, wherein an inner surface of the tube and an outer surface of the at least one infusion needle are liquid-tightly sealed against each other so as to prevent fluid ingress through the tube and into the injection port.

2. The system of aspect 1, wherein an inner diameter of the inner surface of the tube and an outer diameter of the outer surface of the at least one infusion needle match each other so as to liquid- tightly seal against each other in order to prevent fluid ingress through the tube and into the injection port.

3. The system of aspect 1 or 2, wherein one or both of the inner surface of the tube and the outer surface of the at least one infusion needle is made of ceramic material. 4. An at least partly implantable system for injecting a substance into a patient’s body, comprising an infusion needle with an injection port provided on a side surface thereof, wherein the infusion needle is arranged for being advanced and retracted in opposite advancing and retracting directions, wherein, when the infusion needle is in a retracted position, a tip end of the infusion needle is arranged in a tube and, when the infusion needle is in an advanced position, the tip end of the infusion needle extends from the tube so that a substance can be injected through the injection port of the infusion needle into the patient’s body, wherein an inner diameter of an inner surface of the tube and an outer diameter of an outer surface of the infusion needle match each other so as to liquid-tightly seal against each other when the infusion needle is in the retracted position in order to prevent fluid ingress through the tube and into the injection port.

5. The system of aspect 4, wherein one or both of the inner surface of the tube and the outer surface of the infusion needle is made of ceramic material.

FOURTH INDEPENDENT NEW ASPECT combinable with all other aspects - PRE-CONFIGURED ELASTIC OPENING

1. An at least partly implantable system for injecting a substance into a patient’s body, comprising: a housing adapted for implantation inside the patient’s body, the housing having an outer wall with a penetration area, at least one infusion needle disposed in the housing, and a drive unit arranged for advancing and retracting the at least one infusion needle in opposite advancing and retracting directions so that a tip end of the at least one infusion needle penetrates, upon advancement of the at least one infusion needle, said penetration area so as to allow for injecting the substance through said penetration area via the at least one infusion needle, wherein said penetration area is at least partly made of an elastic material in which a passage is pre-configured for the at least one infusion needle to pass through, said passage being normally closed by resilient forces that are generated by the elasticity of the elastic material.

2. The system of aspect 1, wherein the passage opens automatically for the at least one infusion needle to pass through when the infusion needle is being advanced.

3. The system of aspect 1 or 2, wherein the passage has a widened entrance section where the passage is normally open for the at least one infusion needle to enter into the passage.

4. The system of any one of aspects 1 to 3, wherein the tip end of the at least one infusion needle resides inside the passage when the infusion needle is in its retracted position.

5. The system of any one of aspects 1 to 4, wherein the passage is configured as a slit having a lengthwise extension and a widthwise extension. 6. The system of aspect 5, comprising a compressor configured to act upon opposite sides of the elastic material in opposite directions of the slit’s widthwise extension so as to open the passage for the at least one infusion needle when the infusion needle is being advanced.

FIFTH INDEPENDENT NEW ASPECT combinable with all other aspects - ROUNDED OR BEVELED NEEDLE INJECTION PORT

1. An at least partly implantable system for injecting a substance into a patient’s body, comprising: a housing adapted for implantation inside the patient’s body, the housing having an outer wall with a penetration area, at least one infusion needle disposed in the housing, and a drive unit arranged for advancing and retracting the at least one infusion needle in opposite advancing and retracting directions so that a tip end of the at least one infusion needle penetrates, upon advancement of the at least one infusion needle, said penetration area so as to allow for injecting the substance through said penetration area via the at least one infusion needle, wherein an injection port is provided on a side surface of the at least one infusion needle, said injection port having a rounded or beveled edge at a transition between the injection port and the side surface.

2. The system of aspect 1, wherein the rounded or beveled edge is provided at least on opposite sides of the injection port, wherein a hypothetical connecting line between said opposite sides of the injection port extends along the advancing and retracting directions of the infusion needle.

3. An infusion needle comprising an injection port on a side surface thereof, said injection port having a rounded or beveled edge at a transition between the injection port and the side surface.

4. The infusion needle of aspect 3, wherein the infusion needle extends in a longitudinal direction and wherein the rounded or beveled edge is provided at least on opposite sides of the injection port, wherein a hypothetical connecting line between said opposite sides of the injection port extends along the longitudinal direction of the infusion needle.

SIXTH INDEPENDENT NEW ASPECT combinable with all other aspects - NEEDLE WITH STYLET

1. An at least partly implantable system for injecting a substance into a patient’s body, comprising: a housing adapted for implantation inside the patient’s body, the housing having an outer wall with a penetration area, at least one infusion needle disposed in the housing so as to penetrate the penetration area, and a drive unit arranged for advancing and retracting the at least one infusion needle in opposite advancing and retraction directions between an advanced position and a retracted position, wherein the system is adapted to inject the substance into the patient’s body via the at least one infusion needle when the infusion needle is in the advanced position, and wherein injection of the substance into the patient’s body via the at least one infusion needle is not possible when the infusion needle is in the retracted position, wherein the infusion needle comprises: a tip end and a hollow body, wherein an injection port is provided in a front side of the tip end through which the substance is dispensable from the hollow body to the outside of the infusion needle, and a stylet which is movable within the hollow body between an advanced position, in which the stylet is so far advanced inside the hollow body that it closes the injection port so as to prevent fibrosis from growing into the infusion needle when the infusion needle is implanted in a patient, and a retracted position, in which the stylet is so far retracted inside the hollow body that a pathway is open for the substance to flow through the hollow body out of the injection port. The system of aspect 1, wherein a feeding port is provided in a side wall of the hollow body so as to allow for the substance to be fed through the feeding port into the hollow body and wherein an injection port is provided in a front side of the tip end through which the substance is dispensable to the outside of the infusion needle. The system of aspect 1 or 2, wherein, in the advanced position of the stylet, the stylet extends from the tip end of the at least one infusion needle. The system of aspect 3, wherein a tip end of the stylet is sharp for piercing through tissue of the patient when the at least one infusion needle is being advanced. The system of aspect 4, wherein the tip end of the infusion needle is blunt. The system of any one of aspects 1 to 5, wherein the tip end of the at least one infusion needle penetrates, upon advancement of the at least one infusion needle, said penetration area. The system of any one of aspects 1 to 5, wherein the tip end of the at least one infusion needle extends from the penetration area when the at least one infusion needle is in its retracted position. The system of aspect 7, wherein protection walls are provided on the housing, preferably on opposite sides of the tip end of the at least one infusion needle, so as to prevent the tip end to get into contact with tissue of the patient when the at least one infusion needle is in its retracted position. The system of any one of aspects 1 to 8, wherein the at least one infusion needle is laterally displaceable and wherein the penetration area in the housing’s outer wall comprises a septum through which the at least one infusion needle extends, wherein the septum is movable in a lateral direction along with the at least one infusion needle when the at least one infusion needle is displaced laterally. An infusion needle comprising: a tip end and a hollow body, wherein a feeding port is provided in a side wall of the hollow body so as to allow a substance to be fed through the feeding port into the hollow body and wherein an injection port is provided in a front side of the tip end through which the substance is dispensable to the outside of the infusion needle, and a stylet which is movable within the hollow body between an advanced position, in which the stylet is so far advanced inside the hollow body that it closes the injection port so as to prevent fibrosis from growing into the infusion needle when the infusion needle is implanted in a patient, and a retracted position, in which the stylet is so far retracted inside the hollow body that a pathway is open for the substance to flow through the hollow body out of the injection port. The infusion needle of aspect 9, wherein, in the advanced position of the stylet, the stylet extends from the tip end of the infusion needle. The infusion needle of aspect 10, wherein a tip end of the stylet is sharp for piercing through tissue of the patient when the infusion needle is advanced. The infusion needle of aspect 11, wherein the tip end of the infusion needle is blunt. The infusion needle of any one of aspects 1 to 12, wherein a tip end section of the infusion needle comprising the tip end is curved in a plane of curvature.