US20120065460A1 - Implantable access port system - Google Patents

Implantable access port system Download PDF

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Publication number
US20120065460A1
US20120065460A1 US12881460 US88146010A US20120065460A1 US 20120065460 A1 US20120065460 A1 US 20120065460A1 US 12881460 US12881460 US 12881460 US 88146010 A US88146010 A US 88146010A US 20120065460 A1 US20120065460 A1 US 20120065460A1
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Prior art keywords
gear
injection port
anchor
plurality
teeth
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
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US12881460
Inventor
Greg Nitka
Edwin J. Kayda
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Allergan Inc
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Allergan Inc
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, E.G. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F5/00Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
    • A61F5/0003Apparatus for the treatment of obesity; Anti-eating devices
    • A61F5/0013Implantable devices or invasive measures
    • A61F5/005Gastric bands
    • A61F5/0066Closing devices for gastric bands
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M39/00Tubes, tube connectors, tube couplings, valves, access sites or the like, specially adapted for medical use
    • A61M39/02Access sites
    • A61M39/0208Subcutaneous access sites for injecting or removing fluids
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M39/00Tubes, tube connectors, tube couplings, valves, access sites or the like, specially adapted for medical use
    • A61M39/02Access sites
    • A61M39/0247Semi-permanent or permanent transcutaneous or percutaneous access sites to the inside of the body
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M39/00Tubes, tube connectors, tube couplings, valves, access sites or the like, specially adapted for medical use
    • A61M39/02Access sites
    • A61M39/0208Subcutaneous access sites for injecting or removing fluids
    • A61M2039/0223Subcutaneous access sites for injecting or removing fluids having means for anchoring the subcutaneous access site
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M39/00Tubes, tube connectors, tube couplings, valves, access sites or the like, specially adapted for medical use
    • A61M39/02Access sites
    • A61M39/0247Semi-permanent or permanent transcutaneous or percutaneous access sites to the inside of the body
    • A61M2039/0261Means for anchoring port to the body, or ports having a special shape or being made of a specific material to allow easy implantation/integration in the body

Abstract

An implantable injection port comprises a base. A first gear is coupled to the base, and a first anchor is coupled to the first gear. A second gear is coupled to the base, and a second anchor is coupled to the second gear. A top portion of the injection port is spaced apart from the base of the port and has a first plurality of top teeth that engage with a first plurality of gear teeth on the first gear. This engagement occurs prior to rotation of the second gear. The top portion rotates, which causes rotation of the first gear, which in turn causes movement of the first anchor through the anchor opening of the base and into the tissue of the patient. The first gear and the second gear rotate non-simultaneously.

Description

    BACKGROUND
  • 1. Field
  • The present invention relates generally to implantable access ports and attachment mechanisms or systems for attaching the implantable access ports to a patient. More specifically, the present invention relates to implantable access ports with independent moving gears for the anchors, and related actuation devices.
  • 2. Description of the Related Art
  • Implantable medical devices for performing therapeutic functions for a patient are well known. Such devices include pace makers, vascular access ports, injection ports (such as those used with gastric banding devices) and gastric pacing devices. Such devices are attached to a human, typically subcutaneously, in an appropriate place in order to function properly. It is desirable that the procedure to implant such devices be quick, easy, efficient, and require as small of an incision as possible.
  • A suture (also known as stitches) is typically used by doctors to hold skin, internal organs, blood vessels and all other tissues of the human body together after they have been severed by injury, incision or surgery. Suturing is both time consuming and inconvenient. Surgical fasteners, such as staples, clips, clamps, bands, tacks, or other wound or incision closure devices, have been used in surgical procedures to eliminate the need for suturing. Surgical fasteners are commonly used in surgical procedures to allow a surgeon to fasten, secure, and/or repair bodily tissue. In these applications, the surgeon often uses a fastener implanting device loaded with one or more surgical fasteners to accomplish in a few seconds what would have taken many minutes to perform by suturing. This reduction in operating time reduces blood loss and trauma to the patient.
  • Typically, such surgical fasteners have been used mainly for the closure of incisions or wounds, or to fasten tissues together. A surgical fastener that can be used with a number of different types of implantable medical devices would be beneficial for surgeons. Currently, surgical systems that incorporate surgical fasteners often use extremely specialized devices that may be unnecessarily complicated and are unsuitable for adaptation to other applications.
  • As a result, the majority of implantable medical devices are secured with sutures. For example, when inserting a gastric band and an associated access port, the associated access port may be sutured into place with 3 to 5 sutures against the rectus muscle sheath. Such placement of the sutures is often challenging because the associated access port is placed below several inches of bodily tissue (e.g., fat), and suturing the associated access port often takes as long as placing the gastric band itself. An improved fastening device would allow easy, one-step attachment with security equivalent to the sutured medical device.
  • One conventional method for fastening an implantable access port to the patient includes an external pistol-like applying means. The external pistol may include a trigger having geared teeth, a gear which meshes with the geared teeth, and a spring. The external pistol attaches to the implantable access port and tightens a fastener into the tissue of the patient upon pressing of the trigger. After attachment, the external pistol is removed from the implantable access port. Examples of similar methods may be found in European Patent Application Pub. No. 1736194 and U.S. Patent Application Pub. No. 2005/0283118.
  • Another conventional method for fastening an implantable access port includes fasteners extending from the housing of the implantable access port. In a self-attaching method, the implantable access port may be self-attached upon the surgeon applying a distal force to the access port housing, causing the fasteners to penetrate the tissue, engaging the tissue to hold the access port in place. Examples of similar methods may be found in U.S. Patent Application Pub. Nos. 2004/0254537, 2006/0190039, 2006/0235445, and 2009/0259190. In an electronic method, the fasteners may be electronically switched between a deployed position and an un-deployed position using an actuator.
  • European Patent Application Pub. No. 1543861 and U.S. Patent Application Pub. No. 2005/0131352 disclose an injection port that may be implanted using separate fasteners that are not part of the port prior to implantation. These fasteners are inserted one at a time using a tool. Thus, the tool is repositioned prior to implanting each fastener, which may lead to inefficiencies and inaccuracies in the implantation. U.S. Pat. No. 7,374,557 also discloses individually inserted fasteners.
  • The present invention overcomes at least some of the drawbacks of these conventional medical devices and methods.
  • SUMMARY
  • Generally described herein are implantable access ports and related actuation devices. The apparatus, systems and methods described herein provide relatively easy attachment capabilities of the implantable access ports to bodily tissue.
  • In one example embodiment, an implantable injection port comprises a base with a first anchor opening. A first gear is coupled to the base and is rotatable about a first axis, and a first anchor is coupled to the first gear. A second gear is coupled to the base and is rotatable about a second axis, and a second anchor is coupled to the second gear. The first gear has a first plurality of gear teeth, and the second gear has a second plurality of gear teeth.
  • A top portion of the injection port is spaced apart from the base of the port and has a first plurality of top teeth that engage with the first plurality of gear teeth on the first gear. This engagement occurs prior to rotation of the second gear. The top portion rotates, which causes rotation of the first gear, which in turn causes movement of the first anchor through the anchor opening of the base and into the tissue of the patient. The first gear rotates about the first axis independently of the second gear rotating about a second axis and prior to the second anchor being implanted in the tissue of the patient. Thus, the first gear and the second gear rotate non-simultaneously.
  • In another embodiment of the present invention, an actuation device for attaching an implantable injection port comprises a head for coupling to the implantable injection port. A first drive band is coupled to a trigger of the actuation device, and a second drive band is coupled to the first drive band for translating motion from the trigger of the actuation device to the second drive band. The second drive band interfaces with a top portion of the implantable injection port to facilitate deploying an anchor of the implantable injection port into the tissue of the patient. A switch on a housing of the actuation device is operable to direct the second drive band to rotate the top portion of the implantable injection port in an implanting direction or a retracting direction.
  • Further, in accordance with an embodiment, a method for implanting an implantable injection port comprises coupling a gripping portion of an actuation device to a top portion of the implantable injection port. A trigger of the actuation device is depressed when a switch in the actuation device is located in an implanting orientation. A vertical drive band is then directed through the switch to contact the top portion of the implantable injection port and rotate the top portion in an implanting direction.
  • At a first time, a first anchor coupled to a first gear is implanted into the tissue of the patient in response to a first set of top teeth causing the first gear to rotate. At a second time, a second anchor coupled to a second gear is implanted into the tissue of the patient in response to the first set of top teeth or a second set of top teeth causing the second gear to rotate.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • The features, objects, and advantages of the invention will become more apparent from the detailed description set forth below when taken in conjunction with the drawings, wherein:
  • FIG. 1 illustrates a patient with an implantable injection port and an applier tool according to an embodiment of the present invention.
  • FIG. 2A illustrates a perspective view of an implantable injection port according to an embodiment of the present invention.
  • FIG. 2B illustrates a perspective view of an implantable injection port showing a stem according to an embodiment of the present invention.
  • FIG. 3 illustrates a perspective view of an implantable injection port without a port housing according to an embodiment of the present invention.
  • FIG. 4 illustrates an exploded, perspective view of an implantable injection port according to an embodiment of the present invention.
  • FIG. 5A illustrates a perspective view of an applier tool according to an embodiment of the present invention.
  • FIG. 5B illustrates a perspective view of an applier tool without a housing cover according to an embodiment of the present invention.
  • FIG. 5C illustrates an exploded, perspective view of an applier tool according to an embodiment of the present invention.
  • FIG. 6A illustrates a sectional view of a gripping end of an applier tool according to an embodiment of the present invention.
  • FIG. 6B illustrates a perspective view of a gripping end of an applier tool according to an embodiment of the present invention.
  • FIG. 6C illustrates a sectional view of a gripping end of an applier tool showing a vertical drive band in an implanting orientation according to an embodiment of the present invention.
  • FIG. 6D illustrates a perspective view of a gripping end of an applier tool showing a vertical drive band in an implanting orientation according to an embodiment of the present invention.
  • FIG. 6E illustrates a sectional view of a gripping end of an applier tool showing a vertical drive band in a removal orientation according to an embodiment of the present invention.
  • FIG. 6F illustrates a perspective view of a gripping end of an applier tool showing a vertical drive band in a removal orientation according to an embodiment of the present invention.
  • FIG. 7A illustrates a bottom view of an applier tool separated from an implantable injection port according to an embodiment of the present invention.
  • FIG. 7B illustrates a bottom view of an applier tool mated with an implantable injection port according to an embodiment of the present invention.
  • FIG. 8A illustrates a perspective view of an applier tool without a housing cover, where the applier tool is mated with an implantable injection port according to an embodiment of the present invention.
  • FIG. 8B illustrates a perspective view of an applier tool mated with an implantable injection port according to an embodiment of the present invention.
  • FIG. 9 illustrates an anchor in an undeployed position in an implantable injection port according to an embodiment of the present invention.
  • FIG. 10 illustrates two anchors in a partially deployed position in an implantable injection port according to an embodiment of the present invention.
  • FIG. 11A illustrates two anchors in a deployed position according to an embodiment of the present invention.
  • FIG. 11B illustrates another view of two anchors in a deployed position according to an embodiment of the present invention.
  • FIG. 12 illustrates a perspective view of an applier tool mated with an implantable injection port having two deployed anchors according to an embodiment of the present invention.
  • FIG. 13A illustrates an implantable injection port with two deployed anchors and two partially deployed anchors according to an embodiment of the present invention.
  • FIG. 13B illustrates an implantable injection port with four deployed anchors according to an embodiment of the present invention.
  • FIG. 13C illustrates a perspective view of an implantable injection port with four deployed anchors according to an embodiment of the present invention.
  • FIG. 14 illustrates a perspective view of an applier tool mated with an implantable injection port having four deployed anchors according to an embodiment of the present invention.
  • DETAILED DESCRIPTION
  • Apparatus, systems and methods that implement the embodiments of the various features of the present invention will now be described with reference to the drawings. The drawings and the associated descriptions are provided to illustrate some embodiments of the present invention and not to limit the scope of the present invention. Throughout the drawings, reference numbers are re-used to indicate correspondence between referenced elements.
  • A system is disclosed having a port (e.g., an implantable access port or an implantable injection port) that is securely fastened to bodily tissue of a human or a patient. The port is used to fill and remove fluid from an inflatable portion of a band (e.g., a gastric band) via a catheter attached between the port and the inflatable portion of the band. One or more anchors (e.g., four anchors) of the port may be subcutaneously and securely attached to the bodily tissue of the human by rotating one or more mating components (e.g., an applier, an axle, a cap, a gear, etc.). The one or more mating components provide a continually secure attachment of the one or more anchors to the bodily tissue of the patient after surgery.
  • FIG. 1 is a simplified partial front view of a human body 105 with a food intake restriction system, such as an implantable gastric banding system 100 having a band 110, a port 130 and an applier 135 according to an embodiment of the present invention. The gastric banding system 100 is used to treat obesity and to attach to a tissue of a patient. The band 110 may be a gastric band, such as the Lap-Band®, and may be adjustable, implantable, inflatable and positioned around or near the upper portion of a stomach 120 of a human 105. Generally, the band 110 is placed about the fundus, or esophageal junction, of a patient's upper stomach forming a stoma that restricts the food's passage into a lower portion of the stomach. The band 110 may include an inflatable portion (e.g., a cavity) made of silicone rubber, or another type of biocompatible material, that inflates or expands inward to constrict the stoma (stomach inlet) when filled with a fluid (e.g., saline) from the tubing, such as a catheter 125. Alternatively, a mechanical device or a combination hydraulic/mechanical device may be coupled to the band 110 to constrict the stoma. When the stoma is of an appropriate size that is restricted by the band 110, food held in the upper portion of the stomach may provide a feeling of satiety or fullness that discourages overeating.
  • The port 130 may be implanted in a body region accessible for needle injections from a syringe 140 and/or for receiving telemetry communication signals. The port 130 is a medical device that may be referred to as an access port, an injection port, an implantable access device/port or a housing. The port 130 fluidly communicates with the inflatable portion of the band 110 via the catheter 125.
  • A medical professional (e.g., doctor, health care provider, nurse, surgeon, technician, etc.) may position and temporarily or permanently implant the port 130 inside the body of the human 105 in order to perform adjustments of the food intake restriction or stoma created by the band 110. The medical professional, for example, may implant the port 130 in the lateral, subcostal region of the human's abdomen under the skin and layers of fatty tissue, or on or near the sternum of the human 105. Also, any other suitable attachment areas or port sites may be used.
  • The applier 135 may be used to secure the port 130 to the human 105, as depression of an applier trigger facilitates rotation of a portion of the port 130 to secure anchors of the port 130 into bodily tissue of the human 105. In particular, the anchors may be moved from an undeployed position to a deployed position. The applier 135 may be a tool such as a delivery tool.
  • FIGS. 2A-2B are perspective views of the port 130 according to an embodiment of the present invention, illustrating a top portion 205 that connects to or meshes with the applier 135. FIG. 3 is a perspective view of the port 130 of FIGS. 2A-2B with the top portion 205 removed to show a set of gears 375 with gear teeth 380 coupled to anchors 255. FIG. 4 is an exploded, perspective view showing the different parts of the port 130 of FIG. 2 according to an embodiment of the present invention.
  • Referring to FIGS. 2A-4, the port 130 is configured to receive fluid from the syringe 140 for movement into the inflatable portion of the band 110. The port 130 includes the top portion 205 and the reservoir 410. The reservoir 410 contains an interior space for holding the fluid. The reservoir 410 may be an internal titanium port reservoir or a port without the top portion 205. As shown in FIG. 4, the reservoir 410 is formed in the shape of a cylinder.
  • The top portion 205 may be a drive cap, a port cap, a rotating cap, a top cap or a top outer ring. The top portion 205 may have a lip 261 that facilitates rotating the top portion 205 to implant the port 130, and a lip 262 that facilitates rotating the top portion 205 to remove the port 130, as discussed further below. The top portion 205 may be attached to or may be integrally formed with an inner ring 206. The inner ring 206 may also be referred to as a flange. Alternatively, the top portion 205 may include the inner ring 206.
  • The top portion 205 may have a center opening 207. The center opening 207 allows the inner ring 206 to fit therein. In addition, a septum 215 (e.g., a needle penetrable septum) may be located or positioned within the inner ring 206 and/or the center opening 207 of the top portion 205. The inner ring 206 and/or the septum 215 may be attached to the reservoir 410. The top portion 205 may rotate without rotating the inner ring 206 and/or the septum 215. That is, the inner ring 206 and/or the septum 215 may be permanently attached or fixedly attached to the reservoir 410. In one embodiment, the top portion 205 is moveably or rotatably attached to the inner ring 206.
  • As an example, the syringe 140 may be used to pierce the septum 215, thus allowing the fluid in the syringe 140 to pass into the reservoir 410 and then ultimately through the catheter 125 and into the inflatable portion of the band 110. Also, the syringe 140 may be used to remove fluid from the reservoir 410, which causes the fluid in the inflatable portion of the band 110 to be removed therefrom. The septum 215 may be made of any suitable needle penetrable material, for example, a self sealing, needle penetrable material.
  • The port 130 has a base 245, one or more axles 350, one or more axle holders 451, one or more gears 375 and one or more anchors 255. The anchors 255 and the gears 375 may be formed as one piece, or as separate pieces that may be joined together. The base 245 may also be referred to as a port base, a bottom base, a bottom cap, a bottom ring or a bottom portion. The base 245 may lie along a plane that is substantially parallel to the plane defined by the top portion 205. The reservoir 410 is fixedly attached to the base 245 and does not move with the rotation of the top portion 205.
  • The base 245 includes one or more anchor openings 365 and one or more tip openings 370. As an example, the one or more anchor openings 365 may be formed in the shape of a rectangle and the one or more tip openings 370 may be formed in the shape of a circle. The anchors 255 may be locked into place in the base 245 after deployment using a flat interference locating feature, for example, in the anchor openings 365. A housing 200 is disposed about the reservoir 410, between the base 245 and the top cover 250.
  • The axle holder 451 is attached to or integrated with the base 245. The axle holder 451 may include two pylons 451 a, 451 b, each having a hole for the axle 350 to pass therethrough (see FIG. 4). The two pylons 451 a, 451 b are positioned adjacent to and on opposite sides of the anchor opening 365. The anchor 255 and the gear 375 also have openings that allow for the axle 350 to pass therethrough. The component with the anchor 255 and the gear 375 fit between the two pylons 451 a, 451 b. The axle 350 passes through the holes of the pylon 451 a, the anchor 255, the gear 375, and the pylon 451 b and is positioned therein. The rotational movement of the gear 375 causes a similar circular or rotational movement of the anchor 255.
  • The axle 350 may rotate circularly when force is applied thereon. The axle 350 may also be referred to as a center pin. The gear 375, attached to the axle 350, may rotate in unison with and/or about the axle 350.
  • The base 245 may be moveably attached to the top portion 205 by the reservoir 410. A stem 240 is attached to the reservoir 410 for moving the fluid from the port 130 to the band 110. The stem 240 may include a strain relief element which locks into a housing 200 and protects the catheter 125 from folding, kinking, rotating, or torquing when the catheter 125 is connected to the reservoir 410. The housing 200 may also be referred to as a port housing. The housing 200 surrounds the port 130 and covers the components therein.
  • A radiopaque marker 420 is a type of locator element on the port 130 that is visible under an x-ray. The radiopaque marker 420 may be secured in the housing 200 so as not to hide the radiopaque marker 420. The radiopaque markers 420 can be used to facilitate identification of the type of gastric band or other useful information to be identified by the x-ray image of the port 130, for example, by using varied configurations, sizes or shapes of the radiopaque marker 420.
  • In accordance with an embodiment, the housing 200, the base 245, the top portion 205, and the gears 375 may be made of implantable grade plastic. Further, the anchors 255, the axels 250, and the radiopaque markers 420 may be made of implantable grade metal. Additionally, the reservoir 410 may be made of implantable grade titanium, and the septum 215 may be made of implantable silicone. It should be understood that other materials are contemplated within the scope of the present invention, and the above are only representative materials according to an embodiment.
  • In an embodiment, the port 130 may be assembled as follows. The anchor 255 and the gear 375 structure and/or assembly is inserted between the pylons 451 a, 451 b, and the anchor assembly is rotatably secured to the pylons 451 a, 451 b with the axle 250. The axle head may be configured to sit flush with the pylon 451 a. The above process is repeated until all of the anchors 255 and the gears 375 are assembled. In an embodiment, the anchors 255 are assembled in a fully deployed position. The reservoir 410 and the stem 240 subassembly are then inserted into the base 245, for example, by leading with the stem 240 and coming in from the bottom of the base 245. The stem 240 may be aligned over a supporting block on the base 245. Then, the septum 215 may be inserted into the reservoir 410. The housing 200 is then aligned with the radiopaque markers 420 and inserted, following which the top portion 205 is aligned and inserted. The inner ring 206 or a port cover may then be inserted and pressed into place around the septum 215 and within the top portion 205.
  • In accordance with various embodiments, FIGS. 5A-5C illustrate an applier 135 that is configured to interface with the top portion 205 of the port 130. The applier 135 includes an applier housing 539 and a housing top cover 538. The applier 135 further includes a head or a gripping portion 581 configured to mate with the top portion 205 of the port 130.
  • A trigger 582 is movably coupled to the applier housing 539 to allow a physician to actuate the port 130 in order to implant the anchors 255. The trigger 582 is biased away from the applier housing 539 via a spring 563. The trigger 582 is also coupled to a pulley 583. The pulley 583 is coupled to a first drive band 584, and the first drive band 584 is coupled to a second drive band 586 to facilitate actuating the port 130, as will be described further below. The first and second drive bands 584, 586 may be made of NITL, and other components of the applier 135 may be made of plastic and/or may be designed to be disposable. A switch 587 is operatively coupled to the applier housing 539 to direct the second drive band 586 in an implanting direction or a removal direction to facilitate implanting or removing the port 130, which will also be discussed further below.
  • In accordance with an embodiment of the present invention, and with reference to FIGS. 6A-6B, the first drive band 584 may be referred to as a horizontal drive band. To clarify, and with reference specifically to FIG. 6A, in an embodiment, the first drive band 584 may be a substantially flat drive band with a horizontal orientation, with respect to the gripping portion 581 of the applier 135, where the first drive band 584 mates with the second drive band 586.
  • Further, in an embodiment, the second drive band 586 may be referred to as a vertical drive band because of the second drive band's 586 vertical orientation, with respect to the gripping portion 581, where the first drive band 584 mates with the second drive band 586. Such a configuration allows the first drive band 584 to curve up the applier housing 539, and allows the second drive band 586 to curve with respect to the curvature of the gripping portion 581 of the applier 135. Other orientations and geometries of the drive bands 584, 586 that facilitate rotating the top portion 205 of the port 130 in response to a depression of the trigger 582 are contemplated within the scope of the present invention.
  • The switch 587 may further comprise a switch channel 590 configured to receive the second drive band 586 and direct the second drive band 586 through a first band channel 588 a or a second band channel 588 b in the applier 135. The switch 587 may rotate automatically or manually to direct the second drive band 586 down the appropriate band channel 588 a, 588 b. For example, a physician may rotate the switch 587 depending on whether or not the port 130 will be implanted or removed. In another embodiment, the switch 587 may automatically toggle to a removal position after the trigger 582 is depressed and released to implant the port 130.
  • For example, to implant the port 130, the switch channel 590 may direct the second drive band 586 through the first band channel 588 a so that the second drive band 586 moves clockwise along a first band surface 589 a of the gripping portion 581. FIGS. 6C-6D illustrate the extended second drive band 586 along the first band surface 589 a to illustrate the motion along the first band surface 589 a (without showing the connected port 130) according to an embodiment of the present invention. With momentary reference to FIGS. 8A-8B, in accordance with an embodiment, a partial perspective view of the applier 135 gripping the port 130 is shown, with the second drive band 586 passing through the switch, but prior to beginning rotation of the top portion 205 to implant the port 130.
  • In this manner, the second drive band 586 may be configured to interface with the top portion 205 of the port 130 to rotate the top portion 205 in a clockwise fashion in order to implant the anchors 255 in the tissue of the patient 105. For example, with reference also to FIGS. 2A, 11, and 13-14, the second drive band 586 may be configured to interface with a lip 261 on the top portion 205 to facilitate rotating the top portion 205 clockwise by pushing against the lip 261.
  • The lip 261 may be referred to as an implanting lip because the second drive band 586 pushes against the implanting lip 261 to implant the port 130. A similar lip 262 (see FIG. 2A) may be located on another part of the top portion 205 to allow the second drive band 586 to push against the lip 262 to rotate the top portion 205 counter-clockwise. The lip 262 may be referred to as a removal lip because the second drive band 586 pushes against the removal lip 262 to remove the port 130.
  • Accordingly, the first band channel 588 a may be referred to as an implanting band channel, the first band surface 589 a may be referred to as an implanting band surface, and the second drive band 586 may cause the top portion 205 to move in an implanting direction by pushing against the lip 261 when the second drive band 586 moves through the implanting band channel 588 a and along the implanting band surface 589 a.
  • Similarly, to remove the port 130, the switch channel 590 may direct the second drive band 586 through the second band channel 588 b so that the second drive band 586 moves counter-clockwise along a second band surface 589 b of the gripping portion 581. FIGS. 6E-6F illustrate the extended second drive band 586 along the second band surface 589 b to illustrate the motion along the second band surface 589 b (without showing the connected port 130) according to an embodiment of the present invention.
  • In this manner, the second drive band 586 may be configured to interface with the top portion 205 of the port 130 to rotate the top portion 205 in a counter-clockwise fashion in order to remove the anchors 255 from the tissue of the patient 105. For example, the second drive band 586 may interface with a lip 262 (see FIG. 2A), ridge, or other structure on the top portion 205 to facilitate pushing on the structure to rotate the top portion 205 in a counter-clockwise direction. The lip 262 may be referred to as a removal or an extraction lip because the second drive band 586 pushes against the removal lip 262 to remove the port 130.
  • Accordingly, the second band channel 588 b may be referred to as a removal band channel, the second band surface 589 b may be referred to as a removal band surface, and the second drive band 586 may cause the top portion 205 to move in a removal direction when the second drive band 586 moves through the removal band channel 588 a and along the removal band surface 589 a. However, in other embodiments, it should be understood that the top portion 205 of the port 130 may be rotated counter-clockwise to implant the anchors 255 and rotated clockwise to remove the anchors 255. In various embodiments, the applier 135 may provide a tactile response, for example, through the trigger 582, to indicate implantation and/or removal of the anchors 255.
  • In various embodiments, the applier tool 135 may be assembled as follows. The vertical drive band 586 and the horizontal drive band 584 may be assembled together using a snap fit or an assembly pin, or other suitable attachment mechanism. The horizontal drive band 584 may then be inserted into the trigger 582, for example, into a groove in the pulley 583. A snap fit, assembly pin, or other suitable mechanism may be used to attach the horizontal drive band 584 to the trigger 582. The spring 563 is then inserted into the trigger 582, and the assembly is inserted into the applier housing 539. The switch 587 is then inserted into the housing 539, and the housing top cover 538 is then secured to the housing 539, for example, by bonding the top cover 538 and the housing 539 together using epoxy or ultrasonic welding.
  • With reference to FIGS. 7A-7B, in accordance with an embodiment, the top portion 205 may comprise one or more fittings 707 (e.g., cavities, holes, snap bosses, or notches) located on a surface of the top portion 205 to allow the applier 135 to attach to or mate with the top portion 205. The fittings 707 may be referred to as snap fittings or bosses because the applier 135 may snap into and out of the fittings 707. The fittings 707 may interface with mating snap leaves 709 on the applier 135. In one embodiment, the top portion 205 rotates in a clockwise or counter-clockwise direction as guided by the applier 135 to facilitate implanting the port 130 into or removing the port 130 from the patient's tissue. The port 130 may be released from the applier 135 by slightly lifting and then retracting the applier 135.
  • With reference to FIG. 9, in an embodiment, the top portion 205 of the port 130 may have top teeth 930 protruding from a bottom surface of the top portion 205. In an example embodiment, the top teeth 930 are positioned about an axis that is substantially perpendicular to a plane defined by the top portion 205. The top teeth 930 include ridges, alternating cut-outs and protrusions, bumpy or uneven surfaces, a flat surface with friction and/or any other surface(s) with sufficient friction to interact with and move components (e.g., the gear 375 and the anchor 255) of the port 130. Various sets or pluralities of top teeth 930 (e.g., a first set/plurality of top teeth, a second set/plurality of top teeth, etc.) may be positioned along an outer edge of the top portion 205 for interacting with different gears 375 at different or the same times.
  • The gear 375 may also be referred to as a pinion gear. The teeth 380 on the gear 375 mate with the top teeth 930 of the top portion 205 to rotate the anchor 255. The teeth 380 and top teeth 930 may include ridges, bumpy surfaces, flat surfaces with friction, and any other surface with sufficient friction to interact with and to move components of the port 130.
  • With reference to FIG. 10, and in accordance with an embodiment, to deploy the anchor 255, the top portion 205 is rotated in a clockwise direction and the top teeth 930 are engaged with the teeth 380 to rotate the gear 375 and the anchor 255 in a counter-clockwise direction causing the anchor 255 to move through the anchor opening 365 and into the tissue of a patient. In an embodiment, and with reference to FIG. 11, the anchor tip 460 may also move into the tip opening 370 when the anchor 255 is fully deployed.
  • The anchor 255 secures the port 130 to the human 105, by the anchor tip 460 penetrating the human's skin or muscle (e.g., abdominal muscle fascia). The anchor tip 460 may also be referred to as a hook or pointed end. The anchor tip 460 is structured to penetrate and enter the bodily tissue as the anchor 255 rotates into the deployed position.
  • In some embodiments, the anchor tip 460 includes one or more flat faces. For example, the anchor tip 460 may have a single facet, or may have two or more facets. The anchor 255 may also be referred to as an attachment mechanism, a hook, a needle anchor, a needle device, or a cork screw. Also, the anchor 255 may be formed in the shape of a hook, a needle or a cork screw (e.g., a series of spirals with a sharp point at the end of the series of spirals). In one embodiment, each anchor 255 may be made of a wire, for example, a bent stainless steel wire having a round cross section and a multi-faceted sharp distal tip. The port 130 may include two, three, four, five or more anchors 255 and related components that are attached and positioned equidistantly around the base 245.
  • In one embodiment, a plurality of anchors 255 are deployed or moved from an un-deployed position (see, e.g., FIG. 9) to a fully-deployed position (see, e.g., FIGS. 13B, 13C, and 14), or from a fully-deployed position to an un-deployed position. In various embodiments, some anchors 255 may be deployed or removed simultaneously. For example, where the port 130 has four anchors 255, and with reference to FIGS. 10 and 11A-11B, opposite anchors 255 may be simultaneously deployed. Further, some anchors 255 may be deployed or removed non-simultaneously. For example, a first set of opposing anchors 255 a may be deployed or removed first, and then a second set of opposing anchors 255 b may be deployed or removed second (see, e.g., FIG. 13A). It should be understood that various other deployment combinations, both simultaneous and non-simultaneous, are contemplated within the scope of the present invention.
  • Each anchor 255 is rotated from an un-deployed position where the anchor 255 is above the base 245 to a deployed position where the anchor 255 travels through the anchor opening 365. When in the deployed position, the anchors 255 fix the port 130 to the bodily tissue. If the port 130 is removed, the anchors 255 may be rotated from the deployed position back to the un-deployed position within the port 130.
  • In the case where the port 130 is used in conjunction with the gastric band 110, the port 130 may be secured, by means of the anchors 255, to the rectus muscle fascia. The anchor 255 may protrude through the anchor opening 365 in the base 245, and may also protrude through the tip opening 370 in the base 245 as the anchor 255 is rotated around the axle 350. The tip opening 370 provides a safe storage position for the anchor tip 460 so the anchor tip 460 does not get dulled or damaged.
  • The base 245 may also have one or more suture holes 285 for suturing the port 130 to the human 105, in the event that the use of the applier 135 to attach the port 130 is not desired or allowable. A drawback of suturing is the additional time and effort required by the medical professional to secure the port 130 during surgery.
  • In some embodiments, the anchors 255 are removable or reversible, allowing the anchors 255 to be detached from the bodily tissue. For example, the top portion 205 can be rotated in a counter-clockwise direction to remove the anchors 255 from the tissue. Specifically, to un-deploy the anchors 255, the top portion 205 is rotated in a counter-clockwise direction and the top teeth 930 are engaged with the teeth 380 to rotate the gear 375 and the anchor 255 in a clockwise direction causing the anchors 255 to move through the anchor opening 365 and out of the tissue. The anchor tip 460 may also move into the anchor opening 365.
  • In one embodiment, a plurality of anchors 255 includes four anchors that are evenly spaced apart around the base 245. Each anchor 255 may be referred to as being independent, which includes being a separate component or having separate operation from another anchor 255. Each anchor 255 includes a curved distal portion such as the anchor tip 460 which engages the bodily tissue and a pivotal proximal portion or a body portion that includes the gear 375, which is rotatably connected to the base 245 of the port 130.
  • As noted above, in various embodiments, the anchors 255 are independently movable between a non-implanted and implanted position. Furthermore, the anchors 255 may be implanted or extracted simultaneously or non-simultaneously. To facilitate deployment of the anchors 255, the plurality of sets of top teeth 930 may be advantageously located around a circumference of the top portion 205 so that the top teeth 930 interact with the teeth 380 at the appropriate time.
  • Although it should be understood that various numbers, configurations, and locations of the top teeth 930, the gears 375, and the anchors 255 are contemplated within the scope of the present invention, the following is a description of a particular configuration according to an embodiment of the present invention.
  • With reference to FIGS. 9, 10, and 11A-B, and in accordance with an embodiment, the top portion 205 includes four sets of top teeth 930. Each set of top teeth 930 is located to allow simultaneous or non-simultaneous deployment of the anchors 255. For example, the four anchors 255 may be spaced equidistantly around the circumference of the port 130 (e.g., every ninety degrees), but the sets of top teeth 930 may not be equidistant.
  • To explain, a first set of the anchors 255 a that are opposite each other may be deployed first, and a second set of anchors 255 b (see FIGS. 13A-13C) that are opposite each other, but that neighbor the first set of anchors 255 a, may be deployed second. A first set of top teeth 930 a (as illustrated in FIG. 9) may interface with the teeth 380 a on a first gear 375 a (or first set of gears 375 a) to facilitate implanting a first anchor 255 a (or first set of anchors 255 a) into the patient's tissue. As illustrated in FIGS. 10 and 11A-11B, these first anchors 255 a are implanted prior to implantation of a second set of anchors 255 b (see FIG. 13B-13C).
  • In an embodiment, and with reference to FIGS. 13A-13C and 14, after the first set of top teeth 930 a moves through the teeth 380 a on the first set of gears 375 a and the first set of anchors 255 a are implanted, the second set of top teeth 930 b interact with the second set of teeth 380 b on the second set of gears 375 b. In this manner, the second set of top teeth 930 b cause the second set of anchors 255 b to be implanted into the tissue of the patient after implantation of the first set of anchors 255 a. The anchors 255 may similarly be non-simultaneously removed from the patient's tissue in reverse of the above mentioned process (e.g., by rotating the top portion 205 counter-clockwise).
  • Although two sets of top teeth 930 a, 930 b have been disclosed, it should be understood that only one set of top teeth 930 may be included in accordance with an embodiment. For example, the set of top teeth 930 may include discrete portions of top teeth 930 that are located opposite from each other along the circumference of the top portion 205. In this manner, the top teeth 930 may first come in contact with the first set of teeth 380 a on the first set of gears 375 a to facilitate implanting the first set of anchors 255 a. As the top portion 205 continues to rotate, the top teeth 930 may then come into contact with the second set of teeth 380 b on the second set of gears 375 b to facilitate implanting the second set of anchors 255 b. Other configurations are contemplated within the scope of the present invention that facilitate non-simultaneous deployment of at least some of the anchors 255.
  • In accordance with various embodiments, non-simultaneous implantation of the anchors 255 may be accomplished by moving the switch 587 of the applier 135 to an implantation position and then depressing the trigger 582 of the applier 135. Depressing the trigger 582 causes the horizontal drive band 584 to act on the vertical drive band 586, which moves through the switch channel 590 and the implanting band channel 588 a.
  • By moving through the implanting band channel 588 a, the vertical drive band 586 acts on the implanting lip 261 to cause the top portion 205 to rotate in a clockwise manner to move the top teeth 930 over the teeth 380 of the gears 375 to implant the anchors 255 into the tissue of the patient. For example, the first set of anchors 255 a may be deployed, and then the second set of anchors 255 b may be deployed, resulting in non-simultaneous deployment of the anchors 255 a, 255 b.
  • In a reverse manner, and in accordance with various embodiments, non-simultaneous removal of the anchors 255 may be accomplished by moving the switch 587 of the applier 135 to a removal position and then depressing the trigger 582 of the applier 135. Depressing the trigger 582 causes the horizontal drive band 584 to act on the vertical drive and 586, which moves through the switch channel 590 and the removal band channel 588 b.
  • By moving through the removal band channel 588 b, the vertical drive band 586 acts on the removal lip 262 to cause the top portion 205 to rotate in a counter-clockwise manner to move the top teeth 930 over the teeth 380 of the gears 375 to remove the anchors 255 from the tissue of the patient. For example, the first set of anchors 255 a may be removed, and then the second set of anchors 255 b may be removed, resulting in non-simultaneous removal of the anchors 255 a, 255 b.
  • The terms “a,” “an,” “the,” and similar referents used in the context of describing the present invention (especially in the context of the following claims) are to be construed to cover both the singular and the plural, unless otherwise indicated herein or clearly contradicted by context. Recitation of ranges of values herein is merely intended to serve as a shorthand method of referring individually to each separate value falling within the range. Unless otherwise indicated herein, each individual value is incorporated into the specification as if it were individually recited herein. All methods described herein can be performed in any suitable order unless otherwise indicated herein or otherwise clearly contradicted by context. The use of any and all examples, or exemplary language (e.g., “such as”) provided herein is intended merely to better illuminate the present invention and does not pose a limitation on the scope of the present invention otherwise claimed. No language in the specification should be construed as indicating any non-claimed element essential to the practice of the present invention.
  • Groupings of alternative elements or embodiments of the invention disclosed herein are not to be construed as limitations. Each group member may be referred to and claimed individually or in any combination with other members of the group or other elements found herein. It is anticipated that one or more members of a group may be included in, or deleted from, a group for reasons of convenience and/or patentability. When any such inclusion or deletion occurs, the specification is deemed to contain the group as modified thus fulfilling the written description of all Markush groups used in the appended claims.
  • Certain embodiments of this invention are described herein, including the best mode known to the inventors for carrying out the invention. Of course, variations on these described embodiments will become apparent to those of ordinary skill in the art upon reading the foregoing description. The inventor expects skilled artisans to employ such variations as appropriate, and the inventors intend for the invention to be practiced otherwise than specifically described herein. Accordingly, this invention includes all modifications and equivalents of the subject matter recited in the claims appended hereto as permitted by applicable law. Moreover, any combination of the above-described elements in all possible variations thereof is encompassed by the invention unless otherwise indicated herein or otherwise clearly contradicted by context.
  • Furthermore, certain references have been made to patents and printed publications throughout this specification. Each of the above-cited references and printed publications are individually incorporated herein by reference in their entirety.
  • Specific embodiments disclosed herein may be further limited in the claims using “consisting of” or “consisting essentially of” language. When used in the claims, whether as filed or added per amendment, the transition term “consisting of” excludes any element, step, or ingredient not specified in the claims. The transition term “consisting essentially of” limits the scope of a claim to the specified materials or steps and those that do not materially affect the basic and novel characteristic(s). Embodiments of the invention so claimed are inherently or expressly described and enabled herein.
  • In closing, it is to be understood that the embodiments of the present invention disclosed herein are illustrative of the principles of the present invention. Other modifications that may be employed are within the scope of the present invention. Thus, by way of example, but not of limitation, alternative configurations of the present invention may be utilized in accordance with the teachings herein. Accordingly, the present invention is not limited to that precisely as shown and described herein.
  • The previous description of the disclosed examples is provided to enable any person of ordinary skill in the art to make or use the disclosed methods and apparatus. Various modifications to these examples will be readily apparent to those skilled in the art, and the principles defined herein may be applied to other examples without departing from the spirit or scope of the disclosed method and apparatus. The described embodiments are to be considered in all respects only as illustrative and not restrictive and the scope of the invention is, therefore, indicated by the appended claims rather than by the foregoing description. All changes which come within the meaning and range of equivalency of the claims are to be embraced within their scope.

Claims (24)

    What is claimed is:
  1. 1. An implantable injection port for use with a gastric band for treating obesity and for attaching to a tissue of a patient, the implantable injection port comprising:
    a base having a first anchor opening;
    a first gear coupled to the base and rotatable about a first axis, the first gear having a first plurality of gear teeth;
    a second gear coupled to the base and rotatable about a second axis, the second gear having a second plurality of gear teeth;
    a first anchor coupled to the first gear; and
    a top portion spaced apart from the base and having a first plurality of top teeth that engage with the first plurality of gear teeth on the first gear prior to rotation of the second gear, the top portion being rotatable causing rotation of the first gear such that the rotation of the first gear causes movement of the first anchor through the anchor opening of the base and into the tissue of the patient.
  2. 2. The implantable injection port of claim 1, wherein the first gear rotates about the first axis independently of the second gear.
  3. 3. The implantable injection port of claim 1, further comprising a second anchor coupled to the second gear.
  4. 4. The implantable injection port of claim 3, wherein subsequent to the first plurality of top teeth engaging with the first plurality of gear teeth on the first gear, the first plurality of top teeth engages with the second plurality of gear teeth on the second gear.
  5. 5. The implantable injection port of claim 4, wherein the first plurality of top teeth engages with the second plurality of gear teeth to cause rotation of the second gear, which causes movement of the second anchor through a second anchor opening of the base and into the tissue of the patient.
  6. 6. The implantable injection port of claim 5, wherein the first anchor and the second anchor move non-simultaneously into the tissue of the patient.
  7. 7. The implantable injection port of claim 5, wherein the first anchor moves into the tissue of the patient at a first time, and wherein the second anchor moves into the tissue of the patient a second time different than the first time.
  8. 8. The implantable injection port of claim 1, further comprising a third gear coupled to the base and rotatable about a third axis, the third gear having a third anchor and a third plurality of gear teeth.
  9. 9. The implantable injection port of claim 8, wherein the top portion comprises a third plurality of top teeth that engage with the third plurality of gear teeth on the third gear to cause movement of the third anchor through a third anchor opening of the base and into the tissue of the patient.
  10. 10. The implantable injection port of claim 9, wherein the third plurality of top teeth engage with the third plurality of gear teeth simultaneously with the engagement of the first plurality of top teeth and the first plurality of gear teeth.
  11. 11. The implantable injection port of claim 9, wherein the third plurality of top teeth engage with the third plurality of gear teeth at a first time, and wherein the first plurality of top teeth engage with the first plurality of gear teeth at the first time.
  12. 12. The implantable injection port of claim 8, wherein the third axis is collinear with the first axis.
  13. 13. The implantable injection port of claim 1, wherein the implantable injection port is attached to the tissue of the patient with an actuation device capable of non-simultaneously rotating the first gear and the second gear.
  14. 14. The implantable injection port of claim 1, further comprising a septum positioned within a center opening of the top portion and made of a self sealing needle penetrable material.
  15. 15. The implantable injection port of claim 14, further comprising a reservoir positioned underneath the septum and between the top portion and the base for holding fluid.
  16. 16. An actuation device for attaching an implantable injection port to a tissue of a patient, the actuation device comprising:
    a head configured to be coupled to the implantable injection port;
    a first drive band coupled to a trigger of the actuation device;
    a second drive band coupled to the first drive band for translating motion from the trigger of the actuation device to the second drive band, wherein the second drive band is configured to interface with a top portion of the implantable injection port to facilitate deploying an anchor of the implantable injection port into the tissue of the patient; and
    a switch operable to direct the second drive band to rotate the top portion of the implantable injection port in an implanting direction or a retracting direction.
  17. 17. The actuation device of claim 16, wherein a face of the first drive band is substantially perpendicular to a face of the second drive band, and wherein the first drive band is a horizontal drive band and the second drive band is a vertical drive band.
  18. 18. The actuation device of claim 16, wherein the head is a gripping portion configured to be coupled to the implantable injection port via a snap feature.
  19. 19. The actuation device of claim 16, wherein the implanting direction of the top portion facilitates implanting the anchor in the tissue of the patient, and wherein the retracting direction of the top portion facilitates retracting the anchor from the tissue of the patient.
  20. 20. The actuation device of claim 16, wherein the implanting direction is clockwise and the retracting direction is counter clockwise.
  21. 21. The actuation device of claim 16, wherein the switch is manually or automatically toggled to a retracting mode after the trigger is depressed and released to implant the anchor in the tissue of the patient.
  22. 22. The actuation device of claim 21, wherein the switch is toggled by rotating from a first position to a second position, wherein the first position guides the second drive band to rotate the top portion of the implantable injection port in the implanting direction, and wherein the second position guides the second drive band to rotate the top portion of the implantable injection port in the retracting direction.
  23. 23. A method for implanting an implantable injection port in a tissue of a patient, the method comprising:
    coupling a gripping portion of an actuation device to a top portion of the implantable injection port;
    depressing a trigger of the actuation device when a switch in the actuation device is located in an implanting orientation;
    directing a vertical drive band through the switch to contact the top portion of the implantable injection port and rotate the top portion in an implanting direction;
    implanting, at a first time, a first anchor into the tissue of the patient in response to a first set of top teeth causing a first gear to rotate, wherein the first anchor is coupled to the first gear;
    implanting, at a second time, a second anchor into the tissue of the patient in response to the first set of top teeth causing a second gear to rotate, wherein the second anchor is coupled to the second gear; and
    toggling the switch to an extracting orientation in response to the trigger being released.
  24. 24. A system for implanting an implantable injection port in a tissue of a patient, the system comprising:
    an actuation device for attaching the implantable injection port to the tissue of the patient, the actuation device comprising:
    a head configured to be coupled to the implantable injection port;
    a first drive band coupled to a trigger of the actuation device;
    a second drive band coupled to the first drive band for translating motion from the trigger of the actuation device to the second drive band, wherein the second drive band is configured to interface with a top portion of the implantable injection port to facilitate deploying an anchor of the implantable injection port into the tissue of the patient; and
    a switch operable to direct the second drive band to rotate the top portion of the implantable injection port in an implanting direction or a retracting direction;
    wherein the implantable injection port comprises:
    a base having an anchor opening;
    a first gear coupled to the base and rotatable about a first axis, the first gear having a first plurality of gear teeth; and
    a second gear coupled to the base and rotatable about a second axis, the second gear having a second plurality of gear teeth;
    wherein the anchor is coupled to the first gear, and
    wherein the top portion is spaced apart from the base and has a first plurality of top teeth that engage with the first plurality of gear teeth on the first gear prior to a second plurality of top teeth engaging with the second plurality of gear teeth on the second gear, the top portion being rotatable causing rotation of the first gear such that the rotation of the first gear causes movement of the anchor through the anchor opening of the base and into the tissue of the patient.
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