K Number
K223254

Validate with FDA (Live)

Device Name
C2 Xplore
Date Cleared
2023-01-27

(98 days)

Product Code
Regulation Number
874.1820
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The C2 Xplore is designed for use in the operating room to measure and display the neurophysiological signals. The system supports the application of Electromyography (EMG) for the purposes of intraoperative neuromonitoring of the peripheral nervous system. The system is not intended for monitoring life-sustaining functions.

Device Description

The C2 Xplore is an electromyography (EMG) monitor for the purposes of intraoperative neuromonitoring of the peripheral nervous system. The C2 Xplore assists the surgeon in nerve identification, helping to locate and identify nerves at risk in the surgical field. The device records the EMG activity from the innervated nerves and provides visual and audible feedback for the surgeon, helping to preserve the nerve structures throughout the procedure. The device is equipped with 8 differential amplifier channels and with two independent stimulators. The C2 Xplore is operated via mechanical turning knobs and a touchscreen on the front. The audio feedback is generated by an integrated loudspeaker. The nerve monitoring provides information about the amplitude and latency of the EMG responses.

AI/ML Overview

The provided text describes the C2 Xplore device, an electromyography (EMG) monitor for intraoperative neuromonitoring of the peripheral nervous system. It outlines various aspects of the device's design, intended use, and comparisons to a predicate device (C2 NerveMonitor System) and a reference device (Medtronic Xomed, Inc Nerve Integrity Monitor 3.0).

However, the document does not contain specific acceptance criteria in numerical or quantitative terms for the device's diagnostic or clinical performance (e.g., sensitivity, specificity, accuracy for nerve identification). Instead, it discusses compliance with general safety, performance, and software standards.

Therefore, I cannot create a table of "acceptance criteria and reported device performance" as defined by specific clinical metrics. The document focuses on regulatory compliance and substantial equivalence rather than a detailed performance study with clinical outcomes.

Based on the information provided, here's what can be extracted and inferred regarding acceptance criteria and performance:

1. Table of Acceptance Criteria and Reported Device Performance:

As no specific quantitative clinical acceptance criteria (e.g., sensitivity, specificity, accuracy) are provided in the document for the device's primary function of nerve identification, a direct table of "acceptance criteria and reported device performance" in that sense cannot be created.

However, the document does detail compliance with various technical standards and internal requirements, which serve as acceptance criteria for different aspects of the device:

Acceptance Criteria CategorySpecific Criteria (from document)Reported Device Performance (from document)
Software Compliance- Compliance with predetermined specifications. - Compliance with applicable guidance documents and standards (FDA guidance on premarket submissions for software, off-the-shelf software, software validation, cybersecurity). - Rigorous development process, including software verification and validation."Test results demonstrate that the C2 Xplore software complies with its predetermined specifications, the applicable guidance documents and standards." "The software was designed and developed according to a rigorous development process, including software verification and validation." "The product successfully underwent the bench testing of the requirements at these levels as part of the verification and validation process."
Electrical Safety- Compliance with IEC 60601-1:2005+A1:2012 (or 2012 reprint). - Compliance with IEC 60601-1-6:2010+AMD1:2013 (Usability). - Compliance with IEC 60601-2-40:2016 (Electromyographs and evoked response equipment). - Class I protection, 4000 V. - Device type BF (Body Floating) for patient leads."The C2 Xplore was tested according to the following standards: [listed standards]. Test results demonstrate that the products comply with the applicable standards." "Class I protection 4000 V" "Device type BF (Body Floating)"
Electromagnetic Compatibility (EMC)- Compliance with IEC 60601-1-2:2014."The essential performance and safety of the C2 Xplore was tested according to the following standards: [listed standard]. Test results demonstrate that the products comply with the applicable standards."
Bench Performance Testing- Compliance with internal requirements for general device, functional, external interface, system accessory, and C2 Xplore software/firmware/OS requirements."The essential performance and safety of C2 Xplore was tested for performance in accordance with internal requirements." "The product successfully underwent the bench testing of the requirements at these levels as part of the verification and validation process."
Human Factors- Demonstration of mitigation of potential use errors. - Safety of user interface design."Moreover, the testing of the influence of human factors on the device was conducted to demonstrate mitigation of potential use errors and safety of the user interface design."
Overall Safety and Effectiveness- As safe, as effective, and performs as well as, or better than, the legally marketed predicate device."The non-clinical tests demonstrate that the device is as safe, as effective, and performs as well as or better than the legally marketed device predicate." "The results of these activities demonstrate that the devices are as safe, effective and perform as well as or better than the predicate device."

2. Sample size used for the test set and data provenance:

  • Test Set Sample Size: Not applicable. The document states, "No additional clinical testing was performed for the C2 Xplore. Therefore, this section does not apply." The performance testing described is primarily technical bench testing and compliance with standards, not a clinical study on patient data.
  • Data Provenance: Not applicable for a clinical test set. The data provenance would be from internal lab testing and compliance assessments, not patient data from a specific geographical region or retrospective/prospective study design.

3. Number of experts used to establish the ground truth for the test set and their qualifications:

Not applicable. As no clinical testing with patient data or medical imaging was performed, there was no need for experts to establish ground truth in a clinical context.

4. Adjudication method for the test set:

Not applicable. No clinical test set requiring expert adjudication was used.

5. If a multi-reader multi-case (MRMC) comparative effectiveness study was done, and the effect size:

No. The document explicitly states, "No additional clinical testing was performed for the C2 Xplore." Therefore, an MRMC study comparing human readers with and without AI assistance was not conducted or reported.

6. If a standalone (i.e., algorithm only without human-in-the-loop performance) was done:

Not applicable in the context of diagnostic AI. The C2 Xplore is a hardware device with integrated software for neuromonitoring, which inherently involves a human (surgeon) interpreting the visual and audible feedback. It is not an "algorithm only" device designed to operate independently of human intervention for its intended use of nerve identification during surgery. Its standalone performance is described through its technical specifications and compliance with safety and performance standards.

7. The type of ground truth used:

For the technical performance (EMG recording, stimulation, electrical safety, EMC, software functionality), the ground truth is established by engineering specifications, international technical standards, and validated test procedures. For example, the accuracy of voltage/current delivery, noise levels, and frequency response would be verified against known, precisely controlled inputs and expected outputs according to design specifications and relevant standards.

8. The sample size for the training set:

Not applicable. The C2 Xplore is described as an electromyography monitor and stimulator, not an AI/ML device that requires a distinct "training set" of data for learning a clinical pattern. Its software compliance involves verification and validation against predetermined specifications and guidance documents, which is a different paradigm from data-driven AI model training.

9. How the ground truth for the training set was established:

Not applicable, as no AI model training set is mentioned for the device.

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January 27, 2023

Inomed Medizintechnik GmbH Anja Riesterer, M.Sc. Regulatory Affairs Manager Im Hausgruen 29 Emmendingen, 79312 Germany

Re: K223254

Trade/Device Name: C2 Xplore Regulation Number: 21 CFR 874.1820 Regulation Name: Surgical Nerve Stimulator/Locator Regulatory Class: Class II Product Code: ETN, GWF Dated: October 14, 2022 Received: October 21, 2022

Dear Anja Riesterer:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part

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801); medical device reporting of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4. Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

Joyce C. Lin -S

for Shu-Chen Peng, Ph.D. Assistant Director DHT1B: Division of Dental and ENT Devices OHT1: Office of Ophthalmic, Anesthesia, Respiratory, ENT and Dental Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known) K223254

Device Name C2 Xplore

Indications for Use (Describe)

The C2 Xplore is designed for use in the operating room to measure and display the neurophysiological signals. The system supports the application of Electromyography (EMG) for the purposes of intraoperative neuromonitoring of the peripheral nervous system.

The system is not intended for monitoring life-sustaining functions.

Type of Use (Select one or both, as applicable)
Prescription Use (Part 21 CFR 801 Subpart D)
Over-The-Counter Use (21 CFR 801 Subpart C)

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510(k) Summary

Submission Date:2022-10-14
Subject 510(k) numberK223254
510(k) Holder:inomed Medizintechnik GmbHIm Hausgruen 2979312 Emmendingen, Germany
Submitter andApplicationCorrespondent:Maximilian WimmerPhone: +49 7641 6414 545Email: m.wimmer@inomed.com
ManufacturingSite:inomed Medizintechnik GmbHIm Hausgruen 2979312 Emmendingen, Germany
Trade Name:C2 Xplore
ClassificationRegulation:Surgical nerve stimulator/locator 21 CFR §874.1820
Product Code:ETN, GWF
RegulationMedicalSpecialty:Ear, Nose, and Throat
SubstantiallyEquivalentDevices:Predicate device 510(k) numberPredicate device Manufacturer/Model
K152505inomed Medizintechnik GmbHC2 NerveMonitor System
Reference device 510(k) numberReference device Manufacturer/Model
K083124Medtronic Xomed, IncNerve Integrity Monitor 3.0

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The C2 Xplore is an electromyography (EMG) monitor for the Device Description: purposes of intraoperative neuromonitoring of the peripheral nervous system. The C2 Xplore assists the surgeon in nerve identification, helping to locate and identify nerves at risk in the surgical field. The device records the EMG activity from the innervated nerves and provides visual and audible feedback for the surgeon, helping to preserve the nerve structures throughout the procedure. The device is equipped with 8 differential amplifier channels and with two independent stimulators. The C2 Xplore is operated via mechanical turning knobs and a touchscreen on the front. The audio feedback is generated by an integrated loudspeaker. The nerve monitoring provides information about the amplitude and latency of the EMG responses. Intended Use of The C2 Xplore is intended for intraoperative neuromonitoring; for Subject Device: recording of electrophysiological signals and stimulating of nerve and muscle tissues. C2 Xplore The C2 Xplore is designed for use in the operating room to measure Indications for and display the neurophysiological signals. Use of Subject Device: The system supports the application of Electromyography (EMG) for the purposes of intraoperative neuromonitoring of the peripheral C2 Xplore nervous system. The system is not intended for monitoring life-sustaining functions. Intended Use of The C2 NerveMonitor System is intended for intra-operative Predicate Device: monitoring and stimulation for localization and identification of cranial and peripheral motor and mixed motor sensory nerves during surgery. C2 NerveMonitor including spinal nerve roots. System K152505 Indications for The C2 NerveMonitor device with the integrated user interface is only Use of Predicate allowed for the surveillance, documentation and functional test of motor nerves. It can be used as an additional helping tool during Device surgical procedures for diagnostic issues. Its basic functions are C2 NerveMonitor similar to those of an EMG diagnostic device. System Indications for C2 NerveMonitor System Monitoring Procedures K152505 include: Extracranial, Intratemporal, Extratemporal, Neck Dissections, and Upper and Lower Extremities.

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Image /page/5/Picture/0 description: The image shows the logo for Inomed. The logo consists of the word "inomed" in bold, black letters, followed by a black square containing a white "i" with two curved arrows around it. Below the word "inomed" is the website address "www.inomed.com".

Indications for C2 NerveMonitor System monitoring of Spinal procedures include:

Degenerative Treatments, Pedicle Screw Procedures, Fusion Cages, Orthopedic Surgery, Open and Percutaneous Lumbar and Cervical Surgical Procedures.

The system is not intended for monitoring life preserving functions.

The system may not be used for diagnosing brain death.

Conclusion of the inomed Medizintechnik GmbH claims that the predicate and subject intended use devices are substantially equivalent in terms of the intended use and evaluation: indications for use. Both the predicate and subject devices can be used for the recording of electrophysiological signals and stimulating nerve and muscle tissues for intraoperative neuromonitoring.

Technology technological characteristics of the C2 Xplore and The the Comparison: predecessor device (predicate device) are equivalent.

Subject devicePredicate device
SystemC2 XploreC2 NerveMonitor System
Manufacturerinomed Medizintechnik GmbHinomed Medizintechnik GmbH
Energy Type
Power100 V - 240 V and 50/60 Hz electricaloutlet connection100 V - 240 V and 50/60 Hz electricaloutlet connection
Performance Specifications - EMG Recording Unit
MeasurementprincipleAmplifiers based on differential(bipolar) type of recordingAmplifiers based on differential(bipolar) type of recording
Recordingchannels8 differential channels8 differential channels
Measurementrange1 mVpp - 500 mVpp (programmable)800 $\mu$ Vpp - 800 mVpp(programmable)
A/D resolution16-bit16-bit
Common-moderejection ratio(CMRR)> 100 dB (50 Hz)> 100 dB (50 Hz)
Input noise level< 1.5 $\mu$ VEff (with hardware filter 30 Hzto 2.5 kHz)< 1.2 $\mu$ VEff (with hardware filter 30 Hzto 1.25 kHz)
Input Impedance> 100 MΩ> 100 MΩ
Hardwarebandpass0.5 Hz - 5 kHz0.5 Hz - 5 kHz
Scanning rate20 kHz20 kHz
Blanking1 - 4 ms1 – 4 ms
Performance Specifications - Stimulation Unit
Stimulationchannels22
FrequencyProgrammable 0.1 – 30 HzProgrammable 1 - 30Hz
PolarityUnipolar, negative rectangular pulseUnipolar, negative rectangular pulse
Voltage limit100 V100 V
Load Impedance0 - 10 kΩ0 – 10 kΩ
Current sensorDisplay of current flow (confirm current)Display of current flow (confirm current)
Visual OutputVisual display shows waveform amplitude and latency time of stimulated and recorded signalsVisual display shows waveform amplitude and latency time of stimulated and recorded signals
Stimulation parameters
Stimulation intensity (I) and pulse width (PW)Image: Stimulation intensity (I) and pulse width (PW)Image: PW
Stimulation frequency (f) rangeImage: 1/f
Stimulator 1 (direct nerve stimulator)
Frequency (f)Programmable 0.1 – 30 HzProgrammable 1 - 30Hz
Pulse width (PW)200 µs200 µs
Current (I)0.01 – 5 mA0.01-5 mA
Maximum RMS stimulation intensity0.39 mA0.39 mA
Minimum electrode size0.001 cm²0.001 cm²
Maximum current density390 mA/cm²390 mA/cm²
Maximum power density25 W/cm²25 W/cm²
Maximum charge density78 µC/cm²78 µC/cm²
Stimulator 2 (continuous stimulator in combination with Medtronic APS electrode)
Frequency (f)max. 2 HzPredicate device: ---Reference device: max. 2 Hz
Pulse width (PW)100 µsPredicate device: ---Reference device: 100 µs
Current (I)0.1 - 3 mAPredicate device: ---Reference device: 0.1 - 3 mA
Maximum RMSstimulationintensity0.04 mAPredicate device: ---Reference device: 0.04 mA
Minimumelectrode size0.0097 cm2Predicate device: ---Reference device: 0.0097 cm2
Maximum currentdensity4.12 mA/cm2Predicate device: ---Reference device: 4.12 mA/cm2
Maximum powerdensity0.93 W/cm2Predicate device: ---Reference device: 0.93 W/cm2
Maximum chargedensity0.41 $\mu$ C/cm2Predicate device: ---Reference device: 0.41 $\mu$ C/cm2
Hardware
WorkstationStandard personal computer (PC)componentsStandard personal computer (PC)components
Printer CapacityWaveform data can be printed on anexternal printerWaveform data can be printed on anexternal printer
Protectionagainst electricalshockClass I protection4000 VClass I protection4000 V
Protectionagainst electricalshock of patientleadsDevice type BF (Body Floating)Device type BF (Body Floating)
Housing materialBaydur 110 FR-6Baydur 110 FR-6
Display unitWhite frame, 12-inch display, touchscreen buttonsGrey frame, 8.4-inch display, soft-keybuttons
PC and storageboardAdvantech MIO-3260Advantech PCM-9361
- IEC 62304:2006+A1:2015, Medical device software –Software life cycle processes
Test results demonstrate that the C2 Xplore software complies withits predetermined specifications, the applicable guidance documentsand standards.
Electrical Safety:The C2 Xplore was tested according to the following standards:- IEC 60601-1:2005 (Third Edition) + CORR. 1:2006 + CORR.2:2007 + A1:2012 (or IEC 60601-1: 2012 reprint), Medicalelectrical equipment – Part 1: General requirements for basicsafety and essential performance.- IEC 60601-1-6:2010 + AMD1:2013, Medical electricalequipment, Part 1-6: General requirements for basic safetyand essential performance - Collateral standard: Usability- IEC 60601-2-40:2016, Medical electrical equipments – Part 2-40: Particular requirements for the basic safety and essentialperformance of electromyographs and evoked responseequipmentTest results demonstrate that the products comply with theapplicable standards.
ElectromagneticCompatibility:The essential performance and safety of the C2 Xplore was testedaccording to the following standards:- IEC 60601-1-2:2014, Medical electrical equipment – Part 1-2:General requirements for basic safety and essentialperformance – Collateral standard: Electromagneticdisturbances – Requirements and tests.Test results demonstrate that the products comply with theapplicable standards
PerformanceTesting - BenchThe essential performance and safety of C2 Xplore was tested forperformance in accordance with internal requirements. The deviceincluding their accessories and corresponding intended combinationswith further products have been designed according to requirementspecifications describing the following aspects:- General device requirements- Functional requirements- External interface requirements- System accessory requirements- C2 Xplore software, firmware, and operating system requirements

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510(k) Summary C2 Xplore

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510(k) Summary C2 Xplore

Summary of Performance Testing:

Biocompatibility: The C2 Xplore does has no patient contact materials, and therefore this section does not apply.

The C2 Xplore contains MAJOR level of concern software. The Software: software was designed and developed according to a rigorous development process, including software verification and validation. Software information is provided in accordance with internal requirements and the following guidance documents and standards:

  • FDA guidance: The content of premarket submissions for software contained in medical devices, May 11, 2005
  • FDA guidance: Off-the-shelf software use in medical devices, -Sep 27, 2019
  • -FDA guidance: General principles of software validation: Final guidance for industry and FDA staff, Jan 02, 2002
  • -FDA guidance: Content of premarket submissions for management of cybersecurity in medical devices, Oct 02, 2014

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Image /page/8/Picture/0 description: The image shows the logo for Inomed. The logo consists of the word "inomed" in bold, black letters, with a stylized "i" in a black square to the right. Below the logo is the website address "www.inomed.com".

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The product successfully underwent the bench testing of the requirements at these levels as part of the verification and validation process.

Moreover, the testing of the influence of human factors on the device was conducted to demonstrate mitigation of potential use errors and safety of the user interface design.

The non-clinical tests demonstrate that the device is as safe, as effective, and performs as well as or better than the legally marketed device predicate.

Performance No additional clinical testing was performed for the C2 Xplore. Testing - Clinical Therefore, this section does not apply.

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Image /page/10/Picture/0 description: The image shows the logo for Inomed. The logo consists of the word "inomed" in bold, black letters, followed by a black square with a white "i" inside. Below the logo is the website address "www.inomed.com".

Conclusion In order to establish the performance and safety characteristics, the C2 Xplore underwent successful testing in terms of the device software, electrical safety, electromagnetic compatibility, bench testing, and human factors engineering. The results of these activities demonstrate that the devices are as safe, effective and perform as well as or better than the predicate device.

Therefore, the C2 Xplore including accessories are considered substantially equivalent to the predicate device.

§ 874.1820 Surgical nerve stimulator/locator.

(a)
Identification. A surgical nerve stimulator/locator is a device that is intended to provide electrical stimulation to the body to locate and identify nerves and to test their excitability.(b)
Classification. Class II.