K Number
K020343
Device Name
SURGASSIST SYSTEM; WIRELESS REMOTE CONTROL (COMPONENT); WIRED REMOTE CONTROL
Date Cleared
2002-04-10

(68 days)

Product Code
Regulation Number
878.4750
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The SurgASSIST™ System with Circular Stapler DLU, has applications throughout the alimentary tract for end-to-end and side-to-side anastomosis. The SurgASSIST™ System with Right Angle Cutter Digital Loading Unit has applications in gastrointestinal, gynecological, surgical procedures for resection, transection, and creation of anastomosis.
Device Description
The SurgASSIST™ Wireless Remote Control Unit is a battery powered, hand held device that transmits control commands to the SurgASSIST™ System Power Console (PC). The existing wired Remote control version will remain as a component of the SurgASSIST System. The wireless version of the Remote Control will be commercialized in addition to the existing wired version, and sold as an accessory to the System. A battery capable of supplying power throughout the predictive life of the Remote Control Unit is permanently installed inside the hermetically sealed case or housing. All Wireless Remote Control Units share identical transmittance frequencies, however each Unit is preprogrammed with a unique identification code. When the Wireless Remote Control Unit is used to poweron the SurgASSIST™ Power Console (PC), this unique identification code is read and stored by the Console. The Power Console, with the stored identification code will then only respond to commands sent by its corresponding Remote Control Unit. The radio frequency commands sent via the hand-held Remote Control Unit are Not considered Wireless Medical Telemetry, as defined by FCC. The frequencies assigned to the transmitter will not be in Medical Telemetry MHz bands set aside by the Wireless Medical Telemetry Service (WMTS).
More Information

No
The summary describes a wireless remote control for a surgical stapling system. The functionality described is limited to transmitting control commands and pairing with a specific console using a unique identification code. There is no mention of AI, ML, image processing, or any other technology typically associated with AI/ML applications in medical devices.

No
The device, the SurgASSIST™ Wireless Remote Control Unit, is an accessory that transmits control commands to a surgical system (SurgASSIST™ System Power Console). The surgical system itself performs procedures like resection, transection, and creation of anastomosis, which are surgical interventions, not therapeutic treatments in the sense of restoring health through non-surgical means or therapies.

No

The device description indicates that the SurgASSIST™ System is used for surgical procedures like resection, transection, and creation of anastomosis, which are treatment-oriented actions, not diagnostic ones. The remote control unit described transmits control commands to a power console, further supporting its role in operative procedures rather than diagnosis.

No

The device description clearly outlines a physical, battery-powered, hand-held device (Wireless Remote Control Unit) that transmits control commands. This is a hardware component, not software only.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD Definition: In vitro diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections. They are used to provide information for diagnosis, monitoring, or screening.
  • Device Description: The SurgASSIST™ System with its components (Circular Stapler DLU, Right Angle Cutter DLU, and Wireless Remote Control Unit) is described as a surgical system used for procedures like anastomosis, resection, and transection within the alimentary tract, gastrointestinal, and gynecological areas.
  • Intended Use: The intended use clearly states applications in surgical procedures on anatomical sites within the body.
  • Lack of IVD Characteristics: There is no mention of analyzing samples from the body, detecting biomarkers, or providing diagnostic information based on laboratory testing. The device is a surgical tool used directly on the patient during a procedure.

Therefore, the SurgASSIST™ System, as described, falls under the category of a surgical device, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The SurgASSIST™ System with Circular Stapler DLU, has applications throughout the alimentary tract for end-to-end and side-to-side anastomosis.

The SurgASSIST™ System with Right Angle Cutter Digital Loading Unit has applications in gastrointestinal, gynecological, and thoracic surgical procedures for resection, transection, and creation of anastomosis.

Product codes

GDW

Device Description

The SurgASSIST™ Wireless Remote Control Unit is a battery powered, hand held device that transmits control commands to the SurgASSIST™ System Power Console (PC).

The existing wired Remote control version will remain as a component of the SurgASSIST System. The wireless version of the Remote Control will be commercialized in addition to the existing wired version, and sold as an accessory to the System.

A battery capable of supplying power throughout the predictive life of the Remote Control Unit is permanently installed inside the hermetically sealed case or housing. All Wireless Remote Control Units share identical transmittance frequencies, however each Unit is preprogrammed with a unique identification code. When the Wireless Remote Control Unit is used to poweron the SurgASSIST™ Power Console (PC), this unique identification code is read and stored by the Console. The Power Console, with the stored identification code will then only respond to commands sent by its corresponding Remote Control Unit.

The radio frequency commands sent via the hand-held Remote Control Unit are Not considered Wireless Medical Telemetry, as defined by FCC. The frequencies assigned to the transmitter will not be in Medical Telemetry MHz bands set aside by the Wireless Medical Telemetry Service (WMTS).

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

alimentary tract, gastrointestinal, gynecological, thoracic

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Not Found

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s)

K003277, K012809

Reference Device(s)

K000908

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 878.4750 Implantable staple.

(a)
Identification. An implantable staple is a staple-like device intended to connect internal tissues to aid healing. It is not absorbable.(b)
Classification. Class II.

0

K020343(P.1 of 3)

Power Medical Interventions, Inc. SurgASSIST™ System with Wireless Remote Control Special 510(k) Device Modification PreMarket Notification January 30, 2002

APR 1 0 2002

Special 510(k) Device Modification PREMARKET NOTIFICATION SAFETY AND EFFECTIVENESS SUMMARY

SurgASSIST™ System with Wireless Remote Control

In Accordance with 21 CFR section 807.92 Power Medical Interventions, Inc., is submitting the following safety and effectiveness summary.

  1. Submitter Information:

Power Medical Interventions, Inc. 110 Union Square Drive New Hope, PA 18938 215-862-4450 PH 215-862-1009 Fax

Applicant:

Laurence A. Potter

Date of Notification:

January 30, 2002

    1. Name of Device:
      SurgASSIST™ System Trade Name: With Wireless Remote Control

Wireless Remote Control Unit Common Name:

Classification Name: Staple, Implantable, GDW; Stapler, GAG

  1. Predicate Devices:
  • a) SurgASSIST™ System with Circular Stapler Disposable Loading Unit with Titanium Implantable Staple, Power Medical Interventions, Inc., K003277.

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1

K020343(112055/

Power Medical Interventions, Inc. SurgASSIST™ System with Wireless Remote Control Unit Special 510(k) Device Modification PreMarket Notification January 30, 2002

  • b) Skylight Imaging Systems, K000908, ADAC Laboratories, Milpitas, CA 95035
  • c) SuraASSIST™ System with Right Angle Linear Cutter Digital Loading Unit, Power Medical Interventions, Inc., K012809.
    1. Device Description:

The SurgASSIST™ Wireless Remote Control Unit is a battery powered, hand held device that transmits control commands to the SurgASSIST™ System Power Console (PC).

The existing wired Remote control version will remain as a component of the SurgASSIST System. The wireless version of the Remote Control will be commercialized in addition to the existing wired version, and sold as an accessory to the System.

A battery capable of supplying power throughout the predictive life of the Remote Control Unit is permanently installed inside the hermetically sealed case or housing. All Wireless Remote Control Units share identical transmittance frequencies, however each Unit is preprogrammed with a unique identification code. When the Wireless Remote Control Unit is used to poweron the SurgASSIST™ Power Console (PC), this unique identification code is read and stored by the Console. The Power Console, with the stored identification code will then only respond to commands sent by its corresponding Remote Control Unit.

The radio frequency commands sent via the hand-held Remote Control Unit are Not considered Wireless Medical Telemetry, as defined by FCC. The frequencies assigned to the transmitter will not be in Medical Telemetry MHz bands set aside by the Wireless Medical Telemetry Service (WMTS).

5) Indications For Use

The SurgASSIST™ System with Circular Stapler DLU, has applications throughout the alimentary tract for end-to-end and side-to-side anastomosis.

The SurgASSIST™ System with Right Angle Cutter Digital Loading Unit has applications in gastrointestinal, gynecological,

000016

2

K020343(P.3 of 3)

Power Medical Interventions, Inc. SurgASSIST™ System with Wireless Remote Control Unit Special 510(k) Device Modification PreMarket Notification January 29, 2002

6) Comparison to Predicate Devices

The flowing table compares the subject device to previously cleared predicate devices:

REMOTE CONTROL PRODUCT FEATURES COMPARISON CHART

| Features &
Description | Power Medical
SurgASSIST™ w/ Wireless RC100 | Predicate Power Medical
SurgASSIST™ w/ Wired RCW100 | Predicate ADAC Laboratories
SKYlight Imaging System |
|---------------------------|-------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Name | SurgASSIST™ System Wireless Remote Control
Unit | SurgASSIST System with Circular Stapler DLU;
SurgASSIST System with Right Angle Linear
Cutter | Skylight Imaging System |
| Manufacturer | Power Medical Interventions, Inc. | Power Medical Interventions, Inc. | ADAC Laboratories |
| 510(k) Clearance Numbers | N/A | K003277; K012809 | K000908 |
| Product Code | RC100 | RCW100
(RCWW was in original K003277submission) | Unknown if this component is sold
separately |
| Intended use | Applications throughout the alimentary tract for
end to end, end to side, and side to side
anastomosis | Applications throughout the alimentary tract for
end to end, end to side, and side to side
anastomosis | Skylight is intended to produce images
depicting the anatomical distributions of
single photon and positron emitting
radioisotopes within the human body for
interpretation by medical personnel. |
| FDA Class | II | II | II |
| Human Factors | Handheld, wireless, pushbutton radio frequency
command | Handheld, pushbutton command, with 3 meter
silicone coated wire for connection to
SurgASSIST Power Console (PC) | Handheld, wireless, pushbutton
command |
| Size | 16 cm x 9.5cm | 16 cm x 9.5 cm with 3 meter attached cord | No details available |
| Housing Material | ULTEM polyether-imide | polycarbonate | Plastic |
| Keypad Material | Parylene coated Silicone Rubber | Parylene coated Silicone Rubber | No details available |
| Command Buttons | "ON" "FIRE" "Release" "OPEN" "CLOSE"
Directions "North" "South" "East" "West" | "ON" "FIRE" "Release" "OPEN" "CLOSE"
Directions "North" "South" "East" "West" | No details available |
| Transmitter / Receiver | RF Transmitter in hand held remote. Receiver in
Power Console (PC) | Contains indicators for appropriate range for
desired closed staple height, but can be deployed
out of range | Will not deploy until the anvil/cartridge
gap is within a certain range on a built in
indicator |
| Power | Battery powered. High Temperature lithium AA
Cell 3.8 VDC, 1.6Ah | None | Presumably battery powered. No details
available |
| Software Containing | Yes | No | No details available |
| Sterilization Methods | Supplied to Customer Non-Sterile
Steam Autoclave Compatible
Ethylene Oxide Compatible
Peracetic Acid Wash Compatible | Supplied to Customer Non-Sterile
Ethylene Oxide Compatible
Peracetic Acid Wash Compatible | No details available |
| How Supplied | Non-Sterile, plastic wrapped in single unit
corrugated box | Non-Sterile, plastic wrapped in single unit
corrugated box | No details available |

3

Image /page/3/Picture/1 description: The image is a black and white logo for the U.S. Department of Health & Human Services. The logo features a stylized image of a bird or abstract human figure. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular pattern around the image.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

APR 1 0 2002

Mr. Laurence A. Potter Vice President, Regulatory Affairs and Quality Assurance Power Medical Interventions, Inc. 110 Union Square Drive New Hope, Pennsylvania 18938

Re: K020343

Trade/Device Name: SurgASSIST™ System with Wireless Remote Control Regulation Number: 878.4750 Regulation Name: Implantable Staple Regulatory Class: II Product Code: GDW Dated: March 8, 2002 Received: March 11, 2002

Dear Mr. Potter:

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 10 mos based of 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. 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.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such additional controls. Existing major regulations affecting your device can he 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 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

4

Page 2 -- Mr. Laurence A. Potter

This letter will allow you to begin marketing your device as described in your Section 510(k) Premarket notification. The FDA finding of substantial equivalence of your device to a legally promative noticated device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801 and additionally 21 CFR Part 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4659. Additionally, for questions on the promotion and advertising of Compliance at (301) 594-4639 Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). Other general information on your responsibilities under the Act may be obtained from the O inision of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely yours,

iriam C. Provost

For Celia M. Witten, Ph.D., M.D. Director Division of General, Restorative and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

5

Power Medical Interventions, Inc. SurgASSIST™ System with Witeless Remote Control United r ower Medical Interroritions, Inc. Bargers - January 30, 2002

Power Medical Interventions, Inc. New Hope, PA 18938

510(k) No. K 020343

Device Name:

SurgASSIST™ System with Wireless Remote Control

INDICATIONS FOR USE: (Note: The intended use for this product modification will be substantially INDIOA HONO I OTC OOL. (Noto: This Interventions, Inc. immediate 510(K) Notification's, K003277 & K012809).

The SurgASSIST™ System with Circular Stapler DLU, has The Gurghout the alimentary tract for end-to-end and side-to-side anastomosis.

The SurgASSIST™ System with Right Angle Cutter Digital Loading Unit has applications in gastrointestinal, gynecological, Eoading "Only has applitiation surgical procedures for resection, transection, and creation of anastomosis.

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED)

Prescription Use Per 21CFR §801.109

OR Over-The-Counter Use

Miriam C. Provost

(Division Sign-Off) Division of General, Restorative and Neurological Devices

510(k) Number K020343

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