K Number
K022126
Device Name
CATHETER INTRODUCER FOR THE STEALTHSTATION SYSTEM
Date Cleared
2003-01-03

(186 days)

Product Code
Regulation Number
882.4560
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The StealthStation® System is intended as an aid for precisely locating anatomical structures in either open or percutaneous procedures. The StealthStation® System is indicated for any medical condition in which the use of stereotactic surgery may be appropriate, and where reference to a rigid anatomical structure, such as the skull, a long bone, or vertebra, can be identified relative to a CT or MR based model or fluoroscopy images of the anatomy. Example procedures include, but are not limited to: Cranial Procedures: Cranial Biopsies Placement Tumor Resections Craniotomies/ Craniectomies Skull Base procedures Thalamotomies/Pallidotomies Pituitary Tumor Removal CSF Leak Repair Pediatric Catheter Shunt Placement General Catheter Shunt Placement Spinal Procedures: Spinal Implant Procedures, such as Pedicle Screw ENT Procedures: Transphenoidal Procedures Intranasal Procedures Orbital Nerve Decompression Procedures Optic Nerve Decompression Procedures Polyposis Procedures Endoscopic Dacryocystorhinostomy Encephalocele Procedures Sinus procedures, such as Maxillary Antrostomies, Ethmoidectomies, Sphenoidotomies/Sphenoid Explorations, Turbinate Resections.and Frontal Sinusotomies Orthopedic Procedures: Total Knee Arthroplasty (Primary and Revision) Unicompartmental Knee Arthroplasty Minimally Invasive Orthopedic Procedures Pediatric Orthopedics Total Hip Replacement (Primary and Revision) Periacetabular Osteotomies Tumor Resection and Bone/Joint Reconstruction Femoral Revision Stabilization and Repair of Pelvic Fractures (Including but not Limited to Acetabular Fractures)
Device Description
This submission allows a surgeon an image guided instrument to place catheter shunts. The Catheter Introducer for the StealthStation® System is technically equivalent to the StealthStation® System. All systems use either active(LED's), passive reflective markers or electromagnetic coils to track surgical instruments in relation to an image guided reference frame. This information is correlated to the patient's CT, MR or fluoroscopic images of the anatomy.
More Information

StealthStation® System, Radionics Optical Tracking System

Not Found

No
The document describes an image-guided surgical navigation system that uses tracking markers to correlate instrument position with pre-operative images. There is no mention of AI or ML in the intended use, device description, or specific sections for AI/ML information.

No
The device is used to precisely locate anatomical structures during surgical procedures, aiding the surgeon rather than directly treating a medical condition.

No

The device is described as an aid for precisely locating anatomical structures and tracking surgical instruments, which falls under surgical navigation or guidance, not diagnosis.

No

The device description explicitly mentions the use of active (LEDs), passive reflective markers, or electromagnetic coils to track surgical instruments, which are hardware components.

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.
  • StealthStation System Function: The StealthStation System is described as an image-guided surgical navigation system. It uses imaging data (CT, MR, fluoroscopy) and tracking technology to help surgeons precisely locate anatomical structures during surgical procedures performed on the patient's body.
  • Intended Use: The intended use clearly states it's an aid for precisely locating anatomical structures in open or percutaneous procedures, which are surgical interventions.
  • Device Description: The description focuses on tracking surgical instruments in relation to images of the patient's anatomy, not on analyzing samples taken from the patient.

The StealthStation System is a surgical navigation device, not a diagnostic test performed on in vitro samples.

N/A

Intended Use / Indications for Use

The StealthStation® System is intended as an aid for precisely locating anatomical structures in either open or percutaneous procedures. The StealthStation® System is indicated for any medical condition in which the use of stereotactic surgery may be appropriate, and where reference to a rigid anatomical structure, such as the skull, a long bone, or vertebra, can be identified relative to a CT or MR based model or fluoroscopy images of the anatomy.

Example procedures include, but are not limited to:
Cranial Procedures:
Cranial Biopsies
Placement
Tumor Resections
Craniotomies/ Craniectomies
Skull Base procedures
Thalamotomies/Pallidotomies
Pituitary Tumor Removal
CSF Leak Repair
Pediatric Catheter Shunt Placement
General Catheter Shunt Placement

Spinal Procedures:
Spinal Implant Procedures, such as Pedicle Screw

ENT Procedures:
Transphenoidal Procedures
Intranasal Procedures
Orbital Nerve Decompression Procedures
Optic Nerve Decompression Procedures
Polyposis Procedures
Endoscopic Dacryocystorhinostomy
Encephalocele Procedures
Sinus procedures, such as Maxillary Antrostomies, Ethmoidectomies, Sphenoidotomies/Sphenoid Explorations, Turbinate Resections, and Frontal Sinusotomies

Orthopedic Procedures:
Total Knee Arthroplasty (Primary and Revision)
Unicompartmental Knee Arthroplasty
Minimally Invasive Orthopedic Procedures
Pediatric Orthopedics
Total Hip Replacement (Primary and Revision)
Periacetabular Osteotomies
Tumor Resection and Bone/Joint Reconstruction
Femoral Revision
Stabilization and Repair of Pelvic Fractures (Including but not Limited to Acetabular Fractures)

Product codes

HAW

Device Description

This submission allows a surgeon an image guided instrument to place catheter shunts. The Catheter Introducer for the StealthStation® System is technically equivalent to the StealthStation® System. All systems use either active(LED's), passive reflective markers or electromagnetic coils to track surgical instruments in relation to an image guided reference frame. This information is correlated to the patient's CT, MR or fluoroscopic images of the anatomy.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

CT or MR based model or fluoroscopy images

Anatomical Site

skull, a long bone, or vertebra (Cranial, Spinal, ENT, and Orthopedic procedures listed in Indications For Use)

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Surgeon, clinical setting (implied)

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)

As required by risk analysis, all verification and validation activities were performed by designated individual(s) and the results demonstrated substantial equivalence.

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

Not Found

Predicate Device(s)

StealthStation® System, Radionics Optical Tracking System

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 882.4560 Stereotaxic instrument.

(a)
Identification. A stereotaxic instrument is a device consisting of a rigid frame with a calibrated guide mechanism for precisely positioning probes or other devices within a patient's brain, spinal cord, or other part of the nervous system.(b)
Classification. Class II (performance standards).

0

Summary of Safety and Effectiveness Catheter Introducer for the StealthStation® System

I. Manufacture:

Medtronic Surgical Navigation Technologies 826 Coal Creek Circle Louisville, CO 80027 USA Telephone Number: (720) 890-3200 Fax Number: (720) 890-3500

JAN 0 3 2003

1/2

II. Contact:

Victoria G. Rendon Clinical and Regulatory Affairs Associate Medtronic Surgical Navigation Technologies

III. Product Name/ Classification Name:

Product Name: Catheter Introducer for the StealthStation® System Classification Name: Stereotaxic Instrument (21 CFR 882.4560) Classification Panel: 84 HAW

Date Summary Submitted IV.

June 28, 2002

V. Description of Device Modification:

This submission allows a surgeon an image guided instrument to place catheter shunts. The Catheter Introducer for the StealthStation® System is technically equivalent to the StealthStation® System. All systems use either active(LED's), passive reflective markers or electromagnetic coils to track surgical instruments in relation to an image guided reference frame. This information is correlated to the patient's CT, MR or fluoroscopic images of the anatomy.

This submission provides new indications that are substantially equivalent to the named predicate devices' indications statement.

VI. Substantial Equivalence:

The Catheter Introducer for the StealthStation® System was substantially equivalent to the StealthStation® System cleared in previous 510(k)'s. Additionally, the Catheter Introducer was determined to be substantially equivalent to the Radionics Optical Tracking System. As required by risk analysis, all verification and validation activities were performed by designated individual(s) and the results demonstrated substantial equivalence.

1

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VII. Indications For Use:

The StealthStation® System is intended as an aid for precisely locating anatomical structures in either open or percutaneous procedures. The StealthStation® System is indicated for any medical condition in which the use of stereotactic surgery may be appropriate, and where reference to a rigid anatomical structure, such as the skull, a long bone, or vertebra, can be identified relative to a CT or MR based model or fluoroscopy images of the anatomy.

Example procedures include, but are not limited to:

(Including but not Limited to Acetabular Fractures)

Cranial Procedures:Spinal Procedures:ENT Procedures:Orthopedic Procedures:
Cranial BiopsiesSpinal Implant Procedures, such as Pedicle ScrewTransphenoidal ProceduresTotal Knee Arthroplasty (Primary and Revision)
PlacementIntranasal ProceduresUnicompartmental Knee Arthroplasty
Tumor ResectionsOrbital Nerve Decompression ProceduresMinimally Invasive Orthopedic Procedures
Craniotomies/ CraniectomiesOptic Nerve Decompression ProceduresPediatric Orthopedics
Skull Base proceduresPolyposis ProceduresTotal Hip Replacement (Primary and Revision)
Thalamotomies/PallidotomiesEndoscopic DacryocystorhinostomyPeriacetabular Osteotomies
Pituitary Tumor RemovalEncephalocele ProceduresTumor Resection and Bone/Joint Reconstruction
CSF Leak RepairSinus procedures, such as Maxillary Antrostomies, Ethmoidectomies, Sphenoidotomies/Sphenoid Explorations, Turbinate Resections, and Frontal SinusotomiesFemoral Revision
Pediatric Catheter Shunt PlacementStabilization and Repair of Pelvic Fractures
General Catheter Shunt Placement

0459

2

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/2/Picture/1 description: The image shows the seal of the Department of Health & Human Services (HHS) of the United States. The seal features the department's name encircling a stylized eagle symbol. The eagle is depicted with three lines forming its body and wings, representing the department's mission to protect the health of all Americans and provide essential human services.

Public Health Service

JAN 0 3 2003

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Medtronic Surgical Navigation Technologies Victoria G. Rendon Clinical and Regulatory Affairs Associate 826 Coal Creek Circle Louisville, Colorado 80027

Re: K022126

Trade/Device Name: Catheter Introducer for the StealthStation® System Regulation Number: 882.4560 Regulation Name: Stereotactic system and accessories Regulatory Class: Class II Product Code: HAW Dated: October 4, 2002 Received: October 7, 2002

Dear Ms. Rendon:

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. 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 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 801); good manufacturing practice requirements as set forth in

3

Page 2 - Ms. Victoria G. Rendon

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.

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 marketed predicate 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), please contact the Office of Compliance at (301) 594-4659. Additionally, for questions on the promotion and advertising of your device, please contact the Office of 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 Division 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.qov/cdrh/dsma/dsmamain.html

Sincerely yours,

Mark A. Milken

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

4

510(k) Number (if known): 1(022126

Device Name: Catheter Introducer for the StealthStation® System

Indications For Use:

The StealthStation® System is intended as an aid for precisely locating anatomical structures in either open or percutaneous procedures. The StealthStation® System is indicated for any medical condition in which the use of stereotactic surgery may be appropriate, and where reference to a rigid anatomical structure, such as the skull, a long bone, or vertebra, can be identified relative to a CT or MR based model or fluoroscopy images of the anatomy.

Example procedures include, but are not limited to:

Cranial Procedures:

Cranial Biopsies Placement Tumor Resections Craniotomies/ Craniectomies Skull Base procedures Thalamotomies/Pallidotomies Pituitary Tumor Removal CSF Leak Repair Pediatric Catheter Shunt Placement General Catheter Shunt Placement

Orthopedic Procedures:

Total Knee Arthroplasty (Primary and Revision) Ethmoidectomies, Sphenoidotomies/Sphenoid Unicompartmental Knee Arthroplasty Minimally Invasive Orthopedic Procedures Pediatric Orthopedics Total Hip Replacement (Primary and Revision) Periacetabular Osteotomies Tumor Resection and Bone/Joint Reconstruction Femoral Revision Stabilization and Repair of Pelvic Fractures (Including but not Limited to Acetabular Fractures)

Spinal Procedures:

Spinal Implant Procedures, such as Pedicle Screw

ENT Procedures:

Transphenoidal Procedures Intranasal Procedures Orbital Nerve Decompression Procedures Optic Nerve Decompression Procedures Polyposis Procedures Endoscopic Dacryocystorhinostomy Encephalocele Procedures Sinus procedures, such as Maxillary Antrostomies, Explorations, Turbinate Resections.and Frontal Sinusotomies

Mark N Melleuson

Division of General, Restorative and Neurological Devices

510(k) Number _

K022126

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

Concurrence of CDRH, Office Of Device Evaluation (ODE)

Prescription Use (Per 21 CFR 801.109) OR

Over-The-Counter Use

(Optional Format 1-2-96)