K Number
K022613
Device Name
HELIX HYDRO-JET
Manufacturer
Date Cleared
2002-10-25

(80 days)

Product Code
Regulation Number
880.5475
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Helix Hydro-Jet is intended for the cutting and dissection of soft tissue such as the liver, kidney, etc. within the abdomen, including Total Mesorectal Excision (TME), in open as well as laparoscopic surgery.
Device Description
The Helix Hydro-Jet is a hydraulic pressure delivery system that uses physiological saline to cut and dissect soft tissue.
More Information

Not Found

No
The summary describes a hydraulic pressure delivery system for cutting and dissecting tissue and explicitly states "Mentions AI, DNN, or ML: Not Found".

No
The device is described as being for "cutting and dissection of soft tissue," which is a surgical tool function, not a therapeutic activity. It assists in surgery rather than directly treating a disease or condition.

No

The device is described as a surgical tool for cutting and dissecting soft tissue, not for diagnosing medical conditions.

No

The device description clearly states it is a "hydraulic pressure delivery system" and mentions "applicators," indicating it is a hardware device that uses physiological saline to cut and dissect tissue.

Based on the provided information, the Helix Hydro-Jet is not an IVD (In Vitro Diagnostic) device.

Here's why:

  • Intended Use: The intended use clearly states the device is for "cutting and dissection of soft tissue such as the liver, kidney, etc. within the abdomen... in open as well as laparoscopic surgery." This describes a surgical tool used directly on living tissue in vivo.
  • Device Description: The description confirms it's a "hydraulic pressure delivery system that uses physiological saline to cut and dissect soft tissue." This further reinforces its function as a surgical instrument.
  • Lack of IVD Characteristics: IVD devices are used to examine specimens (like blood, urine, tissue samples) outside the body (in vitro) to provide information for diagnosis, monitoring, or screening. The Helix Hydro-Jet does not perform any such analysis on specimens.

Therefore, the Helix Hydro-Jet is a surgical device, not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

The Helix Hydro-Jet is intended for the cutting and dissection of soft tissue such as the liver, kidney, etc, within the abdomen, including Total Mesorectal Excision (TME), in open as well as laparoscopic surgery.

Product codes (comma separated list FDA assigned to the subject device)

FQH

Device Description

The Helix Hydro-Jet is a hydraulic pressure delivery system that uses physiological saline to cut and dissect soft tissue.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Soft Tissue within the Abdomen including TME

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)

All available/known studies involving the Helix Hydro-Jet and like water jet equipment in conjunction with the expanded intended use have been provided in this submission (Note: An exhaustive literature search was performed.). The clinical documentation provided demonstrates that the Helix Hydro-Jet may be used safely and effectively to cut/dissect soft tissue that is in close proximity of the abdomen [Note: Shown by use in Total Mesorectal Excision (TME)]. The evaluations also show that system can be used in laparoscopic procedures for the target tissues with regards to safety and efficacy. Finally, the modified structural and dimensional features of the added applicators do not adversely affect the safety or effectiveness of the Helix Hydro-Jet.

The use of the Helix Hydro-Jet in TME was found to be better in comparison to other approved equipment. Greater visibility and tissue selectivity with the water jet system

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

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K012464

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

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

§ 880.5475 Jet lavage.

(a)
Identification. A jet lavage is a device used to clean a wound by a pulsatile jet of sterile fluid. The device consists of the pulsing head, tubing to connect to a container of sterile fluid, and a means of propelling the fluid through the tubing, such as an electric roller pump.(b)
Classification. Class II (special controls). The device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to § 880.9.

0

510K SUMMARY

Submitted By:

ERBE USA, Inc. 2225 Northwest Parkway Marietta, GA 30067

Tel: 770-955-4400 Fax: 770-955-2577

OCT 2 5 2002

022613

John Tartal Contact Person:

08/05/02 Date Prepared:

Common Name: Water Jet Dissector

Helix Hydro-Jet™ Trade/Proprietary Name:

Classification Name: Jet Lavage (21CFR880.5475)

FQH Product Code:

Legally Marketed Device: Helix Hydro-Jet

Note: This 510(k) is being submitted to modestly expand the intended use for the Helix Hydro-Jet. There are three additional applicators in this 510(k) that would support the added indications. They were also included in the previous 510(k) [K012464] but were removed when the intended use was limited.

Device Description:

The Helix Hydro-Jet is a hydraulic pressure delivery system that uses physiological saline to cut and dissect soft tissue. A very detail description of the system can be found in the previous 510(k), K012464, Device Description 1-1.

Note: A summary of design control activities, risk analysis, verifications/validations, and biocompatibility can also be found respectively in Sections 4-1, 5-1, 6-1, 9-1, and 8-1 of the previous 510(k). Also, certifications and the declaration of conformity are in the former 510(k) Appendices A and B respectively.

Intended Use *:

The Helix Hydro-Jet is intended for the cutting and dissection of soft tissue such as the liver, kidney, etc, within the abdomen, including Total Mesorectal Excision (TME), in open as well as laparoscopic surgery.

*Modified 10/18/02 per request by FDA.

1

510K SUMMARY

Similarities and Differences of the Modified Device to the Current Device (Predicate Comparison/Substantial Equivalence):

The modified device is the same as the predicate except for a slight expansion of the intended use and the addition of supporting applicators.

The difference to the indication is:

    1. Cutting and dissection of soft tissue in the abdomen including Total Mesorectal Excision (TME)* {Change from just using the device in the Abdomen} and
    1. Laparoscopic use in treating the target tissue (Change from just using the device in open surgerv).

The modest change to the intended use is supported by scientific documentation provided in this Section as apart of Clinical Evaluations (See 111-9).

Collectively the added applicators are different in that:

    1. One of the applicators has a handle and a flexible tip,
    1. The maximum cannula length changed from 300 to 336 mm, and
    1. One of the applicators has a hook.

The additional features in having a handle, flexible tip, hook, and/or being slightly longer provide surgeon's applicators that would especially be useful in hard to reach areas as well as for laparoscopic use in or near the abdomen. The applicators have been verified/validated in design control. Risk analysis also has been performed with regards to the features.

Conclusion:

All available/known studies involving the Helix Hydro-Jet and like water jet equipment in conjunction with the expanded intended use have been provided in this submission (Note: An exhaustive literature search was performed.). The clinical documentation provided demonstrates that the Helix Hydro-Jet may be used safely and effectively to cut/dissect soft tissue that is in close proximity of the abdomen [Note: Shown by use in Total Mesorectal Excision (TME)]. The evaluations also show that system can be used in laparoscopic procedures for the target tissues with regards to safety and efficacy. Finally, the modified structural and dimensional features of the added applicators do not adversely affect the safety or effectiveness of the Helix Hydro-Jet.

The use of the Helix Hydro-Jet in TME was found to be better in comparison to other approved equipment. Greater visibility and tissue selectivity with the water jet system

2

t

:・・

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:

CharacteristicsModified DevicePredicate Device
ManufacturerAndreas Pein
Medizintechnik GmbHAndreas Pein
Medizintechnik GmbH
510(k) ApplicantERBE USA, Inc.*Andreas Pein
Medizintechnik GmbH
Device NameWater Jet DissectorWater Jet Dissector
Trade NameHelix Hydro-Jet™Helix Hydro-Jet
510(k) NumberK012464
Indications For UseThe Helix Hydro-Jet is
intended for the cutting
and dissection of soft
tissue such as the liver,
kidney, etc. within the
abdomen, including Total
Mesorectal Excision
(TME), in open as well as
laparoscopic surgery.The Helix Hydro-Jet is
intended for the cutting
and dissection of soft
tissue such as the liver
and kidney in open
abdominal surgery.
Items of the SystemUnit, Suction Container,
Power Cord, Foot Pedal,
Fluid Cartridge, Appli-
cators, and Suction BagUnit, Suction Container,
Power Cord, Foot Pedal,
Fluid Cartridge, Appli-
cators, and Suction Bag
MaterialsNo Change [See the
specific contacting
materials in previous
510(k)- K012464, 8-1.]No Change [See the
specific contacting
materials in previous
510(k)- K012464, 8-1.]
Physical and Dimensional Attributes
• Unit, Suction
Container, Power Cord,
and Foot Pedal
(Reusable) as well as
Fluid Cartridge, and
Suction Bag (Single
Use)No Change [See the
physical and dimensional
attributes in previous
510(k)- K012464, 1-7 to
1-21.]No Change [See the
physical and dimensional
attributes in previous
510(k)- K012464, 1-7 to 1-
21.]
CharacteristicsModified DevicePredicate Device
• ApplicatorsWith and Without a
Handle; With and Without
Suction or Suction
Control; Straight, Bayonet
or Angled Cannula;
Cannula Outer Diameter
Range: 1.6 to 6 mm;
Cannula Length Range:
60 to 336 mm; Sheath:
Pliable or Rigid; Tip:
Rigid, Flexible, Straight,
Curved, and/or Hooked;
Delivered Jet Stream:
Straight or Spatula ShapeWith and Without Suction
or Suction Control;
Straight , Bayonet, or
Angled Cannula; Cannula
Outer Diameter Range:
1.6 to 6 mm; Cannula
Length Range: 60 to 300
mm; Sheath: Pliable or
Rigid; Tip: Straight or
Curved; Delivered Jet
Stream: Straight or
Spatula Shape
Energy DeliveredPressurized Sterile Saline
that Cuts and DissectsPressurized Sterile Saline
that Cuts and Dissects
Pressure and Suction
Ranges as well as Jet
Diameter1 to 2,175 psi; 0 to -11.6
psi; 120 um1 to 2,175 psi; 0 to -11.6
psi; 120 um
Target PopulationPatients Requiring Open
or Laparoscopic Surgery
in and around the
AbdomenPatients Requiring Open
Abdominal Surgery
Anatomical SitesSoft Tissue within the
Abdomen including TMESoft Tissue in the
Abdomen
Condition Provided and Method of Sterilization As Applicable
• Unit, Suction
Container, Power Cord,
Foot Pedal, and
Suction BagNon-SterileNon-Sterile
• Fluid CartridgeSterile/Gamma RadiationSterile/Gamma Radiation
• ApplicatorSterile/Ethylene OxideSterile/Ethylene Oxide
Use Condition
• Unit, Suction
Container, Power Cord,
and Foot PedalReusableReusable
• Fluid Cartridge,
Applicator, and Suction
BagDisposable (Single Use)Disposable (Single Use)

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COMPARISON TABLE

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Image /page/4/Picture/1 description: The image shows the logo for the Department of Health & Human Services USA. The logo consists of a stylized eagle head facing right, with three lines representing feathers or wings extending from the head. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" is arranged in a circular pattern around the eagle head.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Mr. John Tartal Manager, Quality Assurance/Regulatory Affairs ERBE USA, Inc. Surgical Systems 2225 Northwest Parkway Marietta, Georgia 30067

OCT 2 5 2002

Re: K022613

Trade/Device Name: Helix Hydro-Jet™ Regulation Number: 21 CFR 880.5475 Regulation Name: Jet Lavage Regulatory Class: Class II Product Code: FQH Dated: August 5, 2002 Received: August 6, 2002

Dear Mr. Tartal:

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 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.

5

Page 2 - Mr. John Tartal

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 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 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.gov/cdrh/dsma/dsmamain.html

Sincerely yours,

Miriam C. Provost

( or 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

6

NUMBER (IF KNOWN) : , KO22613 510 (k) Helix Hydro-Jet™ DEVICE NAME:

INDICATIONS FOR USE:

The Helix Hydro-Jet is intended for the cutting and dissection of soft tissue such as the liver, kidney, etc. within the abdomen, including Total Mesorectal Excision (TME), in open as well as laparoscopic surgery.

Muriam C. Provost

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

510(k) Number K022613

(PLEASE DO NOT WRITE BELOW THIS DINE-CONTINUE ON ANOTHER P. IF NEBDED.)

Concurrence or coRH, office of Device Evaluation (ODD)

Preseription Use (Per 21 CER 801.109)

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