K Number
K031382
Date Cleared
2003-06-30

(60 days)

Product Code
Regulation Number
876.1500
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The HERMES® O.R. Control Center and Port Expander is indicated for use with Stryker Endoscopy 882 Camera, Stryker Quantum 5000 Light Source, Stryker SE5 Shaver, WOM 20L Insufflator, WOM 2.0L Arthroscopy Pump, Stryker Total Performance System, Berchtold Surgical Lights, Steris Amsco Table Model SP3085, Steris Amsco Table Model SP3085, AESOP®HR (HERMES-Ready™), Valleylab Force FX™ Electro-surgical Unit. Smith & Nephew Dvonics® Access 15 Arthroscopic Fluid Irrigation System, Smith & Nephew Dyonics® Vision 635 Digital Image Management System, Skytron Stellar Series O.R. Lights, Smith & Nephew Dyonics® Power Shaver, and the Smith & Nephew Dyonics® 325Z DV Camera. It can be used in general laparoscopy, nasopharyngoscopy, ear endoscopy, and sinuscopy where a laparoscope/endoscope is indicated for use. A few examples of the more common endoscopic surgeries are laparoscopic cholecystectorny, laparoscopic hernia repair, laparoscopic appendectomy, laparoscopic pelvic lymph node dissection. laparoscopically assisted hvsterectomy. laparoscopic & thoracoscopic anterior spinal fusion. decompression fixation, wedge resection, lung biopsy, pleural biopsy, dorsal sympathectomy, pleurodesis, internal mammary artery dissection for coronary artery bypass, coronary artery bypass grafting where endoscopic visualization in indicated and examination of the evacuated cardiac chamber during performance of valve replacement.

Device Description

The HERMES O.R. Control Center is a computer-driven system whose basic function is to offer the surgeon the additional option of voice control for ancillary devices. The intent of the HERMES O.R. Control Center is to allow for simplified and more direct control of medical device settings by the physician, thereby eliminating the necessity of using the various interfaces existing on ancillary devices, or relying on verbal communications between the surgeon and other personnel in the operating room in order to adjust the surgical equipment.

AI/ML Overview

Here's a breakdown of the acceptance criteria and study information based on the provided document:

This document describes a 510(k) submission for a modification to the HERMES® O.R. Control Center. The provided text primarily focuses on regulatory compliance with various standards and provides limited detail on specific performance acceptance criteria or detailed study results beyond the fact that testing was conducted.

1. Table of Acceptance Criteria and Reported Device Performance

The document lists several international and internal standards to which the device was tested. The "acceptance criteria" for these would typically be compliance with the requirements outlined in each standard. However, the document does not provide specific numerical performance metrics or acceptance thresholds for these tests, nor does it present the reported device performance values against such thresholds. It only states that the device "has been tested to the following standards."

Therefore, the table below reflects the tests performed, but the specific acceptance criteria and performance data are not detailed in the provided text.

Test TitleType of Standard/TestAcceptance Criteria (from standard)Reported Device Performance
IEC 601-1, IEC 601-1 Amendment 1, IEC 601-2-18, EN 60601-1, EN 60601-1-1Medical Electrical Equipment SafetyCompliance with general safety requirementsNot specified in document
UL 2601-1Underwriters Laboratory SafetyCompliance with general safety requirementsNot specified in document
CAN/CSA-C22.2 No. 601.1Medical Electrical Equipment SafetyCompliance with general safety requirementsNot specified in document
EN55022/A1 (Conducted Emission)Electromagnetic Compatibility (EMC)Limits for conducted electromagnetic disturbancesNot specified in document
EN55022/A1 (Radiated Emission)Electromagnetic Compatibility (EMC)Limits for radiated electromagnetic disturbancesNot specified in document
EN61000-4-2 (Electrostatic Discharge)Electromagnetic Compatibility (EMC)Immunity levels to electrostatic dischargeNot specified in document
EN61000-4-3 and EN50140 (RF Immunity)Electromagnetic Compatibility (EMC)Immunity levels to radiated radio-frequency electromagnetic fieldsNot specified in document
EN61000-4-4 (EFT/Bursts Immunity)Electromagnetic Compatibility (EMC)Immunity levels to electrical fast transient/burstsNot specified in document
EN61000-4-5 (Surge Immunity)Electromagnetic Compatibility (EMC)Immunity levels to surgeNot specified in document
EN61000-4-6 (Conducted Immunity)Electromagnetic Compatibility (EMC)Immunity levels to conducted disturbances induced by RF fieldsNot specified in document
EN 60601-1-2 (Emissions and Immunity Test Measurements)Electromagnetic Compatibility (EMC)Compliance with EMC requirementsNot specified in document
VA-24772CMI System Functional TestingInternal criteria for system functionalityNot specified in document
CP-15345CMI Software Verification and ValidationInternal criteria for software quality and correctnessNot specified in document
VA-19795CMI Environmental TestingInternal criteria for environmental robustnessNot specified in document

2. Sample Size Used for the Test Set and Data Provenance

The document does not provide details on "sample size" in the context of test sets for performance evaluation (e.g., number of procedures, patients, or data points). The listed tests are primarily related to product safety, electrical compatibility, and internal functional/software verification. These types of tests typically involve physical units of the device or software code, rather than patient-derived data sets.

The data provenance is not applicable in the context of these engineering and safety tests.

3. Number of Experts Used to Establish Ground Truth for the Test Set and Qualifications

This information is not applicable to the type of tests described. None of the listed tests require a "ground truth" established by medical experts in the way an AI diagnostic device would. The standards relate to safety, electrical, and software compliance.

4. Adjudication Method for the Test Set

Adjudication methods (like 2+1, 3+1) are typically used in studies involving expert review of cases to establish ground truth for a diagnostic device. This is not relevant to the engineering and safety tests listed in the document.

5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study

No MRMC study is mentioned or implied by the listed tests. The device is a control center for surgical equipment, primarily offering voice control. The document describes it as "allowing for simplified and more direct control," but does not present a study comparing human reader performance with and without AI assistance for tasks like diagnosis or image interpretation.

6. Standalone Performance Study

The document does not describe a standalone performance study in the typical sense of evaluating an algorithm's performance on a dataset without human intervention. The "System Functional Testing" (VA-24772) and "Software Verification and Validation" (CP-15345) would involve evaluating the device's functions independently, but these are engineering verification tests, not clinical performance studies on patient data.

7. Type of Ground Truth Used

Given the nature of the listed tests (safety, electrical, environmental, software), the concept of "ground truth" as pathology, outcomes data, or expert consensus is not applicable. The "ground truth" for these tests would be defined by the specifications of the standards themselves (e.g., a certain level of electrical emission, a functional requirement, or a software behavior).

8. Sample Size for the Training Set

The document describes a modification to an existing device, the HERMES® O.R. Control Center, which primarily offers voice control for ancillary devices. The concept of a "training set" is typically associated with machine learning or AI models that learn from data. While the voice control aspect might involve some form of speech recognition that was "trained," the document does not provide any information regarding training sets, their size, or how they were used.

9. How the Ground Truth for the Training Set Was Established

As no training set is mentioned, this information is not provided. If voice recognition was involved, the "ground truth" for training would typically involve annotated audio data where spoken commands are correctly transcribed/labeled.

{0}------------------------------------------------

CONFIDENTIAL

031382

HERMES® O.R. Control Center 510(k) Summarv

In accordance with 21 CFR section 807.92 Computer Motion, Inc. (CMI) is submitting the following 510(k) Summary:

    1. Submitter Information Computer Motion. Inc. 130-B Cremona Drive Goleta, CA 93117 Contact: Keith Lowrey, Manager of Regulatory Affairs
    1. Name of Device:

Proprietary Name: Modification to HERMES® O.R. Control Center Common Name: HERMES Product Code: GCJ Classification Name: Laparoscope for Use in General and Plastic Surgery Regulation Number: 876.1500 Regulation Class: Class II.

    1. This device is substantially equivalent to the HERMES O.R. Control Center, K973700, and the more recent 510(k) for HERMES control of the Skytron Stellar Series O.R. Lights, K030240.
    1. The HERMES O.R. Control Center is a computer-driven system whose basic function is to offer the surgeon the additional option of voice control for ancillary devices.

The intent of the HERMES O.R. Control Center is to allow for simplified and more direct control of medical device settings by the physician, thereby eliminating the necessity of using the various interfaces existing on ancillary devices, or relying on verbal communications between the surgeon and other personnel in the operating room in order to adjust the surgical equipment.

    1. The HERMES® O.R. Control Center and Port Expander is indicated for use with Stryker Endoscopy 882 Camera, Stryker Quantum 5000 Light Source, Stryker SE5 Shaver, WOM 20L Insufflator, WOM 2.0L Arthroscopy Pump. Stryker Total Performance System, Berchtold Surgical Lights, Steris Amsco Table Model SP3085, AESOP®HR (HERMES-Ready™), Valleylab Force FX™ Electro-surgical Unit, Smith & Nephew Dyonics " Access 15 Arthroscopic Fluin
      Irrigation System, Smith & Nephew Dyonics Management System, Skytron Stellar Series O.R. lights, Smith & Nephew Dyonics® Power Shaver, and Smith & Nephew Dyonics® 325Z DV Camera. It can be used in general laparoscopy, nasopharyngoscopy, ear endoscopy, and sinuscopy where a laparoscope/endoscope is indicated for use. A few
      000023

{1}------------------------------------------------

examples of the more common endoscopic surgeries are laparoscopic cholecystectomy, laparoscopic hernia repair, laparoscopic appendectomy, laparoscopic pelvic lymph node dissection, laparoscopically assisted hysterectomy, laparoscopic & thoracoscopic anterior spinal fusion, decompression fixation, wedge resection, lung biopsy, pleural biopsy, dorsal sympathectomy, pleurodesis, internal mammary artery dissection for coronary artery bypass, coronary artery bypass grafting where endoscopic visualization in indicated and examination of the evacuated cardiac chamber during performance of valve replacement. The users of the HERMES O.R Control Center are general surgeons, gynecologists, cardiac surgeons, thoracic surgeons, plastic surgeons, orthopedic surgeons, ENT surgeons and urologists.

TestTitle
IEC 601-1International Standard for MedicalElectrical Equipment
IEC 601-1 Amendment 1International Standard for MedicalElectrical Equipment
IEC 601-2-18International Standard for MedicalElectrical Equipment
UL 2601-1Underwriters Laboratory
CAN/CSA-C22.2 No. 601.1Medical Electrical Equipment Part 1,General Requirements for Safety,General Instructions Part 1
EN55022/A1Conducted Emission
EN55022/A1Radiated Emission
EN61000-4-2Electrostatic Discharge
EN61000-4-3 and EN50140RF Immunity
EN61000-4-4EFT/Bursts Immunity
EN61000-4-5Surge Immunity
EN61000-4-6Conducted Immunity
EN60601-1International Standard for MedicalElectrical Equipment
EN60601-1-1General Requirements for Safety –Collateral Standard
EN 60601-1-2Emissions and Immunity TestMeasurements
VA-24772CMI System Functional Testing
CP-15345CMI Software Verification and Validation
VA-19795CMI Environmental Testing
    1. The HERMES® O.R. Control Center has been tested to the following standards:

{2}------------------------------------------------

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized eagle with three stripes extending from its head, representing health, human services, and well-being. The eagle is encircled by the text "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA".

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JUN 3 0 2003

Mr. Keith Lowrey Manager of Regulatory Affairs Computer Motion, Inc. 130-B Cremona Drive Goleta, California 93117

Re: K031382

Trade/Device Name: Modification to HERMES® O.R. Control Center Regulation Number: 21 CFR 876.1500 Regulation Name: Endoscope and accessories Regulatory Class: II Product Code: GCJ Dated: April 24, 2003 Received: June 11, 2003

Dear Mr. Lowrey:

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.

{3}------------------------------------------------

Page 2 - Mr. Keith Lowrey

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) you may obtain. 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,

Muriam C. Provost

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}------------------------------------------------

INDICATION FOR USE STATEMENT

510(k) Number (if known): ____________________________________________________________________________________________________________________________________________________

Modification to HERMES® O.R. Control Center Device Name:

The HERMES® O.R. Control Center and Port Expander is indicated for use with Stryker Endoscopy 882 Camera, Stryker Quantum 5000 Light Source, Stryker SE5 Shaver, WOM 20L Insufflator, WOM 2.0L Arthroscopy Pump, Stryker Total Performance System, Berchtold Surgical Lights, Steris Amsco Table Model SP3085, Steris Amsco Table Model SP3085, AESOP®HR (HERMES-Ready™), Valleylab Force FX™ Electro-surgical Unit. Smith & Nephew Dvonics® Access 15 Arthroscopic Fluid Irrigation System, Smith & Nephew Dyonics® Vision 635 Digital Image Management System, Skytron Stellar Series O.R. Lights, Smith & Nephew Dyonics® Power Shaver, and the Smith & Nephew Dyonics® 325Z DV Camera. It can be used in general laparoscopy, nasopharyngoscopy, ear endoscopy, and sinuscopy where a laparoscope/endoscope is indicated for use. A few examples of the more common endoscopic surgeries are laparoscopic cholecystectorny, laparoscopic hernia repair, laparoscopic appendectomy, laparoscopic pelvic lymph node dissection. laparoscopically assisted hvsterectomy. laparoscopic & thoracoscopic anterior spinal fusion. decompression fixation, wedge resection, lung biopsy, pleural biopsy, dorsal sympathectomy, pleurodesis, internal mammary artery dissection for coronary artery bypass, coronary artery bypass grafting where endoscopic visualization in indicated and examination of the evacuated cardiac chamber during performance of valve replacement. The users of the HERMES O.R. Control Center are general surgeons, gynecologists, cardiac surgeons, thoracic surgeons, plastic surgeons, orthopedic surgeons, ENT surgeons and urologists.

(PLEASE NO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CRDH, Office of Device Evaluation (ODE)

Prescription Use (per 21 CFR 801.109)

Over-the-Counter Use (Optional Format 1-2-96)

Miriam C. Provost

OR

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

000026

510(k) Number K031382

§ 876.1500 Endoscope and accessories.

(a)
Identification. An endoscope and accessories is a device used to provide access, illumination, and allow observation or manipulation of body cavities, hollow organs, and canals. The device consists of various rigid or flexible instruments that are inserted into body spaces and may include an optical system for conveying an image to the user's eye and their accessories may assist in gaining access or increase the versatility and augment the capabilities of the devices. Examples of devices that are within this generic type of device include cleaning accessories for endoscopes, photographic accessories for endoscopes, nonpowered anoscopes, binolcular attachments for endoscopes, pocket battery boxes, flexible or rigid choledochoscopes, colonoscopes, diagnostic cystoscopes, cystourethroscopes, enteroscopes, esophagogastroduodenoscopes, rigid esophagoscopes, fiberoptic illuminators for endoscopes, incandescent endoscope lamps, biliary pancreatoscopes, proctoscopes, resectoscopes, nephroscopes, sigmoidoscopes, ureteroscopes, urethroscopes, endomagnetic retrievers, cytology brushes for endoscopes, and lubricating jelly for transurethral surgical instruments. This section does not apply to endoscopes that have specialized uses in other medical specialty areas and that are covered by classification regulations in other parts of the device classification regulations.(b)
Classification —(1)Class II (special controls). The device, when it is an endoscope disinfectant basin, which consists solely of a container that holds disinfectant and endoscopes and accessories; an endoscopic magnetic retriever intended for single use; sterile scissors for cystoscope intended for single use; a disposable, non-powered endoscopic grasping/cutting instrument intended for single use; a diagnostic incandescent light source; a fiberoptic photographic light source; a routine fiberoptic light source; an endoscopic sponge carrier; a xenon arc endoscope light source; an endoscope transformer; an LED light source; or a gastroenterology-urology endoscopic guidewire, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 876.9.(2) Class I for the photographic accessories for endoscope, miscellaneous bulb adapter for endoscope, binocular attachment for endoscope, eyepiece attachment for prescription lens, teaching attachment, inflation bulb, measuring device for panendoscope, photographic equipment for physiologic function monitor, special lens instrument for endoscope, smoke removal tube, rechargeable battery box, pocket battery box, bite block for endoscope, and cleaning brush for endoscope. The devices subject to this paragraph (b)(2) are exempt from the premarket notification procedures in subpart E of part 807of this chapter, subject to the limitations in § 876.9.