K Number
K033423
Device Name
REVOLIX LASER SYSTEMS
Date Cleared
2004-01-15

(80 days)

Product Code
Regulation Number
878.4810
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Revolix laser system and its fiber optic delivery system are intended for use in surgical procedures using open, laparoscopic and endoscopic incision, excision, resection, ablation, vaporization, coagulation and hemostasis of soft tissue in use in medical specialities including: Urology, Gasteroenterlogy, Pulmonary, Gynecology, ENT, Dermatology, Plastic Surgery and General Surgery.
Device Description
The RevoLix diode pump solid state is a surgical laser system operating at a wavelength of 2.0 micron. The purpose of the laser is the ablation, coagulation, and hemostasis of soft tissue. The laser is designed for open surgery and surgical applications in aqueous media. The laser power is delivered via a fiber optic delivery system and this is guided by a handpiece or endoscopic surgical instrument. It consists of Laser Console with Internal Computer Control Panel and Display, A fiber optic delivery system, Footswitch.
More Information

Not Found

No
The document describes a surgical laser system with a fiber optic delivery system and internal computer control. There is no mention of AI, ML, image processing, or any other technology typically associated with AI/ML in medical devices. The description focuses on the physical components and intended surgical applications of the laser.

Yes

The device is intended for use in surgical procedures for various ablative and coagulative actions on soft tissue, which directly treats medical conditions.

No

The device description and intended use clearly state that the Revolix laser system is for surgical procedures to ablate, coagulate, and achieve hemostasis of soft tissue. It is a therapeutic device, not a diagnostic one.

No

The device description clearly outlines a physical laser system with a console, fiber optic delivery system, and footswitch, indicating it is a hardware-based medical device, not software-only.

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

Here's why:

  • Intended Use: The intended use clearly states the device is for surgical procedures involving the direct manipulation of soft tissue (incision, excision, resection, ablation, vaporization, coagulation, and hemostasis). This is a therapeutic and surgical application, not a diagnostic one.
  • Device Description: The description details a surgical laser system designed to interact directly with tissue.
  • Lack of Diagnostic Elements: There is no mention of analyzing samples (blood, urine, tissue, etc.) or providing diagnostic information about a patient's condition. IVD devices are used to examine specimens from the human body to provide information for diagnosis, monitoring, or screening.

The Revolix laser system is a surgical tool used for treating conditions by directly acting on tissue, which falls under the category of a therapeutic or surgical device, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The Revolix laser system and its fiber optic delivery system are intended for use in surgical procedures using open, laparosooplound onlostasis of soft tissue in use in use in use in resection, abiation, vaporization, congulation and normost, Gynecology, ENT, Dermatology, Plastic Surgery and General Surgery
Urology
Open and endoscopic surgery (incision, excision, resection, ablation, vaporization, coagulation and hemostasis) including: Urethral Strictures Bladder Neck Incisions (BNI) Bladder Neck Inclisions (BN) Ablation and resection of Bladder Tumors, Uretheral Tumors and Ureteral Tumors. Ablation of Benign Prostatic Hypertrophy (BHP), Transurethral incision of the prostate (TUIP) Holmium Laser Resection of the Prostrate (HoLRP) Holmium Laser Enuculeation of the Prostate (HoLEP) Holmium laser Ablation of the Prostate (HoLAP) Condylomas Lesions of external genitalia
Gasteroenterlogy
Open and endoscopic gasteroenterlogy surgery (incision, excision, resection, ablation, vaporization, coagulation and hemostasis ) including
Appendectomy Polyps Biobsy Gall Bladder calculi Biliary/Bile duct calculi Ulcers Gastric ulcers Duodenal ulcers Non Bleeding Ulcers Pancreatitas Hemorrhoids Cholecystectomy Benign and Malignant Neoplasm Angiodysplasia Colorectal cancer Telangiectasias Telangiectasias of the Osler-Weber-Renu disease Vascular Malformation Gastritis Esophagitis Esophageal ulcers Varices Colitis Mallory-Weiss tear Gastric Erosions
Pulmonary
Open and endoscopic pulmonary surgery (incision, resection, ablation, vaporization, coagulation and hemostasis) of soft tissue
Gynecology
Open and laparoscopic gynecological surgery (incision, excision, resection, ablation, vaporization, coagulation and hemostasis)
ENT
Endoscopic endonasal surgery (incision, excision, resection, ablation, vaporization, coagulation and hemostasis of soft tissue) including: Endonasal/sinus Surgery Partial turbinectomy Polypectomy Dacryocystorhinostomy Frontal Sinusotomy Ethmoidectomy Maxillary antrostomy Functional endoscopic sinus surgery
Dermatology and Plastic Surgery
Incision, excision, resection, ablation, vaporization, coagulation and hemostasis of soft, mucosal, fatty and cartilaginous tissue, in therapeutic plastic, dermatologic and aesthetic surgical procedures including:
Basal Cell Carcinomas Lesions of skin and subcutaneous tissue Skin tags Plantar warts
General Surgery
Open laparoscopic and endoscopic surgery (incision, excision, resection, ablation, vaporization, coagulation and hemostasis) including:
Appendectomy Skin incision Excision of external and internal lesions Complete of partial resection of internal organs, tumors and lesions Biopsy

Product codes

GEX

Device Description

The RevoLix diode pump solid state is a surgical laser system operating at a wavelength of 2.0 milliording soft tissue. The purpose of the laser is the laser is the ablation, coagulation. The laser is designed for open surgery and surgical applications in aqueous media. The laser power is delivered via arro surgical applications in aquebad this is guided by a handpiece or endoscopic surgical instrument.
It consists of
Laser Console with Internal Computer Control Panel and Display A fiber optic delivery system Footswitch

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Urethral, Bladder Neck, Bladder, Uretheral, Ureteral, Prostate, external genitalia, Appendix, Polyps, Gall Bladder, Biliary/Bile duct, Gastric, Duodenal, Pancreas, Hemorrhoids, Colorectal, Esophagus, Colon, Pulmonary soft tissue, Gynecological soft tissue, Endonasal/sinus, turbinectomy, Polypectomy, Dacryocystorhinostomy, Frontal Sinus, Ethmoid, Maxillary antrostomy, skin, subcutaneous tissue, internal organs.

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)

Lumenis – Holmium VersaPulse Power Suite Holmiun Laser Eaments - TomniPulse Max 80 Watt Holmium Laser System

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 878.4810 Laser surgical instrument for use in general and plastic surgery and in dermatology.

(a)
Identification. (1) A carbon dioxide laser for use in general surgery and in dermatology is a laser device intended to cut, destroy, or remove tissue by light energy emitted by carbon dioxide.(2) An argon laser for use in dermatology is a laser device intended to destroy or coagulate tissue by light energy emitted by argon.
(b)
Classification. (1) Class II.(2) Class I for special laser gas mixtures used as a lasing medium for this class of lasers. The devices subject to this paragraph (b)(2) are exempt from the premarket notification procedures in subpart E of part 807 of this chapter, subject to the limitations in § 878.9.

0

JAN 1 5 2004

K033423 1 of 4

Attachment V

510(k) Summary

1. General Information

| Submitter: | AllMed Systems Inc.
9232 Klemetson Drive
Pleasanton CA 94588 |
|-----------------|--------------------------------------------------------------------|
| Phone: | 925-468-0433 |
| Fax: | 925-399-5984 |
| Contact Person: | Peter Allen |
| Date Prepared | 22nd October 2003 |

    1. Names
Device NameRevolix Family of Laser Systems
Common Name2.01micron Laser System
Classification NameLaser Surgical Instrument and accessories

3. Predicate Device

Lumenis – Holmium VersaPulse Power Suite Holmiun Laser Eaments - TomniPulse Max 80 Watt Holmium Laser System

4. Product Description

The RevoLix diode pump solid state is a surgical laser system operating at a The RevolElx diode purpose of the laser is the laser is the ablation, coagulation, wavelength of 2.0 milliording soft tissue. The laser is designed for open surgery and surgical applications in aqueous media. The laser power is delivered via arro surgical applications in aquebad this is guided by a handpiece or endoscopic surgical instrument.

1

K033423 2 of 4

It consists of

Laser Console with Internal Computer Control Panel and Display A fiber optic delivery system Footswitch

5. Indications for Use

The Revolix laser system and its fiber optic delivery system are intended for use in The Revolix laser system and its liber optio dollively of oscision, excision, surgical procedures using open, laparosooplound onlostasis of soft tissue in use in use in use in resection, abiation, vaporization, congulation and normost, Gynecology, ENT, Dermatology, Plastic Surgery and General Surgery

Urology

Open and endoscopic surgery (incision, excision, resection, ablation, vaporization, coagulation and hemostasis) including: Urethral Strictures Bladder Neck Incisions (BNI) Bladder Neck Includio (BN)
Ablation and resection of Bladder Tumors, Uretheral Tumors and Ureteral Tumors. Ablation of Benign Prostatic Hypertrophy (BHP), Transurethral incision of the prostate (TUIP) Holmium Laser Resection of the Prostrate (HoLRP) Holmium Laser Enuculeation of the Prostate (HoLEP) Holmium laser Ablation of the Prostate (HoLAP) Condylomas Lesions of external genitalia

Gasteroenterlogy

Open and endoscopic gasteroenterlogy surgery (incision, excision, resection, ablation, vaporization, coagulation and hemostasis ) including

  • Appendectomy Polyps Biobsy Gall Bladder calculi Biliary/Bile duct calculi Ulcers Gastric ulcers Duodenal ulcers Non Bleeding Ulcers Pancreatitas Hemorrhoids Cholecystectomy Benign and Malignant Neoplasm

2

K033423 3g

  • Angiodysplasia Colorectal cancer Telangjectasias Telangiectasias of the Osler-Weber-Renu disease Vascular Malformation Gastritis Esophagitis Esophageal ulcers Varices Colitis Mallory-Weiss tear Gastric Erosions

Pulmonary

Open and endoscopic pulmonary surgery (incision, resection, ablation, vaporization, coagulation and hemostasis) of soft tissue

Gynecology

Open and laparoscopic gynecological surgery (incision, excision, resection, ablation, vaporization, coagulation and hemostasis)

ENT

Endoscopic endonasal surgery (incision, excision, resection, ablation, vaporization, coagulation and hemostasis of soft tissue) including:

  • Endonasal/sinus Surgery Partial turbinectomy Polypectomy Dacryocystorhinostomy Frontal Sinusotomy Ethmoidectomy Maxillary antrostomy Functional endoscopic sinus surgery

Dermatology and Plastic Surgery

Incision, excision, resection, ablation, vaporization, coagulation and hemostasis of soft, mucosal, fatty and cartilaginous tissue, in therapeutic plastic, dermatologic and aesthetic surgical procedures including:

Basal Cell Carcinomas Lesions of skin and subcutaneous tissue Skin tags Plantar warts

3

K033423 4084

General Surgery

Open laparoscopic and endoscopic surgery (incision, excision, resection, resection, resection, resection, Open laparoscopic and endoscopis cargery (
ablation, vaporization, coagulation and hemostasis) including:

Appendectomy Skin incision Excision of external and internal lesions Excision of external and internal lesions
Complete of partial resection of internal organs, tumors and lesions Biopsy

6. Rationale for Substantial Equivalence

The Revolix laser system with fiber optic delivery devices share intended use,
the same in the find of the first and firstigated foatures and therefore are The Revolix laser system will hoer oplic ucures and therefore and therefore are are
indications for use, similar design features and functional features and therefore and indications for use, similar design leather and the loversuite 10 watt Holmium Laser,
substantially equivalent to the Lumenis VersaPulse 100 watt Holmium Laser substantially equivalent to the Luments versal uise Forrelession
the Trimedyne OmniMax 80 watt Holmium Laser and the Laserscope Green Laser

7. Conclusion

  1. Conclusion
    The Revolix Laser System with fiber optic delivery devices were found to be substantially The Revolix Laser System with hiber optic delivery actives and the surgical laser systems and delivery devices.

4

Image /page/4/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is an abstract symbol resembling an eagle or bird with three stylized wings or feathers.

Public Health Service

JAN 1 5 2004

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Mr. Peter Allen President Allmed Systems, Inc. 9232 Klemetson Drive Pleasanton, California 94588

Re: K033423 Tradc/Device Name: Revolix Regulation Number: 21 CFR 878.4810 Regulation Name: Laser surgical instrument for use in general and plastic surgery and in dermatology Regulatory Class: II Product Code: GEX Dated: October 22, 2003 Received: October 29, 2003

Dear Mr. Allen:

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. Peter Allen

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. 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 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
C.C.

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

510(k) Number: K033423

Revolix Device Name:

Indications For Use:

The Revolix laser system and its fiber optic delivery system are intended for use in surgical The Revolix laser System and its ther optic and endoscopic incision, resection, ablation, procedures using open, laparuscopic and enosus in use in medical specialies including.
vaporization, coagulation and hemostasis of soft tissue in use in medical specializes f vaponzation, coagulation and hemostals of Sort tread in 2001 miles of the Surgery and General Surgery

Urology

Open and endoscopic surgery (incision, excision, resection, ablation, vaporization, coagulation and hemostasis) including:

Urethral Strictures Bladder Neck Incisions (BNI) Bladder Neck Inclisions (DNI)
Ablation and resection of Bladder Tumors, Uretheral Tumors and Ureteral Tumors. Ablation of Benign Prostatic Hypertrophy (BHP), Transurethral incision of the prostate (TUIP) Holmium Laser Resection of the Prostrate (HoLRP) Holmium Laser Enuculeation of the Prostate (HoLEP) Holmium laser Ablation of the Prostate (HoLAP) Condylomas Lesions of external genitalia

Gasteroenterlogy

Open and endoscopic gasteroenterlogy surgery (incision, excision, resection, ablation, vaponzation, coagulation and hemostasis ) including:

Prescription Use v (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter Use ............. (21 CFR 807 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Meriaw C. Provost
Division Sign-Off

Page 1 of 4

Vision Sign-Off) Civision of General, Restorative and Neurological Devices

Ko 33423

7

510(k) Number: K033423

Revolix Device Name:

Indications For Use:

Appendectomy Polyps Biopsy Gall Bladder calculi Biliary/Bile duct calculi Ulcers Gastric ulcers Duodenal ulcers Non Bleeding Ulcers Pancreatitas Hemorrhoids Cholecystectomy Benign and Malignant Neoplasm Angiodysplasia Colorectal cancer Telangiectasias Telangiectasias of the Osler-Weber-Renu disease Vascular Malformation Gastritis Esophaqitis Esophageal ulcers Varices Colitis Mallory-Weiss tear Gastric Erosions

V Prescription Use _ (Part 21 CFR 801 Subpart D)

AND/OR

Over-The-Counter Use _________________________________________________________________________________________________________________________________________________________ (21 CFR 807 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Page 2 of 4

8

510(k) Number: K033423

Revolix Device Name:

Indications For Use:

Pulmonary

Open and endoscopic pulmonary surgery (incision, excision, resection, ablation, vaporization, coagulation and hemostasis) of soft tissue

Gynecology

Open and laparoscopic gynecological surgery (incision, excision, resection, ablation, vaporization, coagulation and hemostasis)

ENT

Endoscopic endonasal surgery (incision, excision, resection, ablation, vaporization, coagulation and hemostasis of soft tissue) including:

  • Endonasal/sinus Surgery Partial turbinectomy Polypectomy Dacryocystorhinostomy Frontal Sinusotomy Ethmoidectomy Maxillary antrostomy Functional endoscopic sinus surgery
    ما Prescription Use (Part 21 CFR 801 Subpart D)

AND/OR


Over-The-Counter Use _________________________________________________________________________________________________________________________________________________________ (21 CFR 807 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Page 3 of 4

9

510(k) Number: K033423

Revolix Device Name:

Indications For Use:

Dermatology and Plastic Surgery

Incision, excision, resection, ablation, vaporization, coagulation and hemostasis of including excludit, resection, abliation, vaponation, or stic, dermatologic and aesthetic surgical procedures including

Basal Cell Carcinomas Lesions of skin and subcutaneous tissue Skin tags Plantar warts

General Surgery

Open laparoscopic and endoscopic surgery (incision, excision, resection, ablation, vaporization, coagulation and hemostasis) including.

Appendectomy Skin incision Excision of external and internal lesions Complete of partial resection of internal organs, tumors and lesions Biopsy

Prescription Use _____________________________________________________________________________________________________________________________________________________________ (Part 21 CFR 801 Subpart D)

AND/OR

....

Over-The-Counter Use _________________________________________________________________________________________________________________________________________________________ (21 CFR 807 Suhpart C)

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


Concurrence of CDRH, Office of Device Evaluation (ODE)

Page 4 of 4