K Number
K033592
Device Name
REPROCESSED SURGICAL SCISSORS AND GRASPERS
Date Cleared
2004-07-27

(257 days)

Product Code
Regulation Number
878.4400
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The ClearMedical Reprocessed Used, Disposable Endoscopic Scissors and Graspers have application in a variety of minimally invasive procedures to facilitate grasping, mobilization, dissection, and transaction of tissue.
Device Description
The Reprocessed SUD (Reprocessed Used, Disposable Endoscopic Scissors and Graspers) is a sterilized SUD. The reprocessed Endopath endoscopic instruments are sterile, single patient use instruments that have a rotating insulated shaft and are designed for use through appropriate surgical trocars. The rotation knob located on the handle rotates the shaft 360 degrees in either direction. Some instruments have a monopolar cautery connector extending from the top of the handle and can be used for electosurgery when properly attached to standard cautery cables and appropriate generators. Other instruments have rachet handles, which allow the instrument jaws to be locked in place. The instrument jaws or scissor blades are activated by compression and release of the ring handles. See instructions for complete mode of operation details. The Reprocessed SUD (Reprocessed Used, Disposable Endoscopic details. The Reprosesses Coasted using EtO sterilization.
More Information

No
The description focuses on the mechanical and electrical functions of reprocessed surgical instruments and does not mention any AI or ML components or capabilities.

No.
The device facilitates grasping, mobilization, dissection, and transaction of tissue during surgery, but it does not directly treat a disease or medical condition.

No

Explanation: The device is described as surgical instruments (scissors and graspers) used for tissue manipulation (grasping, mobilization, dissection, transaction) during minimally invasive procedures. Its function is to perform actions on tissue, not to diagnose conditions or diseases.

No

The device description clearly details physical components like shafts, handles, jaws, and connectors, indicating it is a hardware 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 describes the device's application in surgical procedures for grasping, mobilization, dissection, and transaction of tissue. This is a direct surgical intervention on the patient's body.
  • Device Description: The description details a surgical instrument with features like a rotating shaft, jaws/blades, and potential for electrosurgery. These are all characteristics of a surgical tool used in vivo (within the living body).
  • Lack of IVD Characteristics: There is no mention of the device being used to examine specimens derived from the human body (like blood, urine, tissue samples) to provide information for diagnosis, monitoring, or screening.

IVD devices are used to perform tests in vitro (outside the living body) on samples taken from a patient. This device is clearly designed for use in vivo during a surgical procedure.

N/A

Intended Use / Indications for Use

The ClearMedical Reprocessed Used, Disposable Endoscopic Scissors and Graspers have application in a variety of minimally invasive procedures to facilitate grasping, mobilization, dissection, and transaction of tissue.

Product codes

79GCJ, 79GEI

Device Description

The Reprocessed SUD (Reprocessed Used, Disposable Endoscopic Scissors and Graspers) is a sterilized SUD. The reprocessed Endopath endoscopic instruments are sterile, single patient use instruments that have a rotating insulated shaft and are designed for use through appropriate surgical trocars. The rotation knob located on the handle rotates the shaft 360 degrees in either direction. Some instruments have a monopolar cautery connector extending from the top of the handle and can be used for electosurgery when properly attached to standard cautery cables and appropriate generators. Other instruments have rachet handles, which allow the instrument jaws to be locked in place. The instrument jaws or scissor blades are activated by compression and release of the ring handles. See instructions for complete mode of operation details. The Reprocessed SUD (Reprocessed Used, Disposable Endoscopic details) is reprocessed and sterilized using EtO sterilization.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

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)

K930933

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 878.4400 Electrosurgical cutting and coagulation device and accessories.

(a)
Identification. An electrosurgical cutting and coagulation device and accessories is a device intended to remove tissue and control bleeding by use of high-frequency electrical current.(b)
Classification. Class II.

0

JUL 27 2004 033592 510(k) SUMMARY OF SAFETY & EFFECTIVENESS

This 510(k) Summary details sufficient information to provide an understanding of the This of othy Cammary actalle causes antilal equivalence. For convenience, the summary is formatted pursuant to 21 CFR §807.92. This section may be used, as presented, to romide a substantial equivalence summary to anyone requesting it from the Agency.

21 CFR §807.92 a (1)

|

Submitter:
FALL PROPERTY LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAST LEAS

ClearMedical, Inc 1776 136 Place NE Bellevue, Washington 98005 Contact person: Mike Kovacs Ph: 425-460-2718 Fax: 425-401-1515

Date prepared: 29 June 2004

21 CFR §807.92 a (2)

Trade name:

Reprocessed Used, Disposable Endoscopic Scissors and Graspers

Common name:Laparoscopic/Endoscopic Surgical Instruments
Classification name:79GCJ, Manual Laparoscopic Surgical Instruments
79GEI, Endoscopic Electrosurgical Instruments

21 CFR §807.92 a (3)

Identification of predicate(s): Substantial equivalence for the Reprocessed Used, Disposable Endoscopic Scissors and Graspers is based on its similarities to the predicate devices, Ethicon Endoscopic Surgical Instruments (K930933) 22 June 2003. The Reprocessed Used, Disposable Endoscopic Scissors and Graspers is substantially equivalent to the predicates in intended use, material, design, performance, and physical characteristics.

21 CFR §807.92 a (4)

Device Description-parts and function/concept: The Reprocessed SUD (Reprocessed Used, Disposable Endoscopic Scissors and Graspers) is a sterilized SUD. The reprocessed Endopath endoscopic instruments are sterile, single patient use instruments that have a rotating insulated shaft and are designed for use through appropriate surgical trocars. The rotation knob located on the handle rotates the shaft 360 degrees in either direction. Some instruments have a monopolar cautery connector extending from the top of the handle and can be used for electosurgery when properly attached to standard cautery cables and appropriate generators. Other instruments have rachet handles, which allow the instrument jaws to be locked in place. The instrument jaws or scissor blades are activated by compression and release of the ring handles. See instructions for complete mode of operation

1

Page 2 of 2

details. The Reprocessed SUD (Reprocessed Used, Disposable Endoscopic details. The Reprosesses Coasted using EtO sterilization.

21 CFR §807.92 a (5)

21 CFR §807.92 a (5)
Intended use and relationship to predicate(s): The Reprocessed Used, Disposable Intended use and relationship to predicated for use in a variety of minimally invasive
Endoscopic Scissors and Graspers is indicated for use in a variety of tissue Endoscopic Scissols and Graspers is indication, dissection, and transaction of tissue.

CFR §807.92 a (6)

Of IX 9601:52 a (0) Lechnological characteristics and follations on Scissors and Graspers is similar in
The Reprocessed Used, Disposable Endoscopic Scissors and Graspers is similar in The Reprocessed Osed, Disposable Endooseph Solors
design, material, intended use and technological characteristics to the predicate devices.

21 CFR §807.92 b

21 CFR §807.92 b
This substantial equivalence is based on similarities to the predicate devices in terms of This Substantial oquivalor oquivalism characteristics.

21 CFR §807.92 c

21 CFR 8007.32 €
In accordance with the specifications of this subsection, this summary in accordance with the speomsations of a learly identified as such.

2

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health and 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 a stylized image of an eagle with three lines representing its wings and three wavy lines representing its body.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JUL 27 2004

Mr. Mike Kovacs Vice President, Engineering and Production ClearMedical, Inc. 1776 136th Place, NE Bellevue, Washington 98005

Re: K033592

Trade/Device Name: Reprocessed Used, Disposable Endoscopic Scissors Regulation Number: 21 CFR 878.4400 Regulation Name: Electrosurgical cutting and coagulation device and accessories Regulatory Class: II Product Code: GEI Dated: June 29, 2004 Received: June 30, 2004

Dear Mr. Kovacs:

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. Mike Kovacs

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

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 Statement

Page _ 1 _ of __ 1__

510(k) Number (if known): K033592

Device Name: Reprocessed Used, Disposable Endoscopic Scissors

Indications for Use

The ClearMedical Reprocessed Used, Disposable Endoscopic Scissors The CleanMedical Neprocessou Good, Displantinally invasive procedures
and Graspers have application in a variety of minimaly in a finance and Graspers have application in a varies)
to facilitate grasping, mobilization, dissection, and transaction of tissue...

Prescription Use (Per 21 CFR 801.109)

OR

Over-The-Counter Use Optional Format 1-

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

uriam C. Provost

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

510(k) Number K033592

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