K Number
K050163
Date Cleared
2005-03-24

(58 days)

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

The Henke Sass Wolf of America HSW Bariatric Laparoscope is intended to be used in general laparoscopic surgery. Laparoscopic surgery is a means of performing diagnostic and therapeutic surgical procedures intra-abdominally using equipment that minimizes surgical invasiveness. Rather than creating large incisions to gain access to surgical sites, surgeons view inside the body and operate by using instruments inserted through small skin punctures (inserted through the laparoscope or through another small incision). This includes, but is not limited to such uses as gallbladder and appendix removal, hernia repair, and examination of the abdominal cavity, appendix, gallbladder, and liver.

Bariatric laparoscopes are intended to be used to perform surgical procedures on morbidly obese segments of the patient population.

Device Description

The Henke Sass Wolf of America's Bariatric Laparoscope is identical in terms of materials and modes of construction, optical performance and safety to Henke Sass Wolf GmbH HSW Laparoscopy Set - K941967 and the Stryker - K993045. This Bariatric version is longer (up to 550mm) so that it is capable of performing the same types of procedures on morbidly obese segments of the patient population.

Diameter: 5mm - 10mm
Length: 280mm to 550mm
Direction of View: 0, 30, 45 Degrees
Field of View: 75 Degrees
Shaft: 300 Series Stainless Steel
Body: Stainless Steel
Sidearm: Stainless Steel
Eyepiece: P.E.E.K.
Lenses: Glass or Sapphire

Adapters for connection to all conventional light-guides are supplied as standard.

The device is intended to be sterilized prior to use. The Bariatric Laparoscopes are designed to facilitate cleaning and disinfection as were the predicate devices. There is no difference in design and material that would impact the sterilization validation conducted for the HSW predicate device.

Instructions for cleaning and sterilization are included in the instructions for use. Sterilization and disinfection validation for predicate devices included EtO, Steris, and Sterrad is performed to assure an SAL of 10-6 per AAMI / ISO Standards.

AI/ML Overview

The provided text is a 510(k) premarket notification for a medical device, specifically a bariatric laparoscope. This type of submission focuses on demonstrating substantial equivalence to a legally marketed predicate device, rather than proving safety and effectiveness through clinical trials with detailed acceptance criteria and performance metrics in the way that a new, high-risk device might.

Therefore, much of the requested information about a study that proves the device meets acceptance criteria (e.g., sample sizes for test/training sets, number and qualifications of experts, adjudication methods, MRMC studies, standalone performance, type of ground truth) is not applicable to this type of regulatory submission or the information presented in the document.

The document primarily states that the proposed device is substantially equivalent to existing predicate devices based on design, materials, manufacturing methods, and intended use. The "acceptance criteria" here are essentially the requirements for demonstrating substantial equivalence as per FDA regulations.

Here's an attempt to answer the questions based only on the provided text, while acknowledging the limitations for a 510(k) submission:


1. A table of acceptance criteria and the reported device performance

For a 510(k) submission, "acceptance criteria" are not typically stated as quantified performance targets but rather as demonstrating equivalence to predicate devices. The "performance" is implicitly deemed equivalent if the device meets the characteristics and testing mentioned.

Acceptance Criteria (Implied for 510(k) Substantial Equivalence)Reported Device Performance/Compliance
Intended Use Equivalence: Same indications for use as predicate devices.The Henke Sass Wolf Bariatric Laparoscope shares the same general laparoscopic surgery indications as the predicate devices (gallbladder/appendix removal, hernia repair, examination of abdominal cavity, appendix, gallbladder, and liver). It adds an intention to be used on morbidly obese patients, which is also an indication for one of the predicate devices (Stryker Bariatric Laparoscopes, K993045).
Technological Characteristics Equivalence: Similar design, materials, and operational principles.The device is "identical in terms of materials and modes of construction, optical performance and safety" to the Henke Sass Wolf GmbH HSW Laparoscopy Set (K941967) and the Stryker (K993045). It is longer (up to 550mm) to accommodate bariatric procedures, but this is presented as a variation of an existing feature (length) to serve a specific patient population, which is also covered by one of the predicate devices. The specific dimensions, materials (stainless steel, PEEK, glass/sapphire), and direction/field of view are also specified and implicitly align with industry standards or predicate features.
Safety Testing: Compliance with relevant safety and sterilization standards.Biological Evaluation: Successfully met requirements of ISO 10993-1, ISO 10993-5, ISO 10993-12.
Electrical Safety: Successfully met requirements of IEC 601-2-18 (BF or CF applied part).
Sterilization: Successfully met AAMI/ISO Standards for Sterilization of Medical Devices. Validation conducted for predicate device included EtO, Steris, and Sterrad to assure an SAL of 10^-6. No difference in design/material that would impact this validation.
No New Issues of Safety or Effectiveness: The device does not raise new questions of safety or effectiveness."The HSW Bariatric Laparoscope does not introduce new issues when compared to its predicate devices or uses."

2. Sample sized used for the test set and the data provenance (e.g. country of origin of the data, retrospective or prospective)

Not applicable. This is a 510(k) submission for a medical device (laparoscope), not an AI/software device requiring a "test set" of clinical data for performance evaluation in the typical sense. The "testing" referred to是在工程和生物相容性层面上进行的物理和材料测试,而不是基于临床数据集的性能评估。

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g. radiologist with 10 years of experience)

Not applicable. See point 2.

4. Adjudication method (e.g. 2+1, 3+1, none) for the test set

Not applicable. See point 2.

5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

Not applicable. This device is a physical surgical instrument (laparoscope), not an imaging AI diagnostic aid.

6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done

Not applicable. This device is a physical surgical instrument, not an algorithm.

7. The type of ground truth used (expert concensus, pathology, outcomes data, etc)

Not applicable in the context of clinical performance data. The "ground truth" for this submission revolves around established engineering standards (e.g., ISO for biocompatibility, IEC for electrical safety, AAMI/ISO for sterilization) and the established characteristics and safety profile of the predicate devices.

8. The sample size for the training set

Not applicable. This device is a physical surgical instrument, not an AI/software device requiring a "training set."

9. How the ground truth for the training set was established

Not applicable. See point 8.

§ 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.