K Number
K053560
Device Name
MODIFIED ENDOSHEATH SYSTEM FOR VSI FLEXIBLE CYSTOSCOPE
Date Cleared
2006-03-16

(85 days)

Product Code
Regulation Number
876.1500
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
For endoscopic access and examination of the lower urinary tract including the bladder and, using additional accessories, to perform various diagnostic and therapeutic procedures.
Device Description
The device system described in this 510(k) consists of a flexible, fiberoptic cystoscope and sterile, single use protective sheath.
More Information

Not Found

No
The 510(k) summary describes a flexible, fiberoptic cystoscope and protective sheath, with no mention of AI, ML, image processing, or any other technology typically associated with AI/ML applications in medical devices. The submission is a Special 510(k) for a device modification, focusing on design control and risk analysis, not new technological capabilities like AI/ML.

Yes.
The "Intended Use / Indications for Use" states that the device is used "to perform various diagnostic and therapeutic procedures."

Yes

The "Intended Use / Indications for Use" section explicitly states that the device is for "examination of the lower urinary tract" and to "perform various diagnostic and therapeutic procedures." Examination and diagnostic procedures indicate its use for diagnosis.

No

The device description explicitly states it consists of a flexible, fiberoptic cystoscope and a protective sheath, which are hardware components.

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

Here's why:

  • Intended Use: The intended use is for "endoscopic access and examination of the lower urinary tract" and performing "diagnostic and therapeutic procedures." This describes a device used in vivo (within the body) for direct visualization and intervention.
  • Device Description: The device is a "flexible, fiberoptic cystoscope and sterile, single use protective sheath." This is a physical instrument used for internal examination.
  • Lack of IVD Characteristics: IVD devices are used to examine specimens (like blood, urine, tissue) in vitro (outside the body) to provide information about a person's health. The description of this device and its use does not involve the analysis of specimens outside the body.

Therefore, this device falls under the category of a medical device used for direct examination and procedures within the body, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The Vision-Sciences Flexible Fiberoptic Cystoscope with EndoSheath® System is indicated for use in endoscopic access and examination of the lower urinary tract including the bladder and, using additional accessories, to perform various diagnostic and therapeutic procedures.

Product codes

FAJ

Device Description

The device system described in this 510(k) consists of a flexible, fiberoptic cystoscope and sterile, single use protective sheath.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

lower urinary tract including the bladder

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

Not Found

Key Metrics

Not Found

Predicate Device(s)

K040215, K031786

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

This submission is a Special 510(k): Device Modification as described in FDA's guidance document entitled "The New 510(k) Paradigm - Alternate Approaches to Demonstrating Substantial Equivalence in Premarket Notifications." In support of this 510(k), Vision-Sciences has provided certification of compliance to 21 CFR 820.30 Design Control requirements, and a description of the internal Risk Analysis procedure. V & V activities included modified device labeling, and was addressed through Design Validation and Verification planning.

§ 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.

0

Vision-Sciences, Inc. December 15, 2005

510(k) Summary

Trade Name:Vision-Sciences Flexible Cystoscope with EndoSheath® System
Sponsor:Vision-Sciences, Inc.
9 Strathmore Road
Natick, MA 01760
Registration #1223490
Device Common Name:Cystoscope with sheath
Classification:According to Section 513 of the Federal Food, Drug, and
Cosmetic Act, the device classification is Class II.
Predicate Devices:K040215 - VSI CST-Dx Slide-On Cystoscope Sheath for use with VSI
Flexible Cystoscope
K031786 - VSI TNE-BxD Slide-On EndoSheath® for use with VSI
Flexible Trans-Nasal Esophagoscope
Manufactured by:Vision-Sciences, Inc.
9 Strathmore Road
Natick, MA 01760

Product Description: The device system described in this 510(k) consists of a flexible, fiberoptic cystoscope and sterile, single use protective sheath.

Indications for Use:

The Vision-Sciences Flexible Fiberoptic Cystoscope with EndoSheath® System is indicated for use in endoscopic access and examination of the lower urinary tract including the bladder and, using additional accessories, to perform various diagnostic and therapeutic procedures.

Safety and Performance:

This submission is a Special 510(k): Device Modification as described in FDA's guidance document entitled "The New 510(k) Paradigm - Alternate Approaches to Demonstrating Substantial Equivalence in Premarket Notifications." In support of this 510(k), Vision-Sciences has provided certification of compliance to 21 CFR 820.30 Design Control requirements, and a description of the internal Risk Analysis procedure. V & V activities included modified device labeling, and was addressed through Design Validation and Verification planning.

Conclusion:

Based on the indications for use, technological characteristics, performance testing and comparison to predicate devices, the proposed modified EndoSheath® System for use with VSI Flexible Cystoscope has been shown to be safe and effective for its intended use.

1

MAR 1 6 2006

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Vision-Sciences, Inc. % Ms. Pamela Papineau, RAC Consultant Delphi Medical Device Consulting, Inc. 5 Whitcomb Avenue AYER MA 01432

Re: K053560 Trade/Device Name: Modified EndoSheath® System for VSI Flexible Cystoscope Regulation Number: 21 CFR §876.1500 Regulation Name: Endoscope and accessories Regulatory Class: II Product Code: FAJ Dated: February 27, 2006 Received: March 1, 2006

Dear Ms. Papineau:

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 donot 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 (Premarket Approval), 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.

2

This letter will allow you to begin marketing your device as described in your Section 510(k) This letter will and w you to begin maneling of substantial equivalence of your device to a legally premarked notification: "The PDA mailig sification 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 If you desire specific advice for your do rochers, based on the regulation number at the top of this letter:

21 CFR 876.xxxx(Gastroenterology/Renal/Urology)240-276-0115
21 CFR 884.xxxx(Obstetrics/Gynecology)240-276-0115
21 CFR 892.xxxx(Radiology)240-276-0120
Other240-276-0100

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Also, picase note the regulation emisor, formation on your responsibilities under the Act from the 807.97). Tou may obtain other general missis. Inc. 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/industry/support/index.html.

Sincerely yours,

Nancy C. Higdon

Nancy C. Brogdon Director, Division of Reproductive, Abdominal, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

3

Vision-Sciences, Inc. December 15, 2005

510(k) Number (if known):

Device Name: Modified EndoSheath® System for VSI Flexible Cystoscope

Indications for Use:

For endoscopic access and examination of the lower urinary tract including the bladder and, using additional accessories, to perform various diagnostic and therapeutic procedures.

Prescription Use X (Part 21 CFR 801 Subpart D)

ANDIOR

Over-the -Counter Use (21 CFR 807 Subpart D)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

David A. Larson

(Division Sign-Off) Division of Reproductive, Ab and Radiological Devices 510(k) Number

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