K Number
K061313
Date Cleared
2006-08-31

(113 days)

Product Code
Regulation Number
874.4680
Reference & Predicate Devices
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

EVIS EXERA II XENON LIGHT SOURCE OLYMPUS CLV-180: This light source has been designed to be used with Olympus endoscopes, video system center, and other ancillary equipment for endoscopic diagnosis, treatment and video observation.

EVIS EXERA II VIDEO SYSTEM CENTER OLYMPUS CV-180: This video system center has been designed to be used with Olympus camera heads, endoscopes, light source, monitors, endo-therapy accessories and other ancillary equipment for endoscopic diagnosis, treatment and video observation.

EVIS EXERA II BRONCHOVIDEOSCOPE OLYMPUS BF TYPE P180, BF TYPE 1T180, BF TYPE Q180: These instruments have been designed to be used with an Olympus video system center, light source, documentation equipment, video monitor, endo-therapy accessories (such as biopsy forceps) and other ancillary equipment for endoscopy and endoscopic surgery within the airways and tracheobronchial tree.

VISERA RHINO-LARYNGO VIDEOSCOPE OLYMPUS ENF TYPE V2: This instrument has been designed to be used with an Olympus video system center, light source, documentation equipment, display monitor, and other ancillary equipment for endoscopic diagnosis within the nasal lumens and airway anatomy (including nasopharyngeal and trachea).

VISERA RHINO-LARYNGO VIDEOSCOPE OLYMPUS XENF TYPE VTY1: This instrument has been designed to be used with an Olympus video system center, light source, documentation equipment, display monitor, endo-therapy accessories, and other ancillary equipment for endoscopic diagnosis and treatment within the nasal lumens and airway anatomy (including nasopharyngeal and trachea).

Device Description

The EVIS EXERA II 180 System consists of Olympus camera heads, endoscopes, video system center, light source, monitors, endo-therapy accessories and other ancillary equipment. This system is intended for endoscopic diagnosis, treatment and video observation of the airways, tracheobronchial tree, nasal lumens and airway anatomy.

The primary components of the subject system, which are part of this submission, are:

  • EVIS EXERA II Xenon Light Source Olympus CLV-180.
  • EVIS EXERA II Video System Center Olympus CV-180,
  • EVIS EXERA II Bronchovideoscope Olympus BF -P180, BF -1T180, BF -Q180 .
  • VISERA Rhino-Laryngo Videoscope Olympus ENF-V2, XENF-VTY1

The EVIS EXERA II Xenon Light Source Olympus CLV-180 is intended for endoscopic diagnosis, treatment and video observation. The CLV-180 is identical to the predicate device, EVIS EXERA Xenon Light Source CLV-160A cleared under K051645 except that the device size has been slightly changed. The CLV-180 has an optional fitter which allows the user to enhance endoscopic white light images by selective processing of green and blue light. This feature, referred to as Narrow Band Imaging (NBI) employs an optical filter to filter the white light spectrum, changing it from a broad band to a narrow band. Both an endoscopic image by standard white light illumination and that by NBI illumination can be obtained. The user can select either the standard observation mode by pressing the scope switch on the scope or the NBI mode switch on the CLV-180. In comparison to conventional white light observation, NBI observation provides greater visual contrast of the surface structure and fine capillary patterns of the mucous membranes.

The EVIS EXERA II Video System Center Olympus CV-180 is a video processing system intended for use with Olympus endoscopes such as the subject endoscopes. The CV-180 Video System Center contains the video signal processing technology which enables the endoscope to illuminate, enhance, view, record and transmit video data of endoscopic images. The CV-180 is identical to the predicate device, EVIS EXERA Video System Center CV-160A, cleared under K051645 except that the device size has been slightly changed.

The CV-180 incorporates the following features:
The CV-180 is compatible with any specified Olympus flexible, both video and fiberoptic, and rigid endoscope.
The CV-180 processes the NBI image, generated by the CLV-160A light source and captured by the endoscope's Charged Coupled Device (CCD), creating an enhanced image of the tissue's vasculature.

Both the CLV-180 and CV-180 can be used with any specified Olympus flexible and ridid endoscope models, including gastroscopes, ultrasound gastroscopes, colonoscopes, sigmoidscopes, choledochoscopes, rhino-laryngoscopes, tracheal intubation scopes, transnasal esophago scopes, hysteroscopes, cystoscopes, ureterorenoscopes, laparo-thoracoscopes, for conventional white light endoscopy. The flexible endoscopes which are the subject of this premarket notification are bronchoscope and rhino-laryngoscope models listed in Table 16-2.

Additionally, when they are combined with the new bronchovideoscopes (BF-P180, BF-1T180, BF-Q180), and rhino-laryngo videoscopes (ENF-V2, XENF-VTY1), both an endoscopic image by white light illumination and that by NBI illumination can be obtained. The user can select either the NBI mode or normal mode by pressing the scope switch on the scope or the NBI mode switch on the CLV-160A; the NBI filter in the CLV-180 is inserted on the light axis when the NBI mode is selected.

The new endoscopes are basically identical to each predicate device shown in Table 16-2 in intended use, and similar in specifications, performance and materials. The CV-180 identifies an NBI-compatible scope when it is connected by using the Scope ID function provided with the scopes.

AI/ML Overview

The provided document, a 510(k) summary for the EVIS EXERA II 180 System, outlines the device's technical specifications and claims substantial equivalence to predicate devices. However, it does not contain any information regarding acceptance criteria or a study proving that the device meets such criteria.

The document's purpose is to demonstrate substantial equivalence to existing legally marketed devices, primarily by showing that the new device has "no significant changes in intended use, method of operation, material, or design that could affect the safety or effectiveness of the system." (Page 8). This is a different kind of submission than one requiring a clinical performance study with acceptance criteria.

Therefore, I cannot provide the requested information. The document focuses on comparing the specifications of the subject device (EVIS EXERA II 180 System) components (Light Source, Video System Center, Bronchovideoscopes, Rhino-Laryngo Videoscopes) to their respective predicate devices.

Missing Information from the Provided Document:

  • Acceptance Criteria and Reported Device Performance: No acceptance criteria or reported device performance metrics (e.g., sensitivity, specificity, accuracy) are mentioned.
  • Sample Size and Data Provenance (Test Set): There is no mention of a test set, sample size, or data provenance.
  • Number of Experts and Qualifications (Ground Truth for Test Set): No experts or ground truth establishment for a test set are described.
  • Adjudication Method: No adjudication method is mentioned.
  • Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study: No MRMC study is described.
  • Standalone Performance Study: No standalone performance study of an algorithm is described. The device is an endoscopic system, not an AI algorithm.
  • Type of Ground Truth Used: No ground truth types (e.g., pathology, outcomes data) are mentioned for a performance study.
  • Sample Size for the Training Set: There is no mention of a training set or its sample size.
  • How Ground Truth for the Training Set was Established: No information on training set ground truth establishment is provided.

The document is purely a technical comparison for substantial equivalence rather than a clinical performance study.

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AUG 8 0 2006

510(k) SUMMARY

:

EVIS EXERA II 180 SYSTEM

1. General Information

1. General Information

ApplicantOLYMPUS MEDICAL SYSTEMS CORP.2951 Ishikawa-cho, Hachioji-shi,Tokyo, 192-8507, JapanEstablishment Registration No.: 8010047
Official CorrespondentLaura Storms-TylerExecutive DirectorRegulatory Affairs & Quality AssuranceOlympus America Inc.3500 Corporate ParkwayPO Box 610Center Valley PA 18034-0610Phone: 484-896-5688FAX: 484-896-7128Email: Laura.storms-tyler @olympus.comEstablishment Registration No.: 2429304
Manufacturer
Light source/Video system center:Shirakawa Olympus Co., Ltd.3-1, Aza-Ookamiyama, Ooaza-Odakura, Nishigo-mura,Nishishirakawa-gun, Fukushima, Japan 961-8061Establishment Registration No.: 3002808148
Bronchoscope/Rhino-Laryngoscope:Aizu Olympus Co., Ltd.500 Aza-Muranishi, Ooaza-lidera, Monden-cho,Aizuwakamatsu-shi, Fukushima, Japan 965-8520Establishment Registration No.: 9610595
Suction valve/Biopsy valve:OLYMPUS MEDICAL SYSTEMS CORP. Hinode Plant34-3 Hirai Hinode-machi, Nishitama-gun,Tokyo, Japan 190-0182Establishment Registration No.: 3003637092
Date PreparedApril 1, 2006

.

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. . . . . . . . . .

2. Device Identification

■ Device Name:EVIS EXERA II 180 System
------------------------------------------
  • Common Name: Endoscopic Video Imaging System
  • Class: 11 ﺍﻟﻤﺴﺎﻋﺪﺓ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤﺴ . . . ......... . ....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
  • Classification:

.

Table 16-1. Classification of the EVIS EXERA 160A System
INFORMATION CONSULTION CONSULTION CONSULTION CONSULTION CONSULTURAL CONSULTURATION CONSULTURATION CONSULTURATION
RegulationNumberRegulation NameProduct CodeClassificationPanel
874. 4680Bronchoscope (flexible or rigid)and accessoriesEOQ- Bronchoscope(Flexible or rigid)Ear, Nose &Throat
874.4760Nasopharyngoscope (flexible orrigid) and accessoriesEOB- Nasopharyngoscope(Flexible or rigid)Throat
876.1500Endoscope and accessoriesNWB- Endoscope, accessories,narrow band spectrumGastroenterology& Urology

3. Legally Marketed Device to which Substantial Equivalence is Claimed

The following table shows the primary components (part of this submission) of the EVIS EXERA II 180 System and each device to which we claim substantial equivalence (predicate device).

Table 16-2. Primary Components & Predicate Devices of the EVIS EXERA II 180 Systen.
-------------------------------------------------------------------------------------
Subject Device(Part of this Submission)Predicate DevicePD's510(k) No.
EVIS EXERA II XENON LIGHT SOURCEOLYMPUS CLV-180EVIS EXERA XENON LIGHT SOURCEOLYMPUS CLV-160AK051645
EVIS EXERA II VIDEO SYSTEM CENTEROLYMPUS CV-180EVIS EXERA VIDEO SYSTEM CENTEROLYMPUS CV-160A
EVIS EXERA II BRONCHOVIDEOSCOPEOLYPUS BF TYPE P180EVIS EXERA BRONCHOVIDEOSCOPE
EVIS EXERA II BRONCHOVIDEOSCOPEOLYPUS BF TYPE Q180OLYPUS BF TYPE 160K023984
EVIS EXERA II BRONCHOVIDEOSCOPEOLYPUS BF TYPE 1T180EVIS EXERA BRONCHOVIDEOSCOPEOLYPUS BF TYPE 1T160
VISERA RHINO-LARYNGO VIDEOSCOPEOLYMPUS ENF TYPE V2VISERA RHINO-LARYNGO VIDEOSCOPEOLYMPUS ENF TYPE VK031648
VISERA RHINO-LARYNGO VIDEOSCOPEOLYMPUS XENF TYPE VTY1VISERA RHINO-LARYNGO VIDEOSCOPEOLYMPUS ENF TYPE VTK052452

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4. Device Description

The EVIS EXERA II 180 System consists of Olympus camera heads, endoscopes, video system center, light source, monitors, endo-therapy accessories and other ancillary equipment. This system is intended for endoscopic diagnosis, treatment and video observation of the airways, tracheobronchial tree, nasal lumens and airway anatomy.

The primary components of the subject system, which are part of this submission, are:

  • EVIS EXERA II Xenon Light Source Olympus CLV-180. •
  • EVIS EXERA II Video System Center Olympus CV-180, t
  • EVIS EXERA II Bronchovideoscope Olympus BF -P180, BF -1T180, BF -Q180 .
  • VISERA Rhino-Laryngo Videoscope Olympus ENF-V2, XENF-VTY1 》

The EVIS EXERA II Xenon Light Source Olympus CLV-180 is intended for endoscopic diagnosis, treatment and video observation. The CLV-180 is identical to the predicate device, EVIS EXERA Xenon Light Source CLV-160A cleared under K051645 except that the device size has been slightly changed. The CLV-180 has an optional fitter which allows the user to enhance endoscopic white light images by selective processing of green and blue light. This feature, referred to as Narrow Band Imaging (NBI) employs an optical filter to filter the white light spectrum, changing it from a broad band to a narrow band. Both an endoscopic image by standard white light illumination and that by NBI illumination can be obtained. The user can select either the standard observation mode by pressing the scope switch on the scope or the NBI mode switch on the CLV-180. In comparison to conventional white light observation, NBI observation provides greater visual contrast of the surface structure and fine capillary patterns of the mucous membranes.

The EVIS EXERA II Video System Center Olympus CV-180 is a video processing system intended for use with Olympus endoscopes such as the subject endoscopes. The CV-180 Video System Center contains the video signal processing technology which enables the endoscope to illuminate, enhance, view, record and transmit video data of endoscopic images. The CV-180 is identical to the predicate device, EVIS EXERA Video System Center CV-160A, cleared under K051645 except that the device size has been slightly changed.

The CV-180 incorporates the following features:

The CV-180 is compatible with any specified Olympus flexible, both video and fiberoptic, 1. and rigid endoscope.

The CV-180 processes the NBI image, generated by the CLV-160A light source and 2 captured by the endoscope's Charged Coupled Device (CCD), creating an enhanced image of the tissue's vasculature.

Both the CLV-180 and CV-180 can be used with any specified Olympus flexible and ridid endoscope models, including gastroscopes, ultrasound gastroscopes, colonoscopes, sigmoidscopes, choledochoscopes, rhino-laryngoscopes, tracheal intubation scopes, transnasal esophago scopes, hysteroscopes, cystoscopes, ureterorenoscopes, laparo-thoracoscopes, for conventional white light endoscopy. The flexible endoscopes which are the subject of this premarket notification are bronchoscope and rhino-laryngoscope models listed in Table 16-2.

Additionally, when they are combined with the new bronchovideoscopes (BF-P180, BF-1T180, BF-Q180), and rhino-laryngo videoscopes (ENF-V2, XENF-VTY1), both an endoscopic image by white light illumination and that by NBI illumination can be obtained. The user can select either the NBI mode or normal mode by pressing the scope switch on the scope or the NBI

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

mode switch on the CLV-160A; the NBI filter in the CLV-180 is inserted on the light axis when the NBI mode is selected.

The new endoscopes are basically identical to each predicate device shown in Table 16-2 in intended use, and similar in specifications, performance and materials. The CV-180 identifies an NBI-compatible scope when it is connected by using the Scope ID function provided with the scopes.

5. Indications for Use

EVIS EXERA II XENON LIGHT SOURCE OLYMPUS CLV-180

This light source has been designed to be used with Olympus endoscopes, video system center, and other ancillary equipment for endoscopic diagnosis, treatment and video observation.

EVIS EXERA II VIDEO SYSTEM CENTER OLYMPUS CV-180

This video system center has been designed to be used with Olympus camera heads, endoscopes, light source, monitors, endo-therapy accessories and other ancillary equipment for endoscopic diagnosis, treatment and video observation.

EVIS EXERA II BRONCHOVIDEOSCOPE OLYMPUS BF TYPE P180, BF TYPE 1T180, BF TYPE Q180

These instruments have been designed to be used with an Olympus video system center, light source, documentation equipment, video monitor, endo-therapy accessories (such as biopsy forceps) and other ancillary equipment for endoscopy and endoscopic surgery within the airways and tracheobronchial tree.

VISERA RHINO-LARYNGO VIDEOSCOPE OLYMPUS ENF TYPE V2

This instrument has been designed to be used with an Olympus video system center, light source, documentation equipment, display monitor, and other ancillary equipment for endoscopic diagnosis within the nasal lumens and airway (including nasopharyngeal and trachea).

VISERA RHINO-LARYNGO VIDEOSCOPE OLYMPUS XENF TYPE VTY1

This instrument has been designed to be used with an Olympus video system center, light source, documentation equipment, display monitor, endo-therapy accessories, and other ancillary equipment for endoscopic diagnosis and treatment within the nasal lumens and airway anatomy (including nasopharyngeal and trachea).

6. Comparison of Technological Characteristics

Each primary component of the EVIS EXERA II 180 System is basically identical to its predicate device in intended use, and similar in specifications except for the NBI function. Comparison between the subject and predicate devices is shown in Table 16-3 to 16-9.

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Table 16-3. Comparison of Specifications Subject Device: EVIS EXERA II Xenon Light Source Olympus CLV-180 Predicate Device: EVIS EXERA Xenon Light Source Olympus CLV-160A (K051645)

・・・・・・

SpecificationsSubject DeviceCLV-180Predicate DeviceCLV-160A
Power Supply100-120V ~ ± 10%, 50/60Hz ± 1Hz100-240V~ ±10%, 50/60Hz±1Hz
Over-current ProtectionSame as PD.Fuse type
Input CurrentSame as PD.500VA (at observation)
Size383(W) × 162(H) × 536(D)mm381(W)×162(H)×536(D)mm
WeightSame as PD.15.4kg
Compatible EndoscopesSame as PD.Videoscope Fiberscope Rigid scope
Examination LampSame as PD.Xenon short-arc lamp (ozone-free)300W
Average Lamp LifeSame as PD.Approximately 500 hours of continuous use
Emergency LampSame as PD.Halogen lamp 12V 35W
Average Emergency LampLifeSame as PD.Approximately 500 hours
NBI FilterSame as PDProvided.
Brightness ControlSame as PDAutomatic and Manual
Automatic ExposureSame as PD17 steps
Photography FunctionSame as PD.Not provided
Air FeedingSame as PD4 levels available (off, low, mid, high)
Air Feeding PumpSame as PDDiaphragm type pump
System ConnectorSame as PDProvided
Foot Switch ConnectorSame as PDProvided
CV ConnectorSame as PDProvided
Cooling Air DirectionSame as PDRear
Type of Protection againstElectric ShockSame as PD.Class I
Degree of Protectionagainst Electric Shock ofApplied PartSame as PDTYPE BF or CF applied part(Depend on applied part)
Applicable StandardSame as PDUL60601-1
SpecificationsSubject DeviceCV-180Predicate DeviceCV-160A
Power SupplySame as PD.100-240V~ ±10%、 50/60Hz ± 1Hz
Over-current ProtectionSame as PD.Fuse type
Input CurrentSame as PD.150VA
Size382(W) × 91(H) × 490(D)mm370(W) ×91(H) × 462 (D)mm
Weight10 kg10.6 kg
Compatible EndoscopesSame as PD.• Fiber/rigid scope via camera head• Videoscope
ObservationVideo SignalOutputSame as PD.RGB:3 Y/C:4 VBS:4 HDTV:1
Auto WhiteBalanceSame as PD.Automatically adjusted using the whitebalance switch.At the time of connection with thescope in which Scope ID is provided,compensation is performedautomatically.
Standard ColorChart OutputSame as PD.Color bar image
Color ToneAdjustmentSame as PD.R: ±8 steps B: ±8 stepsCHROMA : ±8steps
Automatic GainControl (AGC)Same as PD.MAX gain: 18dB
ImageEnhancementSame as PD.Edge enhancement: [OFF] [Low] [Med][High] 4 levels availableStructure enhancement:[OFF] [Low][Med] [High] 4 levels available
Iris ModeSelectionSame as PD.AUTO/PEAKEXPOSURE Electrical shutter
Optical ZoomSame as PD.× 1/× 1.2 / × 1.5: 3-Mode
NBI ObservationSame as PD.NBI function
Picture inPictureSame as PD.The image of an external deviceconnected to this instrument isdisplayed on the main monitor togetherwith the endoscopic image.
Communication with ScopeSame as PD.Provided
Foot Switch ConnectorSame as PD.Provided
Record to Memory CardSame as PD.Provided
Type of Protectionagainst Electric ShockSame as PD.Class I
Degree of Protection againstElectric Shock of Applied PartSame as PD.TYPE BF or CF applied part(Depend on applied part)
Applicable StandardSame as PD.UL60601-1

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Table 16-4. Comparison of Specifications Subject Device: EVIS EXERA II Video System Center Olympus CV-180 Predicate Device: EVIS EXERA Video System Center Olympus CV-160A (K051645)

... ..........................................................................................................................................................................

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Table 16-5. Comparison of Specifications Subject Device: EVIS EXERA II Bronchovideoscope BF-P180 Predicate Device: EVIS EXERA Bronchovideoscope BF-160 (K023984)

SpecificationsSubject DeviceBF-P180Predicate DeviceBF-160
Field of View120°120°
Depth of Field3-100 mm3-100 mm
Direction of View0° Forward Viewing0° Forward Viewing
Type of CCDColorColor
Outer Diameter of Distal End4.9 mm5.3 mm
Outer Diameter of InsertionTube4.9 mm5.2 mm
Bending Section AngulationUP/DOWN180° /130°180° /130°
Working Length600 mm600 mm
Inner Diameter of InstrumentChannel2.0 mm2.0 mm

Table 16-6. Comparison of Specifications Subject Device: EVIS EXERA II Bronchovideoscope BF-1T180 Predicate Device: EVIS EXERA Bronchovideoscope BF-1T160 (K023984)

SpecificationsSubject DeviceBF-1T180Predicate DeviceBF-1T160
Field of View120°120°
Depth of Field3-100 mm3-100 mm
Direction of View0° Forward Viewing0° Forward Viewing
Type of CCDColorColor
Outer Diameter of Distal End6.0 mm6.0 mm
Outer Diameter of InsertionTube6.0 mm6.0 mm
Bending Section AngulationUP/DOWN180° /130°180° /130°
Working Length600 mm600 mm
Inner Diameter of InstrumentChannel3.0 mm2.8 mm

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Table 16-7. Comparison of Specifications Subject Device: EVIS EXERA II Bronchovideoscope BF-Q180 Predicate Device: EVIS EXERA Bronchovideoscope BF-160 (K023984)

SpecificationsSubject DeviceBF-Q180Predicate DeviceBF-160
Field of View120°120°
Depth of Field3-100 mm3-100 mm
Direction of View0° Forward Viewing0° Forward Viewing
Type of CCDColorColor
Outer Diameter of Distal End5.5 mm5.3 mm
Outer Diameter of InsertionTube5.1 mm5.2 mm
Bending Section AngulationUP/DOWN180° /130°180° /130°
Working Length600 mm600 mm
Inner Diameter of InstrumentChannel2.0 mm2.0 mm

Table 16-8. Comparison of Specifications

Subject Device: VISERA Rhino-Laryngo Videoscope Olympus ENF type V2 Predicate Device: VISERA Rhino-Laryngo Videoscope Olympus ENF type V (K031648)

SpecificationsSubject DeviceENF-V2Predicate DeviceENF-V
Field of View90°90°
Depth of Field5-50mm5-50mm
Direction of Forward View
Type of CCD ChipColorColor
Outer Diameter of Distal End$\$3.2mm$\$3.9mm
Outer Diameter of Insertion Tube$\$3.4mm$\$3.9mm
Bending Section AngulationUp: 130°Down: 130°Up: 130°Down: 130°
Working Length300mm365mm

To Laura: The ENF-V2 and ENF-V do not have an instrument channel, so I have deleted this column.

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Table 16-9. Comparison of Specifications

Subject Device: VISERA Rhino-Laryngovideoscope Olympus XENF type VTY1 Predicate Device: VISERA Rhino-Laryngovideoscope Olympus ENF type VT (K052452)

SpecificationsSubject DeviceXENF-VTY1Predicate DeviceENF-VT
Field of View90°90°
Depth of Field5-50mm5-50mm
Direction of Forward View
Type of CCD ChipColorColor
Outer Diameter of Distal End$\phi$ 4.8mm$\phi$ 4.8mm
Outer Diameter of Insertion Tube$\phi$ 4.9mm$\phi$ 4.9mm
Bending Section AngulationUp: 130°Down: 130°Up: 130°Down: 130°
Working Length365mm365mm
Inner Diameter of InstrumentChannel$\phi$ 2.0mm$\phi$ 2.0mm

6. Conclusion

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

When compared to the predicate devices, the EVIS EXERA II 180 System does not incorporate any significant changes in intended use, method of operation, material, or design that could affect the safety or effectiveness of the system.

ート | アイトレスト | アイト | アイト | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |

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Image /page/9/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 lines representing its body and wings. The eagle is enclosed in a circle with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

AUG 3 0 2006

Olympus America, Inc c/o Laura Storms-Tyler Executive Director, Regulatory Affairs and Quality Assurance 3500 Corporate Parkway P.O. Box 610 Center Valley, PA 18034-0610

Re: K061313

Trade/Device Name: Olympus Evis Exera 180 System Regulation Number: 21 CFR 874.4680 Regulation Name: Bronchoscope (flexible or rigid) and accessories Regulatory Class: Class II Product Code: EOQ,EOB,NWB Dated: August 1, 2006 Received: August 2, 2006

Dear Ms. Storms-Tyler:

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.

{10}------------------------------------------------

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 (240) 276-0115. 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 (240) 276-3150 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours,

M.B. Eychlemin SiWD

Malvina B. Fydelman, M.D. Director Division of Ophthalmic and Ear, Nose and Throat Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known): K061313 Device Name: EVIS EXERA II 180 SYSTEM Indications for Use:

VISERA RHINO-LARYNGO VIDEOSCOPE OLYMPUS ENF TYPE V2

This instrument has been designed to be used with an Olympus video system center, light source, documentation equipment, display monitor, and other ancillary equipment for endoscopic diagnosis within the nasal lumens and airway anatomy (including nasopharyngeal and trachea).

VISERA RHINO-LARYNGO VIDEOSCOPE OLYMPUS ENF TYPE VTY1

This instrument has been designed to be used with an Olympus video system center, light source, documentation equipment, display monitor, endo-therapy accessories, and other ancillary equipment for endoscopic diagnosis and treatment within the nasal lumens and airway anatomy (including nasopharyngeal and trachea).

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)

Voren A. Baker
Division Sign-Off

(Division Sign-Off)
Division of Ophthalmic Ear,
Nose and Throat Devises

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510(k) Number K061313

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Indications for Use

510(k) Number (if known):

Device Name: EVIS EXERA II 180 SYSTEM

Indications For Use:

EVIS EXERA II XENON LIGHT SOURCE OLYMPUS CLV-180

This light source has been designed to be used with Olympus endoscopes, video system center, and other ancillary equipment for endoscopic diagnosis, treatment and video observation:

EVIS EXERA II VIDEO SYSTEM CENTER OLYMPUS CV-180

This video system center has been designed to be used with Olympus camera heads, endoscopes, light source, monitors, endo-therapy accessories and other ancillary equipment for endoscopic diagnosis, treatment and video observation.

EVIS EXERA II BRONCHOVIDEOSCOPE OLYMPUS BF TYPE P180, BF TYPE 1T180, BF TYPE Q180

These instruments have been designed to be used with an Olympus video system center, light source, documentation equipment, video monitor, endo-therapy accessories (such as biopsy forceps) and other ancillary equipment for endoscopy and endoscopic surgery within the airways and tracheobronchial tree.

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)

510(k) Number

Page 1 of 2

Prescription Use (Per 21 CFR 801.109)

§ 874.4680 Bronchoscope (flexible or rigid) and accessories.

(a)
Identification. A bronchoscope (flexible or rigid) and accessories is a tubular endoscopic device with any of a group of accessory devices which attach to the bronchoscope and is intended to examine or treat the larynx and tracheobronchial tree. It is typically used with a fiberoptic light source and carrier to provide illumination. The device is made of materials such as stainless steel or flexible plastic. This generic type of device includes the rigid ventilating bronchoscope, rigid nonventilating bronchoscope, nonrigid bronchoscope, laryngeal-bronchial telescope, flexible foreign body claw, bronchoscope tubing, flexible biopsy forceps, rigid biopsy curette, flexible biopsy brush, rigid biopsy forceps, flexible biopsy curette, and rigid bronchoscope aspirating tube, but excludes the fiberoptic light source and carrier.(b)
Classification. Class II.