K Number
K063788
Device Name
REPROCESSED ENDOSCOPIC TROCARS AND CANNULAS
Date Cleared
2007-10-15

(298 days)

Product Code
Regulation Number
876.1500
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
Reprocessed Endoscopic Trocars are indicated for use to establish a port of entry for endoscopic instruments in patients requiring minimally invasive surgical procedures.
Device Description
Reprocessed Endoscopic Trocars and Cannulas are designed to establish a port of entry for endoscopic instruments used during minimally invasive surgery. Endoscopic trocars and cannulas are available in a variety of configurations and materials as well as trocar and cannula sets. Trocar seals vary between single-port and multi-port seals.
More Information

Not Found

No
The document describes a reprocessed surgical instrument (trocar) and its intended use and testing, with no mention of AI or ML technology.

No
Therapeutic devices are used to treat or cure a disease or condition. This device is used to establish a port of entry for surgical instruments, which is an ancillary function to a surgical procedure, not a treatment in itself.

No
Explanation: This device is a surgical instrument used to establish a port of entry for other endoscopic instruments during minimally invasive surgery. Its function is to facilitate access for surgical procedures, not to diagnose conditions.

No

The device description clearly states it is a physical device (trocars and cannulas) used to establish a port of entry, and the performance studies involve bench and laboratory testing of physical properties and processes like reprocessing and sterilization.

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

Here's why:

  • Intended Use: The intended use is to "establish a port of entry for endoscopic instruments in patients requiring minimally invasive surgical procedures." This describes a surgical tool used directly on a patient during a procedure, not a device used to examine specimens in vitro (outside the body) to diagnose a condition.
  • Device Description: The description focuses on the physical characteristics and function of the trocars and cannulas for surgical access.
  • Lack of IVD Indicators: There is no mention of analyzing biological samples (blood, urine, tissue, etc.), performing tests on specimens, or providing diagnostic information based on laboratory analysis.

IVDs are devices used to examine specimens from the human body to provide information for the diagnosis, prevention, monitoring, treatment, or alleviation of disease. This device does not fit that description.

N/A

Intended Use / Indications for Use

Reprocessed Endoscopic Trocars and Cannulas are intended for use during minimally invasive surgery for temporary dilation access to the abdominal and thoracic cavities for passage of diagnostic, therapeutic and operative instruments into the abdominal and thoracic cavities, and for percutaneous access to hollow body organs. Reprocessed Endoscopic Trocars and Cannulas are indicated for use to establish a port of entry for endoscopic instruments in patients requiring minimally invasive surgical procedures.

Product codes

NLM

Device Description

Reprocessed Endoscopic Trocars and Cannulas are designed to establish a port of entry for endoscopic instruments used during minimally invasive surgery. Endoscopic trocars and cannulas are available in a variety of configurations and materials as well as trocar and cannula sets. Trocar seals vary between single-port and multi-port seals.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

abdominal and thoracic cavities, hollow body 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)

Bench and laboratory testing was conducted to demonstrate performance (safety and effectiveness) of Reprocessed Endoscopic Trocars and Cannulas. This included the following tests:

  • Biocompatibility .
  • Validation of reprocessing .
  • Sterilization Validation ●
  • Function test(s) .
  • . Packaging Validation
    Performance testing demonstrates that Reprocessed Endoscopic Trocars and Cannulas perform as originally intended.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s)

K041795, K032889, K012884, K012968

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 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.

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P910+3

PART B: 510(k) SUMMARY

| Submitter: | Ascent Healthcare Solutions
10232 South 51st Street
Phoenix, Arizona 85044 | OCT 15 2007 |
|----------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------|
| Contact: | Katie Bray
RA Specialist/Biomedical Engineer
(480) 763-5300 (o)
(480) 763-6089 (f)
kbray@ascenths.com | |
| Date of preparation: | December 13, 2006 | |
| Name of device: | Trade/Proprietary Name: Reprocessed Endoscopic Trocars and
Cannulas
Classification Name: Laparoscope, general & plastic surgery,
reprocessed | |
| Predicate Device | 510(k) Title | Manufacturer |
| K041795 | Modification to Optical Separator | Applied Medical |
| K032889 | Optical Separator | Applied Medical |
| K012884 | Dilating Tip Obturator | Applied Medical |
| K012968 | Trocar Seal | Applied Medical |
| Device description: | Reprocessed Endoscopic Trocars and Cannulas are designed
to establish a port of entry for endoscopic instruments used
during minimally invasive surgery. Endoscopic trocars and
cannulas are available in a variety of configurations and
materials as well as trocar and cannula sets. Trocar seals vary
between single-port and multi-port seals. | |

Bladed Trocars

ManufacturerDescriptionModel
Applied Medical11mm x 100mm Shielded Obturator with Universal Seal, non-
threadedC0638
Applied Medical12mm x 100mm Shielded Obturator with Universal Seal, non-
threadedC0639
Applied Medical11mm x 100mm Shielded Obturator with Universal Seal, threadedC0658
Applied Medical12mm x 100mm Shielded Obturator with Universal Seal, threadedC0659

1

| く

01637-88
Non-Bladed Trocars
ManufacturerDescriptionModel
Applied Medical12mm blunt tip trocarC0718
Applied Medical11mm blunt tip trocarC0717
Applied Medical12mm x 100mm Optical Separator system, handled, non-threadedC0124
Applied Medical12mm x 100mm Optical Separator system, handled, threadedC0128
Applied Medical12mm x 100mm Optical Separator system, non-handled, non-threadedC0126
Applied Medical12mm x 100mm Optical Separator system, non-handled, threadedC0130
Applied Medical11mm x 100mm Optical Separator system, handled, non-threadedC0114
Applied Medical11mm x 100mm Optical Separator system, handled, threadedC0150
Applied Medical11mm x 100mm Optical Separator system, non-handled, non-threadedC0116
Applied Medical11mm x 100mm Optical Separator system, non-handled, threadedC0152
Applied Medical8mm x 100mm Optical Separator system, non-threadedC0675
Applied Medical8mm x 100mm Optical Separator system, threadedC0676
Applied Medical15mm x 100mm Separator system with Universal seal, non-threadedC0604
Applied Medical15mm x 100mm Separator system with Universal seal, threadedC0605
Applied Medical12mm x 100mm Separator system with Universal seal, non-threadedC0682
Applied Medical12mm x 100mm Separator system with Universal seal, threadedC0680
Applied Medical11mm x 100mm Separator system with Universal seal, non-threadedC0667
Applied Medical11mm x 100mm Separator system with Universal seal, threadedC0665
Applied Medical12mm x 100mm Optical Separator, obturator, handledC0120
Applied Medical12mm x 100mm Optical Separator, obturator, non-handledC0122
Applied Medical12mm x 100mm Separator obturatorC0930
Applied Medical11mm x 100mm Separator obturatorC0915
Applied Medical5mm x 100mm Separator obturatorC0901
Applied Medical5mm x 55mm Separator obturatorC0900

Stability Cones and Seals

ManufacturerDescriptionModel
Applied Medical10/11mm Conductive Stability ConeC0704
Applied Medical10/12mm Conductive Stability ConeC0705
Applied Medical12mm disposable non-conductive stability coneC0707
Applied Medical11mm disposable non-conductive stability coneC0706
Applied Medical12mm x 100mm cannula and Universal seal, non-threadedC0632
Applied Medical12mm x 100mm cannula and Universal seal, threadedC0652
Applied Medical11mm x 100mm cannula and Universal seal, non-threadedC0631
Applied Medical11mm x 100mm cannula and Universal seal, threadedC0651
Applied MedicalUniversal® SealsC0600

Reprocessed Endoscopic Trocars and Cannulas are intended Intended use: for use during minimally invasive surgery for temporary dilation access to the abdominal and thoracic cavities for passage of diagnostic, therapeutic and operative instruments into the abdominal and thoracic cavities, and for percutaneous access to hollow body organs. Reprocessed Endoscopic Trocars and Cannulas are indicated Indications for use to establish a port of entry for endoscopic instruments in statement: patients requiring minimally invasive surgical procedures. Ascent Healthcare Solutions 10 Reprocessed Endoscopic Trocars and Cannulas

Traditional 510(k)

2

K063788 Pg 3 of 3

The design, materials, and intended use of Reprocessed Technological Endoscopic Trocars and Cannulas are identical to the predicate characteristics: devices. The mechanism of action of Reprocessed Endoscopic Trocars and Cannulas is identical to the predicate devices in that the same standard mechanical design, materials, and sizes are utilized. There are no changes to the claims, intended use, clinical applications, patient population, performance specifications, or method of operation. In addition, Ascent Healthcare Solutions's reprocessing of Endoscopic Trocars and Cannulas includes removal of adherent visible soil and decontamination. Each individual Endoscopic Trocars and Cannulas is tested for appropriate function of its components prior to packaging and labeling operations.

Performance data: Bench and laboratory testing was conducted to demonstrate performance (safety and effectiveness) of Reprocessed Endoscopic Trocars and Cannulas. This included the following tests:

  • Biocompatibility .
  • Validation of reprocessing .
  • Sterilization Validation ●
  • Function test(s) .
  • . Packaging Validation

Performance testing demonstrates that Reprocessed Endoscopic Trocars and Cannulas perform as originally intended.

Ascent Healthcare Solutions concludes that the modified Conclusion: devices (Reprocessed Endoscopic Trocars and Cannulas) are safe, effective, and substantially equivalent to the predicate devices as described herein.

Ascent Healthcare Solutions Reprocessed Endoscopic Trocars and Cannulas Traditional 510(k)

3

Image /page/3/Picture/1 description: The image is a circular seal for the Department of Health & Human Services - USA. The seal features the department's emblem, which is a stylized caduceus, a symbol often associated with medicine and healthcare. The words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" are arranged in a circular pattern around the emblem.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

OCT 1 5 2007

% Ms. Katie Bray Regulatory Affairs Engineer 10232 South 51st Street Phoenix, Arizona 85044

Ascent Healthcare Solutions

Re: K063788

Trade/Device Name: Reprocessed Endoscopic Trocars and Cannulas Regulation Number: 21 CFR 876.1500 Regulation Name: Endoscope and accessories Regulatory Class: II Product Code: NLM Dated: October 3, 2007 Received: October 5 2007

Dear Ms. Bray:

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.

4

Page 2 - Ms. Katie Bray

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.

Fa Nh Dm
Mark N. Melkerson
Ar Qr
10 lixdr

Director Division of General, Restorative and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

5

K063788

List of Devices:

ManufacturerDescriptionModel
Applied Medical12mm blunt tip trocarC0718
Applied Medical11mm blunt tip trocarC0717
Applied Medical12mm x 100mm Optical Separator system, handled, non-threadedC0124
Applied Medical12mm x 100mm Optical Separator system, handled, threadedC0128
Applied Medical12mm x 100mm Optical Separator system, non-handled, non-threadedC0126
Applied Medical12mm x 100mm Optical Separator system, non-handled, threadedC0130
Applied Medical11mm x 100mm Optical Separator system, handled, non-threadedC0114
Applied Medical11mm x 100mm Optical Separator system, handled, threadedC0150
Applied Medical11mm x 100mm Optical Separator system, non-handled, non-threadedC0116
Applied Medical11mm x 100mm Optical Separator system, non-handled, threadedC0152
Applied Medical8mm x 100mm Optical Separator system, non-threadedC0675
Applied Medical8mm x 100mm Optical Separator system, threadedC0676
Applied Medical15mm x 100mm Separator system with Universal seal, non-threadedC0604
Applied Medical15mm x 100mm Separator system with Universal seal, threadedC0605
Applied Medical12mm x 100mm Separator system with Universal seal, non-threadedC0682
Applied Medical12mm x 100mm Separator system with Universal seal, threadedC0680
Applied Medical11mm x 100mm Separator system with Universal seal, non-threadedC0667
Applied Medical11mm x 100mm Separator system with Universal seal, threadedC0665
Applied Medical12mm x 100mm Optical Separator, obturator, handledC0120
Applied Medical12mm x 100mm Optical Separator, obturator, non-handledC0122
Applied Medical12mm x 100mm Separator obturatorC0930
Applied Medical11mm x 100mm Separator obturatorC0915
Applied Medical5mm x 100mm Separator obturatorC0901
Applied Medical5mm x 55mm Separator obturatorC0900
ManufacturerDescriptionModel
Applied Medical11mm x 100mm Shielded Obturator with Universal Seal, non-threadedC0638
Applied Medical12mm x 100mm Shielded Obturator with Universal Seal, non-threadedC0639
Applied Medical11mm x 100mm Shielded Obturator with Universal Seal, threadedC0658
Applied Medical12mm x 100mm Shielded Obturator with Universal Seal, threadedC0659
ManufacturerDescriptionModel
Applied Medical10/11mm Conductive Stability ConeC0704
Applied Medical10/12mm Conductive Stability ConeC0705
Applied Medical12mm disposable non-conductive stability coneC0707
Applied Medical11mm disposable non-conductive stability coneC0706
Applied Medical12mm x 100mm cannula and Universal seal, non-threadedC0632
Applied Medical12mm x 100mm cannula and Universal seal, threadedC0652
Applied Medical11mm x 100mm cannula and Universal seal, non-threadedC0631
Applied Medical11mm x 100mm cannula and Universal seal, threadedC0651
Applied MedicalUniversal® SealsC0600

6

K063788

pg 1 of 1

Indications for Use Statement 1.

510(k) Number (if known):

Device Name: Reprocessed Endoscopic Trocars and Cannulas

Indications for Use: Reprocessed Endoscopic Trocars are indicated for use to establish a port of entry for endoscopic instruments in patients requiring minimally invasive surgical procedures.

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

Over-The-Counter Use (21 CFR 801 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Division of General, Restorative,
and Neurological Devices

1106374

510(k) Number