K Number
K070877
Date Cleared
2007-07-27

(120 days)

Product Code
Regulation Number
884.4120
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

Endocervical Hysterectomy Electrode is indicated for treatment of following Condition

  1. Excision of inner cervix during supracervical hysterectomy.
Device Description

Not Found

AI/ML Overview

Here's an analysis of the provided text regarding the acceptance criteria and study for the Gyn LLETZ Electrode (Endocervical Hysterectomy Electrode):

Based on the provided document, the device did not undergo a study to prove its performance against specific clinical acceptance criteria in the manner typically seen for novel medical devices or AI-powered devices. This submission is a 510(k) Premarket Notification, which focuses on demonstrating substantial equivalence to a previously legally marketed device (predicate device), rather than proving de novo safety and effectiveness through extensive clinical trials.

The provided document (K070877) is a 510(k) submission for the Gyn LLETZ Electrode.

Here's a breakdown based on your requested information:


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

There are no specific clinical performance acceptance criteria listed in this 510(k) submission, nor is there reported clinical device performance that would traditionally be presented in a table for a study.

The primary "acceptance criteria" for a 510(k) is demonstrating substantial equivalence to a predicate device.

Acceptance Criteria for 510(k) Submission (implied):

  • Meet electrical and mechanical requirements.
  • Be substantially equivalent to the predicate device in terms of intended use, technological characteristics, and safety and effectiveness.

Reported Device Performance:

  • "Meet the electrical and mechanical requirements of ANSI/AAMI HF-18 Standard for Electrosurgical Devices."
  • "The subject device is substantially equivalent to the predicate device." (This is a conclusion, not a performance metric.)

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

  • Sample size: Not applicable. There was no clinical "test set" in the context of proving device performance described in this 510(k) submission. The submission relies on a comparison to a predicate device.
  • Data provenance: Not applicable. Clinical data for device performance was not provided or referenced for this 510(k) submission.

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)

  • Number of experts: Not applicable. No clinical ground truth was established from a test set for this 510(k) submission.
  • Qualifications of experts: Not applicable.

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

  • Adjudication method: Not applicable. No clinical test set or adjudication method was described.

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

  • MRMC study: No. This is not an AI-powered device, and no MRMC study was conducted or reported.
  • Effect size: Not applicable.

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

  • Standalone performance: No. This is an electrosurgical electrode, not an algorithm, so standalone algorithm performance is not relevant.

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

  • Type of ground truth: Not applicable in the context of clinical performance data. The "ground truth" for this 510(k) submission is the regulatory acceptance of the predicate device.

8. The sample size for the training set

  • Sample size for training set: Not applicable. This is not a machine learning or AI device, so there is no "training set."

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

  • Ground truth for training set: Not applicable.

Summary for this specific device and submission:

The document describes a 510(k) premarket notification for an electrosurgical device (Gyn LLETZ Electrode). The primary mechanism for clearance is demonstrating substantial equivalence to a previously cleared predicate device (Apple Medical Fisher Cone Biopsy Electrode, K061651). The submission does not include data from a clinical study with specific performance acceptance criteria, test sets, or ground truth establishment as would be expected for a novel device or an AI/ML product. Instead, it relies on meeting recognized electrical and mechanical standards (ANSI/AAMI HF-18) and a comparison to the predicate device.

{0}------------------------------------------------

MODERN MEDICAL EQUIPMENT MFG. LTD.

5F Gold King Ind. Bldg., - Tai Lin Pai Rd., - KwaiChung, Hong Kong

Modern Medical Equipment

C/O E & M Engineering 1705 Dabney Road, Richmond, Va. 23230

Tel : (804) 353 7160 Fax : 804 - 353 7161 21 June 2007

K070877

Food and Drug Administration Center for Devices and Radiological Health Document Mail Center (HFZ-401)

Rockville, Maryland 20850 Re: 510(k) Premarket Notification, 510 K # 070877

Gyn LLETZ Electrode

Dear Sir or Madam, RE: 510(k) Notification

9200 Corporation Blvd.

This is to notify you that Modern Medical intends to manufacture the following device and market it in the United States.

The following information and the attached technical information are provided in accordance with 21CFR 807.87

a. Device Name

Classification Name:Gyn LLETZ Electrode
Common/ Usual name:LOOP Electrode
Proprietary Name:Endocervical Electrode / EZ hysterectomy Electrode

b. Establishment Registration

Owner Operator number9005334
Registration number:9680721
Establishment Name,Modern Medical EquipmentC/O E & M Engineering1705 Dabney Road,Richmond, Va. 23230

JUL 2 7 2007

{1}------------------------------------------------

K070877 page 2 of 2

Telephone: Fax: Email address: (804) 353 7160 (804)353 7161 bstillman@enmengineering.com

c. Classification Information Classification and Review Panel: Obstetrics/Gynecology

Class:

Product Code HGI

  • d. Performance Standards or Special Controls
    Meet the electrical and mechanical requirements of ANSI/AAMI HF-18 Standard for Electrosurgical Devices.

II

  • e. Labeling
    Copies of draft labeling for this device is attached

  • f. Rationale for Substantial Equivalence
    The subject device is substantially equivalent to the predicate device.

CompanyJeviceK number
Apple MedicalFisher Cone Biopsy Electrodeand the comments of the comments of the comments of the comments of the comments of the comments of the comments of the contribution of the contribution of the contribution oK061651

A discussion regarding the reason and basis for substantial equivalence of the device to the legally marketed predicate device is attached, "Substantial Equivalence to Predicate Devices".

In accordance with the Safe Medical Devices Act of 1990 (SMDA), the safety and effectiveness information upon which this substantial equivalence determination is based will be made available by Modern Medical to interested persons upon request.

To the best of my knowledge, the information and date submitted herein is truthful and accurate. If you require any additional information or clarification, please contact me.

Sincerely,

Bob Stitt

Bob Stillman Modern Medical Equipment

{2}------------------------------------------------

DEPARTMENT OF HEALTH & HUMAN SERVICES

JUL 27 2007

Food and Drug Administration 9200 Corporate Blvd. Rockville MD 20850

Modern Medical Equipment % Mr. Bob Stillman Official Correspond E & M Engineering, Inc. 1705 Dabney Road RICHMOND VA 23230

Re: K070877

Trade/Device Name: Endocervical Hysterectomy Electrode Regulation Number: 21 CFR 884.4120 Regulation Name: Gynecologic electrocautery and accessories Regulatory Class: II Product Code: HGI Dated: July 13, 2007 Received: July 16, 2007

Dear Mr. Stillman:

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 (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.

Image /page/2/Picture/10 description: The image is a black and white circular logo. The logo has the letters "FDA" in the center. Above the letters, the numbers "1906-1906" are written. Below the letters, the word "Centennial" is written. There are three stars below the word "Centennial".

omoting Publio Hoalth

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Page 2 -

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.

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 one of the following numbers, based on the regulation number at the top of this letter:

21 CFR 876.xxx(Gastroenterology/Renal/Urology240-276-0115
21 CFR 884.xxx(Obstetrics/Gynecology).240-276-0115
21 CFR 894.xxx(Radiology)240-276-0120
Other240-276-0100

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/cdrl/industry/support/index.html.

Sincerely yours.

Nancy Chogdon

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

Enclosure

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U.S. Food and Drug Administration

Center for Devices and Radiologic Health

Indications for Use

510K number (if known) : K070877 Device Name : Endocervical Hysterectomy Electrode

Indications for Use A. Endocervical Hysterectomy Electrode is indicated for treatment of following Condition

  1. Excision of inner cervix during supracervical hysterectomy.
Prescription Use
Use
(Part 21 CFR 801 Subpart D)

AND/OR

Over-The counter

CFR 801 Subpart D)

(21 CFR 801 Subpart C)

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

Concurrence of CDRH, Office device evaluation (ODE)

Helene Renner

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

§ 884.4120 Gynecologic electrocautery and accessories.

(a)
Identification. A gynecologic electrocautery is a device designed to destroy tissue with high temperatures by tissue contact with an electrically heated probe. It is used to excise cervical lesions, perform biopsies, or treat chronic cervicitis under direct visual observation. This generic type of device may include the following accessories: an electrical generator, a probe, and electrical cables.(b)
Classification. Class II (performance standards).