K Number
K091721
Device Name
CRYOSUCCESS, MODEL C-SUC-01, C-SUC-02, C-DTS-02, C-DTS-03, C-GTS-13. C-CA-23
Date Cleared
2009-10-02

(113 days)

Product Code
Regulation Number
878.4350
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
To destroy tissue during surgical procedures by applying extreme cold.
Device Description
The CRYOSUCCESS is a hand-held cryosurgical instrument for destroying tissue during surgical procedures by applying cold gas (nitrous oxide, N₂O). The device is based on direct application of nitrous oxide in the liquid phase to the selected treatment area. The N₂0 gas is delivered to the treatment site at -89° C to effect cellular destruction (necrosis). CRYOSUCCES functions by means of heat evaporation upon phase transition, where liquid nitrous oxide (N₂O, laughing gas) is applied to the treatment area by means of a capillary tube at a constant temperature of -89°C (cold performance) followed by evaporation. The treatment may be invasive.
More Information

Not Found

No
The device description and performance studies focus on the physical mechanism of cryosurgery and do not mention any computational or data-driven components indicative of AI/ML.

Yes
The device is used to destroy tissue during surgical procedures, which is a therapeutic intervention.

No

The device is described as a cryosurgical instrument for destroying tissue, not for diagnosis. It performs a therapeutic function by applying extreme cold to destroy cells.

No

The device description clearly states it is a hand-held cryosurgical instrument that applies cold gas to destroy tissue, indicating it is a physical hardware device.

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

Here's why:

  • Intended Use: The intended use is "To destroy tissue during surgical procedures by applying extreme cold." This describes a therapeutic procedure performed directly on a patient's body, not a test performed on a sample taken from the body.
  • Device Description: The description details a hand-held instrument that applies cold gas directly to tissue for destruction. This is a surgical tool, not a device used to analyze biological samples.
  • Lack of IVD Characteristics: The description does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological samples (blood, urine, tissue, etc.)
    • Detecting or measuring substances in samples
    • Providing information for diagnosis, monitoring, or screening

The CRYOSUCCESS is a surgical device used for cryosurgery, a therapeutic procedure.

N/A

Intended Use / Indications for Use

To destroy tissue during surgical procedures by applying extreme cold.

Product codes (comma separated list FDA assigned to the subject device)

GEH

Device Description

The CRYOSUCCESS is a hand-held cryosurgical instrument for destroying tissue during surgical procedures by applying cold gas (nitrous oxide, N₂O). The device is based on direct application of nitrous oxide in the liquid phase to the selected treatment area. The N₂0 gas is delivered to the treatment site at -89° C to effect cellular destruction (necrosis).

CRYOSUCCES functions by means of heat evaporation upon phase transition, where liquid nitrous oxide (N₂O, laughing gas) is applied to the treatment area by means of a capillary tube at a constant temperature of -89°C (cold performance) followed by evaporation. The treatment may be invasive.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

In general any person may be treated, irrespective of gender or age.

Intended User / Care Setting

The treatment must be performed by medically trained specialists.

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)

The relevant requirements set forth in standard ASTM F 882-84 (2002) and the additional requirements specified by the manufacturer are sufficient to assure a safe and effective functioning of the CRYOSUCCESS cryosurgery device. The device has fulfilled the requirements detailed above. The results of the bench testing are summarized in the V&V Plan & Report CRYOSUCCESS enclosed.

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

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K024009

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 878.4350 Cryosurgical unit and accessories.

(a)
Identification —(1)Cryosurgical unit with a liquid nitrogen cooled cryoprobe and accessories. A cryosurgical unit with a liquid nitrogen cooled cryoprobe and accessories is a device intended to destroy tissue during surgical procedures by applying extreme cold.(2)
Cryosurgical unit with a nitrous oxide cooled cryoprobe and accessories. A cryosurgical unit with a nitrous oxide cooled cryoprobe and accessories is a device intended to destroy tissue during surgical procedures, including urological applications, by applying extreme cold.(3)
Cryosurgical unit with a carbon dioxide cooled cryoprobe or a carbon dioxide dry ice applicator and accessories. A cryosurgical unit with a carbon dioxide cooled cryoprobe or a carbon dioxide dry ice applicator and accessories is a device intended to destroy tissue during surgical procedures by applying extreme cold. The device is intended to treat disease conditions such as tumors, skin cancers, acne scars, or hemangiomas (benign tumors consisting of newly formed blood vessels) and various benign or malignant gynecological conditions affecting vulvar, vaginal, or cervical tissue. The device is not intended for urological applications.(b)
Classification. Class II.

0

5 510(k) Summary

In accordance with 21 CFR 807.92, the following information provides sufficient detail to understand the basis for a determination of substantial equivalence.

Submitter Information / Official Correspondent:

Submitter name:New Medical Technologies GmbH
Responsible person:Adrian B. JossOCT - 2 2009
Phone:+41 31 348 46 20
Fax:+41 31 348 46 23
Mailto:joss@ump.ag

US Agent:

| United States
contact address: | Premier Dental Products, 1710 Romano Drive, Plymouth Meeting,
PA 19462 U.S.A. |
|-----------------------------------|----------------------------------------------------------------------------------|
| United States
contact person: | Vince d'Alessandro |
| Phone: | +1 (610) 239 6015 |
| Fax: | +1 (610) 239 6171 |
| Mailto: | VDAlessandro@premusa.com |
| Date prepared: | May 27, 2009 |

Device Name:

Proprietary name:CRYOSUCCESS
510(k) number:K091721
Common name:cryosurgery unit
Classification name:878.4350 Unit, cryosurgery and accessories, Class II
Product code:GEH

Predicate Device:

Substantial Equivalence is claimed with the device, K024009 "CryoProbe", manufactured by H&O Equipments NV/SA on the basis of equivalent intended use / indications for use, technological characteristics and principle of operation.

Device Description:

The CRYOSUCCESS is a hand-held cryosurgical instrument for destroying tissue during surgical procedures by applying cold gas (nitrous oxide, N₂O). The device is based on direct application of nitrous oxide in the liquid phase to the selected treatment area. The N₂0 gas is delivered to the treatment site at -89° C to effect cellular destruction (necrosis).

CRYOSUCCES functions by means of heat evaporation upon phase transition, where liquid nitrous oxide (N₂O, laughing gas) is applied to the treatment area by means of a capillary tube at

1

a constant temperature of -89°C (cold performance) followed by evaporation. The treatment may be invasive.

In general any person may be treated, irrespective of gender or age. The treatment must be performed by medically trained specialists.

Intended Use:

To destroy tissue during surgical procedures by applying extreme cold.

Comparison of Technological Characteristics:

Table 05-1 provides a comparison of the predominant technical characteristics of the new device and the legally marketed predicate device. A more detailed comparison of the devices is presented in section 12-A.

CharacteristicPredicate DeviceDevice Under Evaluation
Device NameCryoProbeCRYOSUCCESS
ModelsCryoProbe c, 1 micro-applicator
(information not clear)Standard tip ( $Ø$ = 1mm)
CryoProbe x, 3 micro-applicatorsStandard tip ( $Ø$ = 2mm)
Standard tip ( $Ø$ = 3mm)
Standard tip ( $Ø$ = 4mm)
Gynecology tip
510(k) NumberK024009K091721
CryogenNitrous oxide (N2O, laughing gas),
available in 8 g or 16 g cartridgesNitrous oxide (N2O, laughing gas),
available in 23,5 g cartridge
Cartridge Pressure: ~50 bar (725 psi)Cartridge Pressure: 50 bar (725 psi)
Shelf life: 2 yearsShelf life: 2 years
Shelf life
(device)2 years5 years (with 2 years warranty)
Treatment
temperatureTemperature: Depending on
distance of device to lesion,
minimum -89°C at contact to lesionTemperature: constant temperature
of -89°C (-128° F) at contact to lesion
MaterialsHousing: aluminumCryo unit (no housing): brass and
stainless steel, gold plated
Micro-applicator: unknownCryotip: metal, gold plated, cryotip in
borosilicate glass 3.3 (such as
DURAN)
Lock cap: unknownProtective cap: thermoplastic rubber
Filter: unknownFilter: stainless steel
O-rings: unknownSeals: PTFE and acrylonitrile-
butadiene-rubber
Cartridge: metalCartridge: metal
Operating
PrincipleThe patented principle of the
CryoProbe™ is based upon the direct
flow of N₂O in liquid phase for the
purpose of freezing with resulting
necrosis of tissue in the practice of
medicine. To achieve this
phenomena a economical gas
cartridge is used. The cartridge is
filled with liquid N₂O (83%) and the
rest with N₂O gas. The liquid N20 is
the refrigerant and the N₂O gas is
the propellant.
The innovation of the CryoProbe™ is
the ability to achieve a constant flow
of liquid N₂O out of the micro-
applicator tip. This is made possible
by maintaining the pressure level
within the instrument until the liquid
N₂O leaves the tip of the micro-
applicator, whereupon it will
immediately expand.CRYOSUCCESS functions by means of
heat evaporation upon phase
transition, where liquid nitrous oxide
(N₂O, laughing gas) is applied to the
treatment area by means of a
capillary tube at a constant
temperature of -89°C (cold
performance) followed by
evaporation. This results in cellular
destruction (necrosis) in the
treatment area. The amount of gas
dispensed is controlled by the
medical specialist pressing the lever
of the device.
Cleaning /
SterilizationAll external parts can be wiped with
a cloth soaked in any non-corrosive
sterilization solution or alcohol /
Whole CryoProbe may be autoclavedThe unit body and cryotips can been
cleaned and disinfected with a
alcohol-based disinfectant or alcohol
/ Steam sterilize tips at 134° C
(273° F), according to the instruction
in the manual of your steam sterilizer
and according to the country specific
law
StorageStore in a cool dry place and keep
out of the reach of childrenProtect the unit against heat and
exposure to direct sunlight. The
storage temperature is between
-10° C and max. +45° C (14° F and
max. 113° F).
MaintenanceChange filter with each cartridge,
exchange o-rings after frequent
autoclavingNo maintenance required, repairs
may only be executed by a licensed
wholesaler / representative

Table 05-1: Comparison of Technological Characteristics

2

Summary of Testing:

The relevant requirements set forth in standard ASTM F 882-84 (2002) and the additional requirements specified by the manufacturer are sufficient to assure a safe and effective functioning of the CRYOSUCCESS cryosurgery device. The device has fulfilled the requirements detailed above. The results of the bench testing are summarized in the V&V Plan & Report CRYOSUCCESS enclosed.

3

Conclusion:

Based on equivalence of intended use / indications for use, technological characteristics and operational principle the applicant concludes, that substantial equivalence between the new and the predicate device has been demonstrated and that the new device, CRYOSUCCESS, is at least as safe and as effective as the legally marketed predicate device, CryoProbe (K024009).

Section 5: 510(k) Summary

.

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Image /page/4/Picture/0 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized eagle with three tail feathers, representing the department's mission to protect the health of all Americans and provide essential human services. The eagle is encircled by the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" in a circular arrangement.

Food and Drug Administration 10903 New Hampshire Avenue Document Mail Center - WO66-G609 Silver Spring, MD 20993-0002

New Medical Technologies, GmbH % Premier Dental Products Mr. Vince D'Alessandro 1710 Romano Drive Plymouth Meeting, Pennsylvania 19462

OCT - 2 2009 -

Re: K091721

Trade/Device Name: Cryosuccess Regulation Number: 21 CFR 878.4350 Regulation Name: Cryosurgical unit and accessories Regulatory Class: Class II Product Code: GEH Dated: May 27, 2009 Received: June 11, 2009

Dear Mr. D'Alessandro:

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 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); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set

5

Page 2 - Mr. Vince D'Alessandro

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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to http://www.fda.gov/cdrh/mdr/ for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

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,

incerely yours.

Mark N. Melkerson Director Division of Surgical, Orthopedic and Restorative Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

6

Indications for Use Statement

510(k) Number (if known): K091721

Device Name:

CRYOSUCCESS

Indications for Use:

To destroy tissue during surgical procedures by applying extreme cold.

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

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)

Nilpeal for men

Division of Surgical, Orthopedic, and Restorative Devices

510(k) Number K091721