K Number
K100533
Device Name
VISTA ENDOSCOPE,89 CM, 56CM , SCOUT BLUNT-TIPPED GUIDE- 106 CM, 86 CM, 53 CM, MODELS FG0027, FG0031, FG0029, FG 0028,
Manufacturer
Date Cleared
2011-02-08

(348 days)

Product Code
Regulation Number
876.1500
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The VISTA™ Endoscope and accessories are intended for use in providing access to, and visualization of, the thoracic and abdominal cavities, to allow for the performance of various diagnostic and therapeutic surgical procedures.
Device Description
The VISTA Endoscope is a flexible fiberscope that allows for visualization of the thoracic and abdominal cavities. The device is labeled non-sterile and must be sterilized prior to use. The Endoscope may be used with or without the SCOUTTM Blunt-tipped Guide accessory, which aids in Endoscope advancement and steerability. The Guide also has a fluid channel (cannula) that may be used to deliver saline that may be required for irrigation during an endoscopic procedure. The SCOUTTM Guide is a sterile, single-use device, sterilized by electron beam radiation.
More Information

Not Found

No
The summary describes a standard flexible fiberscope for visualization and surgical procedures, with no mention of AI/ML capabilities, image processing, or related performance metrics.

Yes
The "Intended Use / Indications for Use" section states that the device is intended "to allow for the performance of various diagnostic and therapeutic surgical procedures."

Yes

The "Intended Use / Indications for Use" states that the device is intended for "providing access to, and visualization of, the thoracic and abdominal cavities, to allow for the performance of various diagnostic and therapeutic surgical procedures." The term "diagnostic" explicitly indicates a diagnostic purpose.

No

The device description clearly outlines physical hardware components (flexible fiberscope, blunt-tipped guide accessory) and mentions sterilization and material standards, indicating it is a hardware device.

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

Here's why:

  • Intended Use: The intended use is to provide access and visualization of the thoracic and abdominal cavities for diagnostic and therapeutic surgical procedures. This is a direct interaction with the patient's body for observation and intervention, not the examination of samples taken from the body.
  • Device Description: The device is a flexible fiberscope used for visualization within the body.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue, etc.) or providing information about a patient's health status based on such analysis.

IVD devices are specifically designed to examine specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. This device is a surgical tool for direct visualization and access during procedures.

N/A

Intended Use / Indications for Use

The VISTA(TM) Endoscope and accessories are intended for use in providing access to, and visualization of, the thoracic and abdominal cavities, to. allow for the performance of various diagnostic and therapeutic surgical procedures.

Product codes

GCJ

Device Description

The VISTA Endoscope is a flexible fiberscope that allows for visualization of the thoracic and abdominal cavities. The device is labeled non-sterile and must be sterilized prior to use. The Endoscope may be used with or without the SCOUT(TM) Blunt-tipped Guide accessory, which aids in Endoscope advancement and steerability. The Guide also has a fluid channel (cannula) that may be used to deliver saline that may be required for irrigation during an endoscopic procedure. The SCOUT(TM) Guide is a sterile, single-use device, sterilized by electron beam radiation.

Mentions image processing

The VISTA Endoscope contains illumination and image fibers that transmit an image from the distal to the proximal end of the device. The image may be viewed through the eyepiece or by attaching a standard endoscopic camera and viewed using a video monitor.

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

thoracic and abdominal cavities

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

Laboratory and performance tests were executed to ensure that the devices functioned as intended and met design specifications. Data demonstrated that the VISTA Endoscope and accessories met all performance testing acceptance criteria and comply with the following standards / guidance documents: EN 60601-2-18: 1996, Medical Electrical Equipment Part . 2: Particular requirements for the safety of endoscopic equipment and the corresponding general standard, EN60601-1:1990 Medical Electrical Equipment, Part 1: General Requirements for Safety ISO 10993-1:2003, Biological evaluation of medical . devices - Part 1: Evaluation and testing AAMI TIR12:2004 - Designing, testing, and labeling . reusable medical devices for reprocessing in health care facilities: A guide for medical device manufacturers (VISTA Endoscope) . ISO 11137:2006, Sterilization of health care products -Radiation (parts 1 and 2) (SCOUT Guide)

Key Metrics

Not Found

Predicate Device(s)

K053382, K051610, K063078

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.

0

K100533 R. 10f3

Vibrynt, Inc.

. ﺗ

VISTA™ Endoscope and Accessories

510(K) SUMMARY

.EEB = 8 254

| Sponsor/Submitter: | Vibrynt, Inc.
701 Galveston Dr.
Redwood City, CA 94063 |
|---------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Contact Person: | Julia S. Anastas
Director, Regulatory Affairs
Phone: 650.362.6136
Fax: 650.362.6186
Email: janastas@vibrynt.com |
| Date Summary was
Prepared: | February 4, 2011 |
| Device Trade Name | VISTATM Endoscope
SCOUTTM Blunt-tipped Guide |
| Device Common
Name: | Endoscope and accessories |
| Device Product
Codes and
Classification
Names: | GCJ, Class II
Endoscope and accessories (21 CFR 876.1500) |
| Predicate Devices: | Olympus Laparo-Thoraco Videoscope (K053382)
Hans Hermann Laparoscopes and Accessories (K051610)
Acclarent MicroEndoscope (K063078) |
| Device Description: | The VISTA Endoscope is a flexible fiberscope that allows for
visualization of the thoracic and abdominal cavities. The device
is labeled non-sterile and must be sterilized prior to use. The
Endoscope may be used with or without the SCOUTTM Blunt-
tipped Guide accessory, which aids in Endoscope advancement
and steerability. The Guide also has a fluid channel (cannula)
that may be used to deliver saline that may be required for
irrigation during an endoscopic procedure. The SCOUTTM
Guide is a sterile, single-use device, sterilized by electron beam
radiation. |
| Indications for Use: | The VISTATM Endoscope and accessories are intended for use
in providing access to, and visualization of, the thoracic and
abdominal cavities, to allow for the performance of various
diagnostic and therapeutic surgical procedures. |

1

Vibrynt, Inc.

VISTA™ Endoscope and Accessories

510(K) SUMMARY

Technological Characteristics: The VISTA Endoscope contains illumination and image fibers that transmit an image from the distal to the proximal end of the device. The image may be viewed through the eyepiece or by attaching a standard endoscopic camera and viewed using a video monitor. The Guide's transparent polycarbonate tip enables visibility during the procedure, while the flexible PVC sheath and adjustable stylet increase steerability and support for difficult-to-reach anatomy. The table below compares the technological characteristics of the VISTA Endoscope to those of the predicate devices.

| Attribute | Subject Device
VISTA
Endoscope | Predicate Device
(Olympus Laparo-
Thoraco
Videoscope
XLTF-VAW) | Predicate Device
(Hans Hermann
Laparoscopic
Instruments) | Predicate Device
(Acclarent
MicroEndoscope) |
|---------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------|
| Indications for
Use | The VISTA
Endoscope and
accessories are
intended for use in
providing access
to, and
visualization of,
the thoracic and
abdominal
cavities, to allow
for the
performance of
various diagnostic
and therapeutic
surgical
procedures. | This instrument
has been designed
. for endoscopic
observation,
diagnosis and
treatment within
the thoracic and
abdominal cavities,
including female
reproductive
organs. | The laparoscopes
and accessories
are intended for
use in providing
access to and
visualization of
body cavities,
organs, and canals
to perform various
diagnostic and
therapeutic
surgical
procedures. | The
MicroEndoscope is
intended to provide
an endoscopic
means to view a
body cavity for ear,
nose, or throat
procedures. |
| Materials
potentially
contacting
patient | Stainless steel,
glass, epoxy
EP42HT-2, blue
ultem, polyimide,
Pebax | Not Known | Surgical grade
stainless steel,
PTFE, PEEK,
several coatings.
silicon and brass
chromium plated | stainless steel,
gradient image
glass, epoxy
EP42HT-2, black
ultem, polyimide,
polyolefin |
| Rigidity | Flexible | Semi-rigid | Rigid | Semi-rigid |
| Viewing Optics | Coherent Fiber | Electronic Video
CCD | Rigid rod-lens | Coherent Fiber |
| Number of Pixels | 50,000 | N/A | N/A | 10,000 |
| Depth of Field | 5mm - infinity | 15-100 mm | Not known | 3-25 mm |
| Field of View | 70° | 80° -90° | Not known | 70° |
| Direction of View | 0° (forward
Viewing) | 0° (forward
Viewing) | 0°,30 °, 45°, 70 ° | 70° |
| Outer Diameter of
Distal End | 5.0 mm | 5.4 - 10.5 mm | 5-10 mm | 0.9 mm |

2

Vibrynt, Inc.

VISTA™ Endoscope and Accessories

510(K) SUMMARY

| Attribute | Subject Device
VISTA
Endoscope | Predicate Device
(Olympus Laparo-
Thoraco
Videoscope
XLTF-VAW) | Predicate Device
(Hans Hermann
Laparoscopic
Instruments) | Predicate Device
(Acclarent
MicroEndoscope) |
|-----------------|--------------------------------------|----------------------------------------------------------------------------|-------------------------------------------------------------------|---------------------------------------------------|
| Jacket Material | Pebax | Not Known | Stainless steel | Polyimide |
| Working Length | 56.4 - 109.7 cm | 33.0 – 37.0 cm | 30.0-33.0 cm | 60.9 cm |

Performance Data: Laboratory and performance tests were executed to ensure that the devices functioned as intended and met design specifications. Data demonstrated that the VISTA Endoscope and accessories met all performance testing acceptance criteria and comply with the following standards / guidance documents: EN 60601-2-18: 1996, Medical Electrical Equipment Part . 2: Particular requirements for the safety of endoscopic equipment and the corresponding general standard, EN60601-1:1990 Medical Electrical Equipment, Part 1: General Requirements for Safety ISO 10993-1:2003, Biological evaluation of medical . devices - Part 1: Evaluation and testing AAMI TIR12:2004 - Designing, testing, and labeling . reusable medical devices for reprocessing in health care facilities: A guide for medical device manufacturers (VISTA Endoscope) . ISO 11137:2006, Sterilization of health care products -Radiation (parts 1 and 2) (SCOUT Guide) Conclusions: When compared to the predicate devices, the VISTA Endoscope and accessories do not incorporate any significant changes in intended use, method of operation, material, or design that could affect the safety or effectiveness of the device.

3

Image /page/3/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo consists of a stylized eagle with three lines representing its wings and body. The eagle is positioned to the right of a circular arrangement of text that reads "DEPARTMENT OF HEALTH & HUMAN SERVICES USA".

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

Vibrynt. Inc. % Ms. Julia S. Anastas Director, Regulatory Affairs 701 Galveston Drive Redwood City, California 94063

FEB - 8 1 .:

Re: K100533

Trade/Device Name: VISTA™ Endoscope; SCOUT™ Blunt-tipped Guide Regulation Number: 21 CFR 876.1500 Regulation Name: Endoscope and accessories Regulatory Class: Class II Product Code: GCJ Dated: February 01, 2011 Received: February 03, 2011

Dear Ms. Anastas:

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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you; however, that device labeling must be truthful and not misleading.

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

4

Page 2 - Ms. Julia S. Anastas

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 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/MedicalDevices/Safety/ReportaProblem/default.htm 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 (301) 796-7100 or at its Internet address http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

Ky. B. R.
for.

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

Enclosure

5

K-100533

1.6

Vibrynt, Inc.

VISTA™ Endoscope and Accessories Traditional 510(k)

INDICATIONS FOR USE STATEMENT

510(k) Number (if known): .K100533

Trade Name: VISTA™ Endoscope SCOUT TM Blunt-tipped Guide

Common Name: Endoscope and Accessories

Indications For Use: The VISTA™ Endoscope and accessories are intended for use in providing access to, and visualization of, the thoracic and abdominal cavities, to. allow for the performance of various diagnostic and therapeutic surgical procedures.

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)

Neil B. Boyle for mka

(Division Sign-Off) Division of Surgical, Orthopedic, and Restorative Devices

510(k) Number K100533