K Number
K110257
Date Cleared
2011-05-06

(98 days)

Product Code
Regulation Number
876.1500
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

Diamond-Flex® Graspers and Dissectors are designed to transmit grasping force through delicate working tips in both minimally invasive and open surgical procedures.

Device Description

Each Diamond-Flex® Grasper and Dissector is comprised of a handle assembly, an elongate shaft and a 'distal end' which comprises a segmented flexible portion and the end-effector or jaw pattern.

AI/ML Overview

Here's an analysis of the provided information regarding the Diamond-Flex® Graspers, focusing on the acceptance criteria and the study proving its performance:

1. Table of Acceptance Criteria and Reported Device Performance

CharacteristicAcceptance Criteria (Standard/Test/FDA Guidance)Reported Device Performance (Results Summary)
Maintains pneumoperitoneumPneumo-peritoneum TestPASS
Articulation system strengthShape Forming Verification TestPASS
Actuation system strengthCrimp Strength TestPASS
Instrument to withstand repeated usesRepeated Simulated Use TestPASS
Instrument to meet customer needs for grasping, dissecting, and providing sufficient rigidity to the user in the actuated stateCustomer Evaluation ReportPASS

2. Sample Size Used for the Test Set and Data Provenance

The provided document does not specify the exact sample sizes used for each of the non-clinical tests. It only lists the tests performed and their outcomes ("PASS").

Regarding data provenance, these are non-clinical bench tests and simulations, not human clinical data. Therefore, concepts like country of origin for data or retrospective/prospective study design are not applicable in this context.

3. Number of Experts Used to Establish Ground Truth for the Test Set and Their Qualifications

For the "Customer Evaluation Report" which assesses customer needs for grasping, dissecting, and rigidity, it implies feedback from users (customers). However, the document does not specify the number of "experts" (e.g., surgeons, medical professionals) involved in this evaluation, nor their specific qualifications.

For the other tests (Pneumo-peritoneum, Shape Forming, Crimp Strength, Repeated Simulated Use), the "ground truth" is established by direct measurement against engineering specifications and performance standards. No human experts are explicitly mentioned as establishing ground truth for these objective functional tests.

4. Adjudication Method for the Test Set

The document does not mention any adjudication method for the test set. Given that most tests are objective engineering performance tests with pass/fail criteria, an adjudication method for conflicting results would likely not be necessary unless specific subjective assessments were performed by multiple individuals.

5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study

A Multi-Reader Multi-Case (MRMC) comparative effectiveness study was not conducted or reported in this 510(k) summary. This type of study is typically for image-based diagnostic or screening devices to assess human reader performance with and without AI assistance. This device is a surgical instrument.

6. Standalone (Algorithm Only Without Human-in-the-Loop Performance) Study

This device, the Diamond-Flex® Graspers, is a physical surgical instrument, not an algorithm or AI system. Therefore, the concept of a "standalone" or "algorithm only" performance study is not applicable. The performance studies conducted evaluate the mechanical and functional integrity of the instrument itself.

7. Type of Ground Truth Used

The ground truth for the tests used in this submission are primarily:

  • Engineering Specifications / Performance Standards: For tests like pneumoperitoneum, articulation system strength, actuation system strength, and repeated simulated use, the "ground truth" is defined by pre-established performance metrics and thresholds that the device must meet to be considered functional, safe, and effective.
  • Customer Needs/Feedback: For the "Customer Evaluation Report," the ground truth is derived from the stated or perceived needs and expectations of the end-users (customers/surgeons) regarding the device's functional performance in a surgical context.

8. Sample Size for the Training Set

This device is a physical medical instrument developed through engineering and manufacturing processes, not an AI/ML algorithm that requires training data. Therefore, the concept of a "training set" and its sample size is not applicable to this 510(k) submission.

9. How the Ground Truth for the Training Set Was Established

As explained above, there is no training set for this type of device. Therefore, the method for establishing ground truth for a training set is not applicable.

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Traditional 510(k) Premarket Notification: Diamond-Flex® Graspers

Image /page/0/Picture/1 description: The image shows the logo for CareFusion. The logo consists of a circular graphic on the left and the word "CareFusion" on the right. The circular graphic appears to be a stylized representation of a globe or sphere with a checkmark incorporated into the design. The text "CareFusion" is written in a bold, sans-serif font.

K.110257 pg 1 of 3

MAY - 6 2011

510(k) SUMMARY

A summary of 510(k) safety and effectiveness information in accordance with 21 CFR 807.92.

SUBMITTER INFORMATION
NameCareFusion Corporation
Address1500 Waukegan Road MPWM, McGaw Park, IL 60085 USA
Phone number(847) 473-7429
Fax number(847) 473-7774
EstablishmentRegistration Number1423507
Name of contact personJane Weber
Date prepared01/19/2011
DEVICE INFORMATION
Trade or proprietarynameDiamond-Flex® Graspers and Dissectors
Common or usual nameReusable Laparoscopic Instrument
Classification nameEndoscope and Accessories
Classification panel78 Gastroenterology and Urology
RegulationClass II per 21CFR 876.1500, Product code GCJ
Product Code(s)89-0500, 89-0501, 89-0502, 89-0503, 89-0504, 89-0505, 89-0506, 89-0507,89-0508, 89-0509, 89-0510, 89-0511, 89-4500, 89-4501, 89-4502, 89-4503,89-4504, 89-4505, 89-4506, 89-4507, 89-4508, 89-4509, 89-4510, 89-4511
Legally marketeddevice(s) to whichequivalence is claimedSnowden-Pencer Inc. - Reusable Laparoscopic Instruments - K930667, GCJSurgical Innovations Limited - EndoFlex 5000 Endoscopic Forceps -K946239, GCJ
Reason for 510(k)submissionNew Device
Device descriptionEach Diamond-Flex® Grasper and Dissector is comprised of a handleassembly, an elongate shaft and a 'distal end' which comprises a segmentedflexible portion and the end-effector or jaw pattern.
Intended use of thedeviceTo grasp and dissect
Indications for useDiamond-Flex® Graspers and Dissectors are designed to transmit graspingforce through delicate working tips in both minimally invasive and opensurgical procedures.

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Traditional 510(k) Premarket Notification: Diamond-Flex® Graspers

Image /page/1/Picture/1 description: The image contains the logo for CareFusion. The logo consists of a circular graphic on the left and the word "CareFusion" on the right. The circular graphic appears to be a stylized representation of a checkmark or a leaf, composed of many small dots.

ﺮ ﺍﻟﻤ

K110257 pg 2 of 3

SUMMARY OF THE TECHNOLOGICAL CHARACTERISTICS OF THE DEVICE COMPAREDTO THE PREDICATE DEVICE
CharacteristicPredicate DeviceSnowden-Pencer Inc.ReusableLaparoscopicInstruments - K930667Predicate DeviceSurgical InnovationsLimited EndoFlex 5000Endoscopic Forceps -K946239New Device
Type of DeviceReusableReusableReusable
MaterialsStainless SteelStainless SteelNitinol AlloySantopreneNylonPEEKAluminumTungsten CarbideStainless SteelNitinol AlloySantopreneNylonPEEKAluminumTungsten Carbide
Length24cm, 33cm, 45 cm33cm, 25.5cm34cm, 45cm
ArticulatingcomponentNoneSegmented flexible portionthat articulates to 40° or 90°Segmented flexible portionthat articulates to 40° or 90°
ArticulationmechanismNoneRotating Actuation knob totighten cable and formshapeRotating Actuation knob totighten cable and formshape
ActuationmechanismHandle operation causesopening and closing ofend effectorHandle operation causesopening and closing of endeffectorHandle operation causesopening and closing of endeffector
Flush port?YesYesYes
Sterilizationsleeve?NoYesYes
Requires insertionthrough trocar?YesYesYes
Form inserted intotrocarNot ApplicableRelaxed-unarticulatedRelaxed-unarticulated
Grasper patterns6106 (same as K930667)

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Traditional 510(k) Premarket Notification: Diamond-Flex® Graspers

Image /page/2/Picture/1 description: The image shows the CareFusion logo. The logo consists of a circular icon on the left and the word "CareFusion" on the right. The icon appears to be a stylized checkmark within a circle, with a fragmented or pixelated effect. The text "CareFusion" is in a bold, sans-serif font.

K110257

Pd 3 of 3

PERFORMANCE DATA

SUMMARY OF NON-CLINICAL TESTS CONDUCTED FOR DETERMINATION OF SUBSTANTIAL EQUIVALENCE

Performance Test Summary-New Device

CharacteristicStandard/Test/FDA GuidanceResults Summary
Maintains pneumoperitoneumPneumo-peritoneum TestPASS
Articulation system strengthShape Forming Verification TestPASS
Actuation system strengthCrimp Strength TestPASS
Instrument to withstand repeatedusesRepeated Simulated Use TestPASS
Instrument to meet customerneeds for grasping, dissecting,and providing sufficient rigidity tothe user in the actuated stateCustomer Evaluation ReportPASS

The results of the non-clinical tests demonstrate the Diamond-Flex® Graspers meet or exceed all performance requirements, and are substantially equivalent to the predicate devices.

00041

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Image /page/3/Picture/1 description: The image shows the logo for the Department of Health & Human Services USA. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" arranged around the perimeter. Inside the circle is an abstract symbol resembling an eagle or bird in flight, composed of three curved lines.

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

MAY - 6 2011

CareFusion 2200, Inc. % Ms. Jane Weber Regulatory Affairs Manager 1500 Waukegan Road McGaw Park, Illinois 60085

Re: K110257

Trade/Device Name: Diamond-Flex® Graspers and Dissectors Regulation Number: 21 CFR 876.1500 Regulation Name: Endoscope and accessories Regulatory Class: II Product Code: GCJ Dated: April 18, 2011 Received: April 20, 2011

Dear Ms. Weber:

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 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

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Page 2 - Ms. Jane Weber

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/Resourcesfor You/Industry/default.htm.

Sincerely yours.

Aty 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

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Traditional 510(k) Premarket Notification Diamond-Flex® Graspers

KII0257 pg 1 of 1

Image /page/5/Picture/2 description: The image contains the logo for CareFusion. The logo consists of a stylized image on the left and the word "CareFusion" on the right. The stylized image appears to be a circular shape with intricate, abstract designs within it.

1500 Waukegan Road McGaw Park, Illinois 60085-6787 847.473.1500 FAX: 847.473.7774

Indications for Use

510(k) Number (if known):

Device Name: Diamond-Flex® Graspers and Dissectors

Indications for Use:

Diamond-Flex® Graspers and Dissectors are designed to transmit grasping force through delicate working tips in both minimally invasive and open surgical procedures.

Prescription Use _ X or Over-The Counter Use _________________________________________________________________________________________________________________________________________________________

(Per 21 CFR 801.109)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

N.H.R. Oden Forman

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

510(k) Number K110257

CareFusion Confidential

§ 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.