K Number
K113330
Device Name
CABLECAP
Manufacturer
Date Cleared
2012-01-12

(59 days)

Product Code
Regulation Number
878.4580
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The device absorbs and diffuses the light transmitted through the cable in order to prevent patient burns and igniting flammable items in the surgical suite.
Device Description
The CableCap device attaches to the distal end of high intensity light cables. The device absorbs and diffuses the light transmitted through the cable in order to prevent patient burns and igniting flammable items in the surgical suite. There are three separate models made for the three types of light cables:
More Information

Not Found

No
The device description and performance studies focus on physical properties (light absorption and diffusion, temperature) and do not mention any computational or data-driven processes indicative of AI/ML.

No
The device's purpose is to prevent patient burns and ignition of flammable items by absorbing and diffusing light; it is not designed to treat a disease, injury, or medical condition.

No
Explanation: The device is designed to prevent burns and ignition by diffusing light, which is a therapeutic/preventative function, not a diagnostic one.

No

The device description clearly states it is a physical device ("attaches to the distal end of high intensity light cables") and describes physical testing ("Bench-top physical testing"). It is not software-only.

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

Here's why:

  • Intended Use: The intended use is to prevent patient burns and ignite flammable items by absorbing and diffusing light from surgical light cables. This is a physical function related to safety during a surgical procedure.
  • Device Description: The description reinforces the physical function of attaching to a light cable and managing light transmission.
  • Lack of IVD Characteristics: There is no mention of the device being used to examine specimens derived from the human body (blood, tissue, urine, etc.) to provide information for diagnosis, monitoring, or treatment.

IVD devices are specifically designed to perform tests on biological samples to gain diagnostic or other health-related information. This device's function is entirely external to the patient's body and related to the surgical environment and equipment.

N/A

Intended Use / Indications for Use

The device absorbs and diffuses the light transmitted through the cable in order to prevent patient burns and igniting flammable items in the surgical suite.

Product codes

FST

Device Description

The CableCap device attaches to the distal end of high intensity light cables. The device absorbs and diffuses the light transmitted through the cable in order to prevent patient burns and igniting flammable items in the surgical suite.

There are three separate models made for the three types of light cables:

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

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-top physical testing was performed by Materials, Engineering, and Testing Corp. located in Oak Ridge, TN. Their Accreditation number is 59214 and they are ISO/IEC 17025:2005 compliant. As an extreme scenario, we assumed that the device might remain in contact with a patient's skin for 30 minutes. As an extra precaution, we doubled this time to 60 minutes for test runs. As indicated in the report included in the testing section, the maximum temperature for the device was only 95 °F, which is still well below the standard.

Therefore, SensorMed is confident that the device temperature will not be a concern even if used for extended periods of time.

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

Not Found

Predicate Device(s)

K101496

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 878.4580 Surgical lamp.

(a)
Identification. A surgical lamp (including a fixture) is a device intended to be used to provide visible illumination of the surgical field or the patient.(b)
Classification. Class II (special controls). The device, when it is an operating room lamp, a surgical instrument light, a surgical floor standing light, an endoscopic surgical light, a surgical light connector, a ceiling mounted surgical light, a surgical light carrier, surgical light accessories, a surgical lamp, a remote illuminator, or an incandescent surgical lamp, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 878.9.

0

K 113330

JAN 1 2 2012

510(k) Summary SensorMed CableCap™ 510(k) Number K401496 K | | 333 O Manufacturer Identification

SensorMed, Inc. Submitted by: 2450 EJ Chapman Dr., Suite 104 Knoxville, TN 37996 865-216-6307 Contact Information: William Milam VP of Engineering SensorMed, Inc. 2450 EJ Chapman Dr., Suite 104 Knoxville, TN 37996 865-216-6307 wmilam@sensormed.com October 10, 2011 Date Prepared: Device Identification Proprietary Name CableCap™

Common Name Light Cable Burn and Fire Prevention Device Classification Name Accessory to Fiberoptic Surgical Light Device Classification 21 CFR 878.4580 Proposed Regulatory Class Class II Device Product Code FST

Device Description

The CableCap device attaches to the distal end of high intensity light cables. The device absorbs and diffuses the light transmitted through the cable in order to prevent patient burns and igniting flammable items in the surgical suite.

There are three separate models made for the three types of light cables:

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Intended Use of the Device

The device absorbs and diffuses the light transmitted through the cable in order to prevent patient burns and igniting flammable items in the surgical suite.

Predicate Device

SensorMed Reusable CableCap device (K101496)

Technology Comparison

1

Both devices are constructed from biocompatible plastics. Both are accessories to hight cables. Both devices attach to the distal end of light cables and modify the outgoing light stream to benefit minimally invasive surgical procedures. Please see the table below for a device comparison table.

| | Reusable
CableCap | Disposable
CableCap |
|-------------------------------------------------------------|----------------------|------------------------|
| Attenuates light from a medical light box | X | X |
| Diffuses light in multiple directions | X | X |
| Is manufactured from a combination of biocompatible plastic | X | X |
| Is autoclave-able | X | no |
| Improves surgical procedure for patient | X | X |
| Does not directly treat or diagnose patient | X | X |
| Works with multiple light sources and different intensities | X | X |

Performance Testing

Bench-top physical testing was performed by Materials, Engineering, and Testing Corp. located in Oak Ridge, TN. Their Accreditation number is 59214 and they are ISO/IEC 17025:2005 compliant. As an extreme scenario, we assumed that the device might remain in contact with a patient's skin for 30 minutes. As an extra precaution, we doubled this time to 60 minutes for test runs. As indicated in the report included in the testing section, the maximum temperature for the device was only 95 °F, which is still well below the standard.

Therefore, SensorMed is confident that the device temperature will not be a concern even if used for extended periods of time.

Conclusion

Verification and validation activities were conducted to establish the performance and safety characteristics of the CableCap. The results of these activities demonstrate that the CableCap is safe and effective when used in accordance with its intended use and labeling.

Therefore, CableCap is considered substantially equivalent to the predicate device.

2

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/2/Picture/1 description: The image shows the logo for the Department of Health & Human Services (HHS). The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" arranged around the perimeter. Inside the circle is a stylized symbol resembling an abstract caduceus or a representation of human figures, with three curved lines forming a shape that suggests movement or flow.

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

SensorMed. Incorporated % Mr. William Milam Vice President of Engineering 2450 EJ Chapman Drive, Suite 104 Knoxville, Tennessee 37996

JAN 1 2 2012

Re: K113330

Trade/Device Name: CableCap Regulation Number: 21 CFR 878.4580 Regulation Name: Surgical lamp Regulatory Class: Class II Product Code: FST Dated: November 9, 2011 Received: November 14, 2011

Dear Mr. Milam:

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 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

3

Page 2 - Mr. William Milam

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 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,//

for Dosh Cr

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

Enclosure

4

Indications for Use

510(k) Number (if known):____ Kxxxxxx=1 | 33330 Device Name:_CableCap Indications For Use:

The device absorbs and diffuses the light transmitted through the cable in order to prevent patient burns and igniting flammable items in the surgical suite.

AND/OR Over-The-Counter Use __________________________________________________________________________________________________________________________________________________ Prescription Use × (Part 21 CFR 801 Subpart D) (21 CFR 807 Subpart C) (PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of In Vitro Diagnostic Devices (OIVD)

Nyl RROh for mkin

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

. 510(k) Number K113330