K Number
K121724
Device Name
ENDOLIGHT LED 1.1 ENDOLIGHTLED 1.2
Date Cleared
2012-09-20

(100 days)

Product Code
Regulation Number
876.1500
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The ENDOLIGHT LED Light Source Projector is intended to illuminate the surgical site during minimally invasive surgical procedures by producing light that is transmitted from the light source through fiber optic cable and a scope.
Device Description
The ENDOLIGHT LED Light Source is a fiber optic light source utilizing a single, solid state, high power, white light emitting diode (LED) to produce visible light that used to illuminate surgical sites during minimally invasive surgical procedures. The light from the ENDOLIGHT LED Light Source is transmitted through an optical cable and a scope. ENDOLIGHT LED 1.1 and 1.2 are comprised of light source and power supply cord. The units consist of aforementioned LED, cooling fan, light port, and protective housing. ENDOLIGHT LED 1.1 and 1.2 are portable and are very similar in design, format, and functionality to other LED light sources including the predicate devices. This product is exclusively intended for use by specialized medical personnel and must only be used by medically qualified and adequately trained persons.
More Information

Not Found

No
The description focuses on basic LED light source technology and explicitly states "Mentions AI, DNN, or ML: Not Found".

No
The device is intended to illuminate the surgical site, not to treat a condition or disease.

No

The device is intended to illuminate the surgical site, not to diagnose a condition or disease.

No

The device description explicitly states it is comprised of a light source and power supply cord, including an LED, cooling fan, light port, and protective housing, which are all hardware components.

Based on the provided information, the ENDOLIGHT LED Light Source Projector is not an IVD (In Vitro Diagnostic) device.

Here's why:

  • Intended Use: The intended use is to "illuminate the surgical site during minimally invasive surgical procedures." This is a direct application of light for visualization within the body during surgery.
  • Device Description: The device description focuses on the physical components and how it generates and transmits light for surgical illumination.
  • Lack of IVD Characteristics: There is no mention of the device being used to examine specimens (like blood, tissue, or urine) outside of the body to provide information for diagnosis, monitoring, or treatment. IVD devices typically involve analyzing biological samples.

Therefore, the ENDOLIGHT LED Light Source Projector is a surgical illumination device, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The ENDOLIGHT LED Light Source Projector is intended to illuminate the surgical site during minimally invasive surgical procedures by producing light that is transmitted from the light source through fiber optic cable and a scope.

Product codes

FCW, NTN

Device Description

The ENDOLIGHT LED Light Source is a fiber optic light source utilizing a single, solid state, high power, white light emitting diode (LED) to produce visible light that used to illuminate surgical sites during minimally invasive surgical procedures. The light from the ENDOLIGHT LED Light Source is transmitted through an optical cable and a scope.

ENDOLIGHT LED 1.1 and 1.2 are comprised of light source and power supply cord. The units consist of aforementioned LED, cooling fan, light port, and protective housing.

ENDOLIGHT LED 1.1 and 1.2 are portable and are very similar in design, format, and functionality to other LED light sources including the predicate devices.

This product is exclusively intended for use by specialized medical personnel and must only be used by medically qualified and adequately trained persons.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

surgical site

Indicated Patient Age Range

Not Found

Intended User / Care Setting

specialized medical personnel and must only be used by medically qualified and adequately trained persons.

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)

Design verification testing demonstrates that the devices function as intended, and the performance did not raise any new issues of safety and effectiveness, and that formal user training is not required.

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

Not Found

Predicate Device(s)

K983628, K082813, K102167

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

K12 / 72 4
Revision 08-21-2012

SEP 2 0 2012

510(k) Summary

Submitter:
Company / Institution name:RICHARD WOLF MEDICAL INSTRUMENTS CORP.
Division name (if applicable):N.A.
Street address:353 Corporate Woods Parkway
City:Vernon Hills
State/Province:Illinois
Country:USA
Contact name:Mr. Ron Haselhorst
Contact title:Quality Assurance / Regulatory Affairs Manager
Date of Preparation:June 08, 2012
FDA establishment registration number:14 184 79
Phone number (include area code):( 847 ) 913 1113
FAX number (include area code):( 847 ) 913 0924
ZIP / Postal Code:60061
Parent Company:
Company / Institution name:Richard Wolf GmbH
FDA establishment registration number:96 111 02
Street address:Pforzheimer Str. 32
City:Knittlingen
State/Province:Baden-Württemberg
Country:Germany
ZIP / Postal Code:75438
Product Information:
Trade name:5160 ENDOLIGHT LED Light Source
Model numbers:5160XXX
Common name:LED Light Source
Classification name:FCW - Light Source, Fiber Optic, Routine
NTN - LED Light Source
Information on devices to which substantial equivalence is claimed:
510(k) NumberTrade or proprietary or model nameManufacturer
1 K9836281 Auto LP 5123 Xenon Light Projector (Product Code GCT)1 Richard Wolf Medical Inst. Corp.
2 K0828132 Stryker LED Light Source (Product Code FCW)2 Stryker Endoscopy
3 K1021673 LO-50 LED Light Source (Product Code FCW, NTN)3 Fiberoptics Technology, Inc

1

K12/724
Revision 08-21-2012

Device Description:

The ENDOLIGHT LED Light Source is a fiber optic light source utilizing a single, solid state, high power, white light emitting diode (LED) to produce visible light that used to illuminate surgical sites during minimally invasive surgical procedures. The light from the ENDOLIGHT LED Light Source is transmitted through an optical cable and a scope.

ENDOLIGHT LED 1.1 and 1.2 are comprised of light source and power supply cord. The units consist of aforementioned LED, cooling fan, light port, and protective housing.

ENDOLIGHT LED 1.1 and 1.2 are portable and are very similar in design, format, and functionality to other LED light sources including the predicate devices.

This product is exclusively intended for use by specialized medical personnel and must only be used by medically qualified and adequately trained persons.

Intended Use:

The ENDOLIGHT LED Light Source Projector is intended to illuminate the surgical site during minimally invasive surgical procedures by producing light that is transmitted from the light source through fiber optic cable and a scope.

Technological Characteristics:

The ENDOLIGHT LED Light Sources 1.1 and 1.2 are technologically similar to predicate device found in this submission in that all/some of the devices:

  • Use fiber optic cables and scopes to transmit the light from the source to the site of the l medical procedure
  • Use an identical technology ie, an LED lamp to produce light while others use an equivalent | source such as a xenon or halogen lamp.
  • . I Utilize similar manual controls to set the light brightness
  • Have similar illumination and quality of light -
  • Operate within an equivalent temperature range -
  • Can utilize a number of commonly available fiber optic cables ー
  • ENDOLIGHT LED 1.2 has a light cable detection feature which shuts the unit off the LED l lamp when the fiber optic cable is detached reducing the chance of unit overheating.

The ENDOLIGHT LED Light Sources are technologically different to predicate devices found in this submission in that:

  • ENDOLIGHT LED 1.2 utilizes a "Safe Start"™ function which after a power interruption of more than five seconds and less then thirty seconds the LED lamp is shut off but retains nominal brightness setting. After thirty seconds the LED lamp is shut off and brightness is reset to 50%.

2

Performance Data:

Design verification testing demonstrates that the devices function as intended, and the performance did not raise any new issues of safety and effectiveness, and that formal user training is not required.

Voluntary Safety and Performance Standards: The ENDOLIGHT LED 1.1 and 1.2 conform to the following Safety Standards:

  • IEC 60601-1-2 Edition 3:2007-03, Medical electrical equipment Part 1-2: General requirements for basic safety and essential performance - Collateral standard: Electromagnetic compatibility - Requirements and tests. (General)

  • IEC 60601-1, Medical Electrical Equipment Part 1: General Requirements for Safety, 1988; Amendment 1, 1991-11, Amendment 2, 1995. (General)

  • IEC 60601-2-18:1996, Amendment 1 2000 Medical electrical equipment Part 2: Particular A requirements for the safety of endoscopic equipment. (Dental/ENT)

Testing was completed by Independent laboratories, certifications are on file.

Clinical Data:

No clinical tests performed.

Rational for Substantial Equivalence:

The Richard Wolf ENDOLIGHT LED Light Source shares the same general indications for use, has similar function features and technological characteristics as the predicate devices, the minor difference(s) do not raise new questions for safety or effectiveness.

The Richard Wolf ENDOLIGHT LED Light Sources were non-clinically tested to determine the safety and efficacy under the indications for use and meet aforementioned safety standards, same as the predicate devices.

For these reasons, the Richard Wolf ENDOLIGHT LED Light Source is substantially equivalent to the existing 510(k) cleared devices sold by: Richard Wolf Medical Instruments Corporation (K983628), Stryker Endoscopy (K082813), and Fiberoptics Technology, Inc (K102167).

3

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/3/Picture/1 description: The image is a black and white logo for the U.S. Department of Health & Human Services. The logo features a stylized eagle-like symbol with three curved lines forming its body and wings. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular pattern around the symbol.

Public Health Service

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

Mr. Ron Haselhorst
Quality Assurance / Regulatory Affairs Manager
Richard Wolf Medical Instruments Corporation
353 Corporate Woods Parkway
VERNON HILLS IL 60061

Re: K121724

Trade/Device Name: ENDOLIGHT LED Light Source Regulation Number: 21 CFR§ 876.1500 Regulation Name: Endoscope and accessories Regulatory Class: II Product Code: FCW, NTN Dated: August 22, 2012 Received: August 27, 2012

Dear Mr. Haselhorst:

We have reviewed your Section 5.10(k) premarket notification of intent to market the indication We have reviewed your Section 3.10(x) promation is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate for use stated in the enclosure) to tegans ment date of the Medical Device Amendments, or to commerce prior to May 20, 1770, the enacifican with the provisions of the Federal Food. Drug, devices that have been reclasined in accerative approval of a premarket approval application (PMA).).).). and Cosment Act (Act) that to hot require approval controls provisions of the Act. The Act. The Act. The Act. The You may, therefore, market the device, buyer to many for annual registration, listing of general controls provisions of the fiel labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability adulteration. Please note. CDNT does not overaliate international and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), ( If your device is classified (SCC above) in Exting major regulations affecting your device can be
it may be subject to additional controls. Extracts of an edition, FDA may it may be subject to additional controls. Externs mayor solo to 898. In addition, FDA may
found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In additio found in the Code of I eactar resguinting your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean Please be advised that IDA's issualite of a but device with other requirements of the Act
that FDA has made a determination that your device of the Force agencies. You must that FDA has made a decommancin as administered by other Federal agencies. You must or any Pederal Statutes and regulations and not limited to: registration and listing comply with an the Act s requirements, mortains, common
(21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting of medical

SEP 2 0 2012

4

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device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set de vice-related adverse ovents) (21 CFR Part 820); and if applicable, the electronic form in the quality by selling (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 II you desire specific advice for your do need on our more offices/ucm115809.htm for go to intp://www.idd.gov/rtladiological Health's (CDRH's) Office of Compliance. Also, please the Center for Deviocs and Radiotoground by reference to premarket notification" (21CFR Part note the regulation onlined, "informations" - " - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 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 I ou may ovan other general mistmational 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,

Benjamin R. Fisher, Ph.D.

Benjamin R. Fisher, Ph.D. Director Division of Reproductive, Gastro-Renal, and Urological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

5

Indication for Use

K121724 510(k) Number (if known):

Device Name: ENDOLIGHT LED Light Source

Intended Use:

The ENDOLIGHT LED Light Source Projector is intended to be used to illuminate the surgical site during minimally invasive surgical procedures by producing light that is transmitted from the light source through fiber optic cable and a scope.

Prescription use S (Part 21 CFR 801 Subpart D) and / or

Over-The Counter Use (Part 21 CFR 801 Subpart C)

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

Concurrence of CDHR office of Device Evaluation (ODE)

Aoy M. Whan

ductive, Gastro-R

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