K Number
K140006
Device Name
ENDOSHIELD BURN PROTECTION SYSTEM
Manufacturer
Date Cleared
2014-06-16

(165 days)

Product Code
Regulation Number
878.4400
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The EndoShield Burn Protection System is an accessory for use with electrosurgical generators and is designed to safely deliver electrosurgical energy and to prevent injury caused by insulation failure and capacitive coupling. EndoShield performs acive electrode monitoring intended to control stray monopolar energy, caused by insulation failure and capacitive coupling in surgical instruments, along the instrument.
Device Description
EndoShield is a self-contained battery-powered electronic module (about the size of a cell phone) with integral instrument and HF power cords: • Module plugs directly into return-electrode receptacle of ESU - Integral cords connect module to - AEM laparoscopic instrument - Foot-control power output receptacle of ESU
More Information

Not Found

No
The summary describes a system for monitoring electrosurgical energy and preventing injury, focusing on hardware and electrical safety. There is no mention of AI, ML, image processing, or data analysis techniques typically associated with AI/ML. The performance studies described are bench testing for essential performance, EMC, electrical safety, and usability, not AI/ML model validation.

No
The device is described as an accessory for electrosurgical generators designed to prevent injury, not to therapeutically treat a condition or disease.

No
Explanation: The device is described as an "accessory for use with electrosurgical generators" designed to "safely deliver electrosurgical energy and to prevent injury caused by insulation failure and capacitive coupling" through "active electrode monitoring." Its purpose is to control stray energy, not to diagnose a medical condition.

No

The device description explicitly states it is a "self-contained battery-powered electronic module" with integral cords, indicating it is a hardware device, not software-only.

Based on the provided information, the EndoShield Burn Protection System is not an IVD (In Vitro Diagnostic) device.

Here's why:

  • Intended Use: The intended use clearly states that the device is an accessory for electrosurgical generators used to deliver energy and prevent injury during surgical procedures. This is an in vivo application (within a living organism), not an in vitro application (outside of a living organism, typically on biological samples).
  • Device Description: The description details a module that connects to an ESU and surgical instruments. This further reinforces its use in a surgical setting.
  • 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.)
    • Providing diagnostic information based on sample analysis
    • Use in a laboratory setting

The device's function is to monitor and control energy delivery during surgery, which is a therapeutic and safety function performed directly on the patient.

N/A

Intended Use / Indications for Use

The EndoShield Burn Protection System is an accessory for use with electrosurgical generators and electrodes that is designed to safely deliver electrosurgical energy and to prevent injury caused by insulation failure and capacitive coupling.

EndoShield performs active electrode monitoring intended to control stray monopolar energy, caused by insulation failure and capacitive coupling in surgical instruments, along the shaft of the instrument.

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

GEI

Device Description

The EndoShield Burn Protection System is a self-contained battery-powered electronic module (about the size of a cell phone) with integral instrument and HF power cords. It enables AEM Monitoring and protection during monopolar laparoscopy, transfers high-frequency (HF) energy from a monopolar electrosurgical unit (ESU) to AEM laparoscopic instruments while providing AEM Monitoring of HF current returning from the instrument's shield. It disables HF energy delivery and presents a visual alert whenever a set up or operational fault is detected. The module plugs directly into the return-electrode receptacle of the ESU, and its integral cords connect the module to the AEM laparoscopic instrument and the foot-control power output receptacle of the ESU.

This system is a safety system for minimally-invasive monopolar electrosurgery, preventing unanticipated or undetected burns from stray HF energy outside the surgeon's field of view. It works by shielding the instrument's shaft from stray HF energy due to insulation breakdown or capacitive coupling and monitors the level of energy picked up by the shield, interrupting energy delivery when energy in the shield approaches excessive levels.

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 Testing:

  • Essential performance testing: In accordance with Design Control requirements per 21 CFR 820.30, essential performance tested in 10 units showed equivalent performance to monopolar function of EM3 AEM Monitor predicate system.
  • EMC, electrical safety, usability: Third-party testing and design-file review demonstrated equivalent performance to monopolar function of EM3 AEM Monitor predicate system.

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.

K122383

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

§ 878.4400 Electrosurgical cutting and coagulation device and accessories.

(a)
Identification. An electrosurgical cutting and coagulation device and accessories is a device intended to remove tissue and control bleeding by use of high-frequency electrical current.(b)
Classification. Class II.

0

Image /page/0/Picture/1 description: The image shows the word "ENCISION" in bold, sans-serif font. Below the word is a thin line, and below that are some blurred words. The "O" in "ENCISION" has a graphic inside of it.

JUN 1 6 2014

510(k) Summary

DeviceEndoShield Burn Protection System
OwnerEncision, Inc.
ContactMike Biggs, Director Engineering and Interim Director RA/QA
Date11 June 2014
Subject DeviceTrade nameEndoShield Burn Protection System
Model numberEM100
Common nameDisposable AEM Monitor
Device nameElectrosurgical, Cutting & Coagulation & Accessories
Regulation number21 CFR 878.4400
Product codeGEI
Device class2
PanelGeneral and Plastic Surgery
Predicate DeviceTrade nameEM3 AEM Monitor
Device nameElectrosurgical, Cutting & Coagulation & Accessories
ManufacturerEncision Inc.
Market clearance510(k): K122383 (2013)

Device Description

| Device
purpose | • Enables AEM Monitoring and protection during monopolar laparoscopy
• Transfers high-frequency (HF) energy from monopolar electrosurgical unit
(ESU) to AEM laparoscopic instruments while providing AEM Monitoring of
HF current returning from the instrument's shield
• Disables HF energy delivery and presents a visual alert whenever a set up
or operational fault is detected |
|-------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| AEM
technology | • Safety system for minimally-invasive monopolar electrosurgery
• Prevents unanticipated or undetected burns from stray HF energy outside
the surgeon's field of view
• Works by shielding instrument's shaft from stray HF energy due to insulation
breakdown or capacitive coupling
• Monitors level of energy picked up by shield; interrupting energy delivery
when energy in shield approaches excessive levels |
| | Continued on next page |

ENCISION INC. + 6797 WINCHESTER CIRCLE • BCULDER, CO BO3D1 • 303,444.2693 • WWENDSHON.COM

1

Device Description (continued)

DeviceEndoShield is a self-contained battery-powered electronic module (about the
componentssize of a cell phone) with integral instrument and HF power cords:
• Module plugs directly into return-electrode receptacle of ESU
  • · Integral cords connect module to
    • AEM laparoscopic instrument
    • Foot-control power output receptacle of ESU

Technological Characteristics

EndoShield miniaturizes and integrates the primary monopolar functions of the predicate device, , EM3 AEM monitor, into a single-use, self-contained system.

Technology

| Logic | • Battery-powered digital and analog electronic circuitry
• 3V Lithium battery
• Normally-open relay controlling primary HF energy path
• DSP HF current measurement of shield-to-ground HF energy
• Shield HF threshold detection results in opening of relay of primary HF path
and lighting of red visual indicator |
|-------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Instrument
connector | Dual, gold plated, spring loaded, connector allowing free rotation of connector
on instrument post at end of instrument cord |
| ESU return
connector | Standard CQM-type return electrode three-pin plug on back of monitor
module |
| ESU HF
output
connector | Standard ESU foot-control instrument plug on short cord from module |
| Visual
indicator | • Green light-emitting diode lighting a ready light: a "✓" molded into the
electronic module housing
• Red light-emitting diode lighting an alarm/not-ready light: an "X" molded into
the electronic module housing |

2

510(k) Summary: EndoShield Burn Protection System

Function
Enables
energy
deliveryAssures all connections are proper before enabling energy delivery and
presenting a visual "ready" indication by lighting a green "✓" on face of
electronic module
Shields from
stray energyMonitor connections shunt stray energy, attempting to pass through the
insulated shaft of an AEM instrument by insulation breakdown or capacitive
coupling, back to the ESU
Disables
energy
deliveryMonitor shuts down the electrosurgical procedure if the level of stray energy
reaches dangerous levels
Indicates faultVisual alert—extinguishes green "✓" and lights red "X" on face of electronic
module—indicates a fault is detected, either at set up (system not ready) or
during operation (excess stray energy)

Intended Use

The EndoShield Burn Protection System is an accessory for use with electrosurgical generators and electrodes that is designed to safely deliver electrosurgical energy and to prevent injury caused by insulation failure and capacitive coupling.

EndoShield performs active electrode monitoring intended to control stray monopolar energy, caused by insulation failure and capacitive coupling in surgical instruments, along the shaft of the instrument.

Equivalence

Based on operating principle, intended use, technology, safety, and performance; the EndoShield Burn Protection System is substantially equivalent to its predicate device, the monopolar function of the EM3 AEM Monitor.

EndoShield equivalence to EM3 (Monopolar function)
Intended UseIdentical intended use as an accessory for use with electrosurgical generators
and electrodes to safely deliver electrosurgical energy and to prevent injury
caused by insulation failure and capacitive coupling through active electrode
monitoring.
Operating
principleIdentical operating principle: shunting stray energy from the shield of an AEM
Instrument to ESU return-electrode ground and disabling energy delivery
should stray-energy current exceed a predetermined threshold.

Continued on next page

3

Equivalence (continued)

EndoShield equivalence to EM3 (Monopolar function)
MaterialsSubstantially equivalent materials: typical electrical wires, connectors, analog
and logic components, and printed circuit boards; primary differences are
battery instead of mains power and plastic instead of metal enclosure.
TechnologySubstantially equivalent circuitry: discrete digital logic, analog electronics,
and HF power relays instead of FPGA logic device (with software), analog
electronics, and HF power relays
PerformanceSubstantially equivalent: specifications are equivalent, except for the alarm
display being visual only and not specific to the type of fault detected
EMC and
Electrical
SafetyIdentical standards and internal design control assurances, including
recognized international standards:
• IEC 60601-1 (3rd Ed.) compliant
• IEC 60601-1-2 compliance
• IEC 60601-2-2 compliance
Human
factors/
usabilityIdentical standards and internal design control assurances, including
recognized international standards:
• IEC 60601-1-6 compliance
• IEC 62366 compliance

Bench Testing

| Essential
performance
testing | In accordance with Design Control requirements per 21 CFR 820.30,
essential performance tested in 10 units showed equivalent performance to
monopolar function of EM3 AEM Monitor predicate system. |
|--------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| EMC,
electrical
safety,
usability | Third-party testing and design-file review demonstrated equivalent
performance to monopolar function of EM3 AEM Monitor predicate system. |

4

510(k) Summary: EndoShield Burn Protection System

Biocompatibility

Patient ContactNo direct or indirect contact with patient
Biocompatibility EvaluationNone required

Sterility / Packaging

| Sterility | • Method of sterilization: ethylene oxide gas
• Methodology: ANSI-AAMI-ISO 11135-1:2007
• Sterility assurance level: 10⁻⁶ or better
• Sterilization performance: By a qualified contract sterilizer |
|-----------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Sterility
Maintenance/
Shelf Life | • Initially, product validated for sterility and function to one year shelf life
• Assurance method: accelerated aging
• Validated shelf life indication: "use by" date on all labels-boxes and
pouches
• Post-market extension of shelf life: life extended as data from accelerated
and real-time aging tests demonstrate greater longevity |

Conclusion

EndoShield Burn Protection System is substantially equivalent to the monopolar function of its predicate devices in performance and intended use. There are no significant differences between EndoShield Burn Protection System and the EM3 predicate in design which would raise new issues of safety and effectiveness, performance, function or intended use of the device. Technological similarities between the predicate device and the proposed device also demonstrate equivalence.

5

Image /page/5/Picture/0 description: The image shows the logo for the Department of Health & Human Services USA. The logo features a stylized eagle with three lines representing its wings and three wavy lines below, possibly representing water. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" is arranged in a circular fashion around the eagle.

DEPARTMENT OF HEALTH & HUMAN SERVICES

Public Health Service

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

June 16, 2014

Encision Incorporated Mr. Mike Biggs Vice President, Regulatory and Quality 6797 Winchester Circle Boulder, Colorado 80301

Re: K140006

Trade/Device Name: EndoShield Burn Protection System Regulation Number: 21 CFR 878.4400 Regulation Name: Electrosurgical, Cutting & Coagulation & Accessories Regulatory Class: Class II Product Code: GEI Dated: May 14, 2014 Received: May 15, 2014

Dear Mr. Biggs:

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 subicct 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

6

Page 2 - Mr. Mike Biggs

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 contact the Division of Small Manufacturers, International and Consumer Assistance at its tollfree number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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,

David Krause -S

for

Binita S. Ashar, M.D., M.B.A., F.A.C.S. Director Division of Surgical Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

7

DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

510(k) Number (if known) K140006

Device Name

EndoShield Burn Protection System

Indications for Use (Describe)

The EndoShield Burn Protection System is an accessory for use with electrosurgical generators and is designed to safely deliver electrosurgical energy and to prevent injury caused by insulation failure and capacitive coupling. EndoShield performs acive electrode monitoring intended to control stray monopolar energy, caused by insulation failure and capacitive coupling in surgical instruments, along the instrument.

Type of Use (Select one or both, as applicable)

2 Prescription Use (Part 21 CFR 801 Subpart D)

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

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