K Number
K140290
Device Name
STOPLOSS JONES TUBE
Manufacturer
Date Cleared
2014-12-02

(300 days)

Product Code
Regulation Number
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The StopLoss Jones tube system is intended for use during repair of the lacrimal system for intubation and bypass to canalicular pathologies.
Device Description
The StopLoss Jones Tube assembly consists of a flanged glass tube and silicone washer. The glass tube is Pyrex borosilicate glass and the silicone is NuSil. It is offered in a range of sizes as follows: ID 1.15 -1.25mm OD 1.90 - 2.10mm Lengths 9-22mm +/-0.5mm in 1mm increments The device is provided sterile for single use only.
More Information

Not Found

No
The device description and performance studies focus on the physical properties and functionality of a glass tube and silicone washer for lacrimal system repair. There is no mention of software, algorithms, or data processing that would indicate the use of AI or ML.

Yes
The device is intended for use during repair of the lacrimal system for intubation and bypass to canalicular pathologies, which directly addresses a medical condition or abnormality, characterizing it as a therapeutic device.

No

The device is described as being used for "intubation and bypass to canalicular pathologies" during repair of the lacrimal system, which indicates a therapeutic or restorative function, not a diagnostic one.

No

The device description clearly states it is a physical assembly consisting of a glass tube and silicone washer, which are hardware components.

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

Here's why:

  • Intended Use: The intended use is "during repair of the lacrimal system for intubation and bypass to canalicular pathologies." This describes a surgical or interventional procedure performed on the patient's body, not a test performed on a sample taken from the patient's body.
  • Device Description: The device is a physical tube and washer intended for insertion into the lacrimal system. This is a medical device used for treatment or support, not for diagnostic testing.
  • Lack of Diagnostic Elements: There is no mention of the device being used to analyze a sample (like blood, urine, tissue, etc.) or to provide information about a patient's health status based on such analysis.

IVD devices are specifically designed to perform tests on samples taken from the human body to provide information for diagnosis, monitoring, or screening. This device does not fit that description.

N/A

Intended Use / Indications for Use

The StopLoss Jones tube system is intended for use during repair of the lacrimal system for intubation and bypass to canalicular pathologies.

Product codes

OKS

Device Description

The StopLoss Jones Tube assembly consists of a flanged glass tube and silicone washer. The glass tube is Pyrex borosilicate glass and the silicone is NuSil. It is offered in a range of sizes as follows: ID 1.15 -1.25mm OD 1.90 - 2.10mm Lengths 9-22mm +/-0.5mm in 1mm increments The device is provided sterile for single use only.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Lacrimal system

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

The following non-clinical bench tests were performed: The strength of the bond between the glass tube and the silicone washer using calibrated Instrom equipment was evaluated during stability testing. A pig nose model was used to establish the internal low profile for intubation of the lacrimal anatomy. Sterilization validation has been performed to assure the SAL of 10-6, and packaging and shelf life testing allows for labeling the device with a 5-year shelf life. The device was tested to assure maintenance of integrity after shipping (a transportation validation study). The device was also tested to assure it is non-pyrogenic. Biocompatibility of the materials and the final device have been presented in the 510(k).

Key Metrics

Not Found

Predicate Device(s)

Gunther Weiss Scientific Glassblowing Co., Inc.: Jones Tube (Pre-Amendment device), DCS Surgical, Inc., DCS Lacrimal Stent (K113316)

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

N/A

0

Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized caduceus symbol, which is often associated with healthcare. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular pattern around the symbol.

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

December 2, 2014

LJT Surgical Ltd. c/o Patsy J. Trisler, JD, RAC Qserve Group US, Inc. 5600 Wisconsin Avenue, #509 Chevy Chase, MD 20815

Re: K140290

Trade/Device Name: StopLoss Jones Tube Regulation Number: Preamendment Regulation Name: Preamendment Regulatory Class: Unclassified Product Code: OKS Dated: October 21, 2014 Received: October 24, 2014

Dear Ms. Trisler:

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.

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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 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 Industry and Consumer Education 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. 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 Industry and Consumer Education 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.

Kesia Y. Alexander -S

for Malvina B. Eydelman, M.D. Director Division of Ophthalmic and Ear, Nose and Throat Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Indications for Use Form

510(k) Number (if known): K140290

StopLoss Jones Tube System Device Name:

Indications for Use:

The StopLoss Jones tube system is intended for use during repair of the lacrimal system for intubation and bypass to canalicular pathologies.

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

Concurrence of Center for Devices and Radiological Health (CDRH)

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510(k) SUMMARY

Submitter Name:LJT Surgical, Ltd.
Submitter Address:3-15 Wallace Way
Hitchin, Hertfordshire
SG4 OSE England
Contact Person:Andrew Pearson
Managing Director
Phone Number:44 1628 782537
Date Prepared:January 30, 2014; Revised October 6 2014
Device Trade Name:StopLoss Jones Tube System
Device Classification:Unclassified
Regulatory Name:Lacrimal Stent and Intubation Set
Classification Number:n/a
Product Code:OKS
Predicate Device(s):Gunther Weiss Scientific Glassblowing Co., Inc.: Jones Tube
(Pre-Amendment device)
DCS Surgical, Inc., DCS Lacrimal Stent (K113316)
Indications for Use
Statement:The StopLoss Jones tube system is intended for use during
repair of the lacrimal system for intubation and bypass to
canalicular pathologies.
Device Description:The StopLoss Jones Tube assembly consists of a flanged glass
tube and silicone washer. The glass tube is Pyrex borosilicate
glass and the silicone is NuSil. It is offered in a range of sizes as
follows:
ID 1.15 -1.25mm
OD 1.90 - 2.10mm
Lengths 9-22mm +/-0.5mm in 1mm increments
The device is provided sterile for single use only.
Summary of Testing:The following non-clinical bench tests were performed:
The strength of the bond between the glass tube and the silicone
washer using calibrated Instrom equipment was evaluated during
stability testing.
A pig nose model was used to establish the internal low profile
for intubation of the lacrimal anatomy.
Sterilization validation has been performed to assure the SAL of
10-6, and packaging and shelf life testing allows for labeling the
device with a 5-year shelf life.

4

The device was tested to assure maintenance of integrity after shipping (a transportation validation study).

The device was also tested to assure it is non-pyrogenic.

Biocompatibility of the materials and the final device have been presented in the 510(k).

  • Comparison to the The StopLoss Jones Tube has the same intended use and the Predicate Devices: same principles of operation as both predicates. The materials used are the same as the borosilicate glass and silicone used to make the predicate devices.
    The primary technological differences are that the StopLoss tube was designed with a silicone safety washer/flange which is not present on either predicate.

This difference does not introduce new types of questions of safety and effectiveness. The testing performed on the integrity of the flange and bond strength sufficiently addresses this difference.

Substantjal The comparisons and study data presented in the 510(k) lead to Equivalence the conclusion that StopLoss Jones Tube is substantially Conclusion: equivalent to the predicate devices.