K Number
K140964
Device Name
CALCULASE II
Date Cleared
2014-09-04

(142 days)

Product Code
Regulation Number
878.4810
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The laser is used to create laser energy for the destruction of calculi and/or for soft tissue treatments such as the cutting of tissue and the opening of stenosis and strictures during endoscopic urological applications.
Device Description
The KARL STORZ Calculase II is a Ho-YAG desktop laser that emits a mid-infrared beam at the wavelength of 2080nm with pulse energy of 500-2000mJ and pulse frequency of 4 – 15Hz. The laser energy is transmitted into the tissue via an optical fiber, with the maximum limit of the laser energy set at 20W. The laser energy generated by Calculase II enables the optimal lithotripsy of all calculus compositions in the human body and soft tissue treatment such as the ablation of strictures and stenosis, for example. Calculase II is a desktop unit designed to be mobile so that it can be easily transported and placed on top of a desk or cart and positioned within the treatment room by using special, retractable handles located on the both sides of the desktop units. All controls and displays required for operating the unit (On/off switching key, fiber connection port, power setting. etc.) are located on the front of the device in a user-friendly control panel and easy-to-read LED displays, which make the unit safe and easy to operate by the users. The 1-pedal footswitch allows the users to release the laser to the intended area during use. The Calculase II Holmium Laser system uses a flexible laser fiber, inserted into an endoscope (flexible, semi-rigid and rigid) through the urethra or percutaneously to fragment and vaporize the calculi stone located in the bladder, urethra, or kidney. With the proper energy level setting, it can also perform soft tissue treatments such as ablation of strictures and stenosis. For lithotripsy, proper energy level should be set depending on the fiber diameter, hardness of stone, and location of the stone. The laser emission is activated by a footswitch pedal, which allows the operator to be "hands-free" for specific target fragmentation. With the fiber placed lightly against the stone or soft tissue in the contact procedure, pulses of energy are used to fragment and vaporize the stone or ablate strictures and stenosis. As the laser beam is concentrated on the target area, the surrounding tissue can relax, cool and dissipate the heat in between the short bursts. This way the target tissue sustains cumulative thermal effect with maximum protection of the surrounding area.
More Information

AURIGA QI (K121570)

AURIGA QI (K121570)

No
The description focuses on the physical characteristics and operational parameters of a laser device for lithotripsy and soft tissue treatment. There is no mention of AI, ML, or any computational processing that would suggest the use of such technologies.

Yes
The device is used for the destruction of calculi and soft tissue treatments during endoscopic urological applications, which are medical treatments.

No

The device is described as a laser used for the destruction of calculi and for soft tissue treatments, which are therapeutic actions, not diagnostic.

No

The device description clearly outlines a hardware-based laser system (Ho-YAG desktop laser) with physical components like a fiber connection port, control panel, LED displays, and a footswitch. It is not solely software.

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

Here's why:

  • Intended Use: The intended use clearly states the device is used to create laser energy for the destruction of calculi and/or for soft tissue treatments during endoscopic urological applications. This involves direct interaction with the patient's body for therapeutic purposes.
  • Device Description: The description details a laser system that transmits energy via an optical fiber into tissue to fragment stones or ablate soft tissue. This is a physical intervention on the patient.
  • Lack of IVD Characteristics: There is no mention of the device being used to examine specimens derived from the human body (like blood, urine, tissue samples) to provide information for diagnosis, monitoring, or screening.

IVD devices are used in vitro (outside the body) to analyze biological samples. This device is used in vivo (inside the body) for treatment.

N/A

Intended Use / Indications for Use

The laser is used to create laser energy for the destruction of calculi and/or for soft tissue treatments such as the cutting of tissue and the opening of stenosis and strictures during endoscopic urological applications.

Product codes

GEX

Device Description

The KARL STORZ Calculase II is a Ho-YAG desktop laser that emits a mid-infrared beam at the wavelength of 2080nm with pulse energy of 500-2000mJ and pulse frequency of 4 – 15Hz. The laser energy is transmitted into the tissue via an optical fiber, with the maximum limit of the laser energy set at 20W.

The laser energy generated by Calculase II enables the optimal lithotripsy of all calculus compositions in the human body and soft tissue treatment such as the ablation of strictures and stenosis, for example.

Calculase II is a desktop unit designed to be mobile so that it can be easily transported and placed on top of a desk or cart and positioned within the treatment room by using special, retractable handles located on the both sides of the desktop units. All controls and displays required for operating the unit (On/off switching key, fiber connection port, power setting. etc.) are located on the front of the device in a user-friendly control panel and easy-to-read LED displays, which make the unit safe and easy to operate by the users. The 1-pedal footswitch allows the users to release the laser to the intended area during use.

The Calculase II Holmium Laser system uses a flexible laser fiber, inserted into an endoscope (flexible, semi-rigid and rigid) through the urethra or percutaneously to fragment and vaporize the calculi stone located in the bladder, urethra, or kidney. With the proper energy level setting, it can also perform soft tissue treatments such as ablation of strictures and stenosis. For lithotripsy, proper energy level should be set depending on the fiber diameter, hardness of stone, and location of the stone.

The laser emission is activated by a footswitch pedal, which allows the operator to be "hands-free" for specific target fragmentation. With the fiber placed lightly against the stone or soft tissue in the contact procedure, pulses of energy are used to fragment and vaporize the stone or ablate strictures and stenosis.

As the laser beam is concentrated on the target area, the surrounding tissue can relax, cool and dissipate the heat in between the short bursts. This way the target tissue sustains cumulative thermal effect with maximum protection of the surrounding area.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

bladder, urethra, or kidney

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)

Non-Clinical Performance Data: Calculase II is tested according to the following standard: IEC 60601-1 IEC 60601-1-2 IEC 60601-2-22 IEC 60825-1
Additional bench testing for performance verification and validation purposes: Max Output Pulse Duration, Pulse Energy
The bench testing performed verified and validated that the Calculase II has met all its design specification and is substantially equivalent to the predicate device, AURIGA QI, for urological procedures.

Clinical Performance Data: No clinical information is required for this submission

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

Not Found

Predicate Device(s)

AURIGA QI (K121570)

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 878.4810 Laser surgical instrument for use in general and plastic surgery and in dermatology.

(a)
Identification. (1) A carbon dioxide laser for use in general surgery and in dermatology is a laser device intended to cut, destroy, or remove tissue by light energy emitted by carbon dioxide.(2) An argon laser for use in dermatology is a laser device intended to destroy or coagulate tissue by light energy emitted by argon.
(b)
Classification. (1) Class II.(2) Class I for special laser gas mixtures used as a lasing medium for this class of lasers. The devices subject to this paragraph (b)(2) are exempt from the premarket notification procedures in subpart E of part 807 of this chapter, subject to the limitations in § 878.9.

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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 circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is a stylized image of three human profiles facing to the right, overlapping each other to create a sense of depth and connection.

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

September 3, 2014

Karl Storz Endoscopy-America, Inc. Winkie Wong Regulatory Affairs Specialist 2151 E. Grand Avenue El Segundo. CA 90245-5017

Re: K140964

Trade/Device Name: Calculase II Regulation Number: 21 CFR§ 878.4810 Regulation Name: Powered Laser Surgical Instrument Regulatory Class: II Product Code: GEX Dated: April 11, 2014 Received: April 17, 2014

Dear Winkie Wong,

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.

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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 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/ResourcesforYou/Industry/default.htm.

Sincerely yours.

Herbert P. Lerner -S

for

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

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Indications for Use

510(k) Number (if known) K140964

Device Name Calculase II

Indications for Use (Describe)

The laser is used to create laser energy for the destruction of calculi and/or for soft tissue treatments such as the cutting of tissue and the opening of stenosis and strictures during endoscopic urological applications.

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

Prescription Use (Part 21 CFR 801 Subpart D)

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

PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON A SEPARATE PAGE IF NEEDED.

FOR FDA USE ONLY

Concurrence of Center for Devices and Radiological Health (CDRH) (Signature)

This section applies only to requirements of the Paperwork Reduction Act of 1995.

DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.

The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:

Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff(@fda.hhs.gov

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

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Image /page/3/Picture/0 description: The image contains the logo for Karl Storz Endoskope. The logo is in blue and features the word "STORZ" in large, bold letters. Below the word "STORZ" is the phrase "KARL STORZ - ENDOSKOPE" in smaller letters.

510(k) SUMMARY OF SAFETY AND EFFECTIVENESS

This summary of 510(k) safety and effectiveness information is being submitted in accordance with the requirements of the Safe Medical Devices Act (SMDA) of 1990 and 21 CFR 807.92. All data included in this document is accurate and complete to the best of KSEA's knowledge.

| Applicant: | Karl Storz Endoscopy-America, Inc
2151 E. Grand Avenue
El Segundo, CA 90245 |
|-----------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Contact: | Winkie Wong
Regulatory Affairs Specialist
424-218-8379
424-218-8519 |
| Date of Preparation: | April 11, 2014 |
| Device Identification: | Trade Name: Calculase II
Common Name: Powered Laser Surgical Instrument
Classification Name: Powered Laser Surgical Instrument |
| Product Code: | GEX |
| Regulation: | CFR 878.4810 |
| Predicate Device(s): | AURIGA QI (K121570) |
| Device Description: | The KARL STORZ Calculase II is a Ho-YAG desktop laser
that emits a mid-infrared beam at the wavelength of 2080nm
with pulse energy of 500-2000mJ and pulse frequency of 4 –
15Hz. The laser energy is transmitted into the tissue via an
optical fiber, with the maximum limit of the laser energy set at
20W.

The laser energy generated by Calculase II enables the optimal
lithotripsy of all calculus compositions in the human body and
soft tissue treatment such as the ablation of strictures and
stenosis, for example. |
| | Calculase II is a desktop unit designed to be mobile so that it
can be easily transported and placed on top of a desk or cart
and positioned within the treatment room by using special,
retractable handles located on the both sides of the desktop
units. All controls and displays required for operating the unit
(On/off switching key, fiber connection port, power setting.
etc.) are located on the front of the device in a user-friendly
control panel and easy-to-read LED displays, which make the
unit safe and easy to operate by the users. The 1-pedal
footswitch allows the users to release the laser to the intended
area during use. |
| | The Calculase II Holmium Laser system uses a flexible laser
fiber, inserted into an endoscope (flexible, semi-rigid and rigid)
through the urethra or percutaneously to fragment and vaporize
the calculi stone located in the bladder, urethra, or kidney.
With the proper energy level setting, it can also perform soft
tissue treatments such as ablation of strictures and stenosis.
For lithotripsy, proper energy level should be set depending on
the fiber diameter, hardness of stone, and location of the stone. |
| | The laser emission is activated by a footswitch pedal, which
allows the operator to be "hands-free" for specific target
fragmentation. With the fiber placed lightly against the stone
or soft tissue in the contact procedure, pulses of energy are
used to fragment and vaporize the stone or ablate strictures and
stenosis. |
| | As the laser beam is concentrated on the target area, the
surrounding tissue can relax, cool and dissipate the heat in
between the short bursts. This way the target tissue sustains
cumulative thermal effect with maximum protection of the
surrounding area. |
| Indications For Use: | The laser is used to create laser energy for the destruction of
calculi and/or for soft tissue treatments such as the cutting of
tissue and the opening of stenosis and strictures during
endoscopic urological applications |
| Technological
Characteristics: | The predicate and subject devices are both Holmium Laser
System that emit laser energy at the wavelength of 2080nm.
However, due to the limitation of the indications of the subject
device compared to the predicate, they have minor differences
in the technological characteristics. These differences are: |
| | The subject device has a maximum energy output as
● |
| | 20W, whereas the predicate has the maximum
energy output as 30W; a difference of 10W in
maximum energy.
The range for pulse duration for the subject device
is 100 – 500 μs, whereas the predicate device's
range for pulse duration is 200 – 500 μs; a
difference of 100µs in the lower limit for pulse
duration. The ranges for the frequency and pulse energy for
the subject device are 4 – 15 Hz and 500 – 2000 mJ,
respectively, whereas the predicate device has the
ranges for the frequency and pulse energy are 4 – 20
Hz and 200 – 4000 mJ, respectively; a difference of
5 Hz in the upper limit of the frequency range, 300
mJ in the lower limit and 2000 mJ in the upper limit
of the pulse energy's range. The bench test data for the Calculase II Holmium Laser System
demonstrates that the design characteristics used as the basis
for the comparison have been met. The results show that the
subject device has met all its specifications. The performance
validation test report, System Test Record, is provided in
section 021_Performance Testing of this submission.
Combining the minor difference in specifications with the
limited indication of use in the Calculase II compared to the
predicate device, Auriga QI, Calculase II does not raise new
issues of safety and effectiveness and the devices are
substantially equivalent for urological application. |
| Non-Clinical
Performance Data: | Calculase II is tested according to the following standard:
IEC 60601-1 IEC 60601-1-2 IEC 60601-2-22 IEC 60825-1 Additional bench testing for performance verification and
validation purposes:
Max Output Pulse Duration |
| | Pulse Energy |
| | The bench testing performed verified and validated that the
Calculase II has met all its design specification and is
substantially equivalent to the predicate device, AURIGA QI,
for urological procedures. |
| Clinical
Performance Data: | No clinical information is required for this submission |
| Conclusion: | The Karl Storz's Calculase II is substantially equivalent to its
predicate devices. The non-clinical testing demonstrates that
the device is as safe and effective as the legally marketed
devices. |

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