K Number
K142700
Manufacturer
Date Cleared
2014-12-19

(88 days)

Product Code
Regulation Number
884.1730
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The InsufflatOR Needle™ is intended for percutaneous insertion into the peritoneal cavity for the purpose of insufflation with carbon dioxide, to establish pneumoperitoneum prior to the placement of trocars during laparoscopic procedures.

Device Description

The Gynetech InsufflatOR Needle is a sterile disposable Veress needle which is available in 120mm or 150mm length. The device is equipped with a spring-loaded, round-tipped obturator. In addition, there is a "slide switch" which permits easy ON-OFF control of gas flow. The most proximal end contains a male luer lock connector for connection to a CO2 gas line. The InsufflatOR Needle has applications in gynaecological laparoscopy and other laparoscopic procedures.

AI/ML Overview

The provided document describes the Gynetech InsufflatOR Needle, a Veress needle for establishing pneumoperitoneum during laparoscopic procedures. The submission is for a 510(k) premarket notification, claiming substantial equivalence to a predicate device, the GeniCon Pneumo-Needle (K993625).

The document does not contain the detailed information requested regarding acceptance criteria and a study proving the device meets those criteria in the context of an AI/ML medical device. The information provided relates to the substantial equivalence of a physical medical device (InsufflatOR Needle) to a predicate device, focusing on manufacturing specifications, sterilization methods, and basic performance tests relevant to its mechanical function.

Therefore, most of the requested information, which pertains to AI/ML device performance studies, ground truth establishment, sample sizes for training/test sets, expert qualifications, adjudication methods, and MRMC studies, is not present in the provided text.

Based on the available text, here's what can be extracted:

1. A table of acceptance criteria and the reported device performance:

The document mentions that the InsufflatOR Needle was manufactured to the "same exact specifications as the predicate device by GeniCon." It also states, "All testing undertaken to demonstrate substantial equivalence of the requirements of its predetermined acceptance criteria and intended use." However, it does not explicitly list the specific acceptance criteria or the numerical performance results for most of these tests. It lists the types of tests performed.

Acceptance Criteria (Implicit)Reported Device Performance (Implicit)
Tip pull strength/resistanceMeets same exact specifications as predicate device
Switch operation functionalityMeets same exact specifications as predicate device
Spring obturator functionalityMeets same exact specifications as predicate device
Needle puncture forceMeets same exact specifications as predicate device
EtO sterilization validation according to ISO 11135-1:2007Testing conducted and demonstrated substantial equivalence
Ethylene Oxide Sterilisation Residuals according to ISO 10993-7:2008Testing conducted and demonstrated substantial equivalence
Packaging integrity after accelerated agingTesting conducted and demonstrated substantial equivalence
Device functional performance after accelerated agingTesting conducted and demonstrated substantial equivalence

2. Sample size used for the test set and the data provenance:
Not applicable as this is a physical device, not an AI/ML algorithm requiring a data test set in the traditional sense. The "test set" described refers to physical devices undergoing functional and sterility testing. The sample size for these specific physical tests is not mentioned. Data provenance (country of origin, retrospective/prospective) is not relevant for this type of device submission.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts:
Not applicable. Ground truth as typically understood for AI/ML devices is not relevant here. The "ground truth" for this device would be its physical and functional specifications.

4. Adjudication method (e.g., 2+1, 3+1, none) for the test set:
Not applicable for this type of device.

5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance:
Not applicable. This is not an AI-assisted device.

6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done:
Not applicable. This is not an algorithm.

7. The type of ground truth used (expert consensus, pathology, outcomes data, etc.):
Not applicable in the context of AI/ML. For this physical device, the "ground truth" implicitly refers to the established engineering specifications and performance characteristics of the predicate device and relevant international standards (e.g., ISO for sterilization).

8. The sample size for the training set:
Not applicable. This is not an AI/ML device that requires a training set.

9. How the ground truth for the training set was established:
Not applicable.

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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 features the department's name in a circular arrangement around a stylized symbol. The symbol consists of three human profiles facing right, with flowing lines beneath them, representing the department's mission to protect the health of all Americans.

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

December 19, 2014

Gynetech Pty. Ltd. % Kevin MacDonald Clinical/Regulatory Consultant 229 Marvilla Circle Pacifica, CA 94044

Re: K142700 Trade/Device Name: InsufflatOR Needle, 12cm/15cm Regulation Number: 21 CFR 884.1730 Regulation Name: Laparoscopic insufflator Regulatory Class: II Product Code: HIF Dated: November 16, 2014 Received: November 21, 2014

Dear Kevin MacDonald,

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 devicerelated adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in

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the quality systems (OS) 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" (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 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,

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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Section 6: Indications for Use Statement

Indications for Use

510(k) Number (if known): K142700

Device Name: InsufflatOR Needle

Indications for Use:

The InsufflatOR Needle™ is intended for percutaneous insertion into the peritoneal cavity for the purpose of insufflation with carbon dioxide, to establish pneumoperitoneum prior to the placement of trocars during laparoscopic procedures.

Prescription Use X (Part 21 CFR 801 Subpart D)

AND/OR

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

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE OF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

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Image /page/3/Picture/0 description: The image contains the word "gynetec" in a sans-serif font. The first part of the word, "gyne", is in blue, while the second part, "tec", is in gray. To the right of the word is a stylized blue letter "g" surrounded by a pattern of blue dots.

Section 7: 510(k) Summary

This 510(k) summary is being submitted in accordance with the requirements of SMDA and 21CFR § 807.92(c).

Submitted by:Gynetech Pty Ltd
122-124 Balmain Street, Richmond VIC 3121, Australia
Phone: +61 3 9413 5555
Contact email: qa@gynetech.com.au
Fax: +61 3 9413 5555
Contact PersonKevin MacDonald
Clinical/Regulatory Consultant
229 Marvilla Circle
Pacifica, CA 94044
Phone: 415-609-9875
Email: k-macdonald@sbcglobal.net
Date Prepared:December 17, 2014
Proprietary Name:InsufflatOR Needle
Common Name:Veress Needle
Classification:ll
Regulation Number:884.1730
Regulation Name:Laparoscopic insufflator
Panel:Obstetrics/Gynecology
Product Code:HIF
Predicate Devices:GeniCon Pneumo-Needle (K993625)
Device Description:The Gynetech InsufflatOR Needle is a sterile disposable Veress needle which is
available in 120mm or 150mm length. The device is equipped with a spring-loaded,
round-tipped obturator. In addition, there is a "slide switch" which permits easy ON-
OFF control of gas flow. The most proximal end contains a male luer lock connector
for connection to a CO2 gas line. The InsufflatOR Needle has applications in
gynaecological laparoscopy and other laparoscopic procedures.
Indications for Use:The InsufflatOR Needle™ is intended for percutaneous insertion into the peritoneal
cavity for the purpose of insufflation with carbon dioxide, to establish
pneumoperitoneum prior to the placement of trocars during laparoscopic procedures.

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Image /page/4/Picture/0 description: The image contains the word "gynetech" in blue and gray font. The word "gyne" is in blue, and the word "tech" is in gray. To the right of the word is a blue circle made of dots with a white "g" in the center.

Comparison of Subject Device to Predicate Device
AttributeInsufflatOR NeedleGeniCon Pneumo-Needle
510(k) numberK142700K993625
Regulation Number884.1730884.1730
ClassificationClass IIClass II
Classification NameInsufflator, LaparoscopicInsufflator, Laparoscopic
Product Code andClassification PanelHIFObstetrics/Gynecology PanelHIFObstetrics/Gynecology Panel
ManufacturerAdvanced Medical Design International LLC (see EstablishmentRegistration Details in Attachment 5)Same
DescriptionThe Gynetech InsufflatOR Needle is a sterile and single useproduct. It incorporates a spring loaded blunt style mechanism.It is used to establish pneumoperitoneum prior to trocar andcannula insertion during laparoscopic procedures. TheInsufflatOR Needle is available in 120mm and 150mm lengthsand has applications in gynaecological laparoscopy and otherlaparoscopic procedures.The GeniCon Pneumo-Needle is a sterile disposableVeress needle which is available in 120mm or150mm length. The device is equipped with a spring-loaded, round-tipped obturator. In addition, there isa "slide switch" which permits easy ON-OFF controlof gas flow. The most proximal end contains a maleluer lock connector for connection to a CO2 gas line.
Indications for UseThe InsuffaltOR Needle™ is intended for percutaneous insertioninto the peritoneal cavity for the purpose of insufflation withcarbon dioxide, to establish pneumoperitoneum prior to theplacement of trocars during laparoscopic procedures.Same
Anatomical sitesAbdominalSame
Consisted InstrumentsVeress NeedleObturatorSame
MaterialsHub - Model grade PCGas Trap - High density Polyethylene (HDPE)Same

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Image /page/5/Picture/0 description: The image shows the logo for "Gynetech". The word "gyne" is in blue, and the word "tech" is in gray. To the right of the word is a blue circle made of dots, with a white "g" in the center.

Comparison of Subject Device to Predicate Device
AttributeInsufflatOR NeedleGeniCon Pneumo-Needle
Shaft - Stainless Steel 304 (Inner shaft 1.6135 / Outer shaft 2.1131)Spring - Stainless steel and ABS pink
DimensionsLength: 120mm or 150mmSame
Performance StandardsNot ApplicableNot Applicable
Sterilization methodEthylene OxideGamma radiation
PackagingTyvek pouchSame

Performance Data

The contract manufacturer, Advanced Medical, LLC, manufactures the InsufflatOR Needle to the same exact specifications as the predicate device by GeniCon. This includes specifications for:

  • . Tip pull test
  • . Switch operation test
  • Spring obturator test
  • Needle puncture force test

To evaluate the change in sterilization method, the following tests were conducted on the InsufflatOR Needle:

  • EtO Sterilization Validation in accordance with ISO 11135-1:2007 Sterilisation of Healthcare Products Ethylene Oxide ●
  • Ethylene Oxide Sterilisation Residuals, ISO 10993-7:2008 Biological Evaluation of Medical Devices .
  • . Packaging integrity and device functional performance testing following accelerated aging.

Conclusion:

All testing undertaken to demonstrate substantial equivalence of the requirements of its predeternined acceptance criteria and intended use. The acceptance criteria and intended use of the Gynetech Insufflat to the predicate device. These test results confirm that the Gynetech InsufflatOR Needle is as safe and effective as the predicate device.

§ 884.1730 Laparoscopic insufflator.

(a)
Identification. A laparoscopic insufflator is a device used to facilitate the use of the laparoscope by filling the peritoneal cavity with gas to distend it.(b)
Classification. (1) Class II (performance standards).(2) Class I for tubing and tubing/filter kits which include accessory instruments that are not used to effect intra-abdominal insufflation (pneumoperitoneum). 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 § 884.9.