K Number
K143447
Device Name
Dilapan-S
Date Cleared
2015-04-17

(136 days)

Product Code
Regulation Number
884.4260
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Dilapan-S is to be used whenever cervical softening and dilation is desired. Some examples are: - 1. Cervical stenosis - a. related to dysmenorrhea - b. considered a possible cause of infertility - c. resulting from cauterization or conization - 2. Placement and removal of intrauterine devices - 3. Induction of labor - 4. Radium placement - 5. Drainage of uterine cavity - 6. Endometrial biopsy - 7. Uterine curettage - 8. Suction cannula aspiration - 9. Operative hysteroscopy
Device Description
DILAPAN-S is a hygroscopic cervical dilator that is manufactured from AQUACRYL, a proprietary hydrogel. The dilators are firm hygroscopic rods, similar in shape to natural laminaria tents. DILAPAN-S is capable of increasing in diameter on average from three (3) millimeters to 8.3-10 mm, or four (4) millimeters to 10-12.5 millimeters within 4-6 hours as they absorb moisture from the genital tract. In clinical trials, DILAPAN-S has been shown to dilate the cervix gradually. It may not be necessary to use general or local anesthetics during the insertion process, thereby eliminating their associated risks to the patient. A Marker String is tied securely to the handle of the DILAPAN - S, and is provided to indicate location. DILAPAN-S is capable of increasing its volume as it absorbs moisture from the genital tract through hygroscopic action. The volume of DILAPAN-S subsequently exerts radial pressure on the surrounding structures (uterine neck) to dilate progressively. Endocervical pressure on the uterine neck results in mechanical dilation and promotes cervical ripening through reversible cell dehydration and local endogenous prostaglandins release promoting collagen reorganization. DILAPAN-S is available in boxes of 10 or 25 dilators and in the following dimensions: 4mm x 65mm, 4mm x 55mm, 3mm x 55mm. Each DILAPAN - S is individually wrapped in a single foil pouch and is sterilized by gamma radiation.
More Information

Not Found

No
The device description focuses on the physical properties and hygroscopic action of the material for cervical dilation, with no mention of AI or ML technologies.

Yes
The device is used to achieve cervical softening and dilation for various medical indications, directly affecting the body's function for therapeutic purposes like induction of labor or drainage of the uterine cavity.

No

The device description and intended use indicate that Dilapan-S is used for cervical softening and dilation, which are therapeutic or procedural actions, not diagnostic ones.

No

The device description clearly states that DILAPAN-S is a physical, hygroscopic rod made of hydrogel, which is a hardware component. It functions by absorbing moisture and expanding, exerting physical pressure. This is not a software-only device.

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

Here's why:

  • IVD Definition: In vitro diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections. They are used to provide information for diagnosis, monitoring, or screening.
  • Dilapan-S Function: Dilapan-S is a physical device inserted into the cervix to cause mechanical dilation and promote cervical ripening. It works by absorbing moisture and expanding, exerting pressure on the surrounding tissue.
  • Lack of Sample Analysis: The description of Dilapan-S does not involve the analysis of any biological samples from the patient. Its function is purely mechanical and physiological within the body.

Therefore, Dilapan-S is a medical device used for a physical procedure (cervical dilation), not an in vitro diagnostic test.

N/A

Intended Use / Indications for Use

Dilapan-S is to be used whenever cervical softening and dilation is desired. Some examples are:

    1. Cervical stenosis
    • a. related to dysmenorrhea
    • b. considered a possible cause of infertility
    • c. resulting from cauterization or conization
    1. Placement and removal of intrauterine devices
    1. Induction of labor
    1. Radium placement
    1. Drainage of uterine cavity
    1. Endometrial biopsy
    1. Uterine curettage
    1. Suction cannula aspiration
    1. Operative hysteroscopy

Product codes

PKN

Device Description

DILAPAN-S is a hygroscopic cervical dilator that is manufactured from AQUACRYL, a proprietary hydrogel. The dilators are firm hygroscopic rods, similar in shape to natural laminaria tents. DILAPAN-S is capable of increasing in diameter on average from three (3) millimeters to 8.3-10 mm, or four (4) millimeters to 10-12.5 millimeters within 4-6 hours as they absorb moisture from the genital tract.

In clinical trials, DILAPAN-S has been shown to dilate the cervix gradually. It may not be necessary to use general or local anesthetics during the insertion process, thereby eliminating their associated risks to the patient. A Marker String is tied securely to the handle of the DILAPAN - S, and is provided to indicate location.

DILAPAN-S is capable of increasing its volume as it absorbs moisture from the genital tract through hygroscopic action. The volume of DILAPAN-S subsequently exerts radial pressure on the surrounding structures (uterine neck) to dilate progressively. Endocervical pressure on the uterine neck results in mechanical dilation and promotes cervical ripening through reversible cell dehydration and local endogenous prostaglandins release promoting collagen reorganization.

DILAPAN-S is available in boxes of 10 or 25 dilators and in the following dimensions: 4mm x 65mm, 4mm x 55mm, 3mm x 55mm. Each DILAPAN - S is individually wrapped in a single foil pouch and is sterilized by gamma radiation.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

cervical, uterine neck

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)

Comparison testing was performed with Laminaria. Swell testing, expansion force, comparisons of diameter variations and speed of swelling was assessed. Dilapan-S swells to greater diameters and faster rates than Laminaria, and also exerts greater forces during swelling. The safe and effective use of DILAPAN-S has been previously shown in numerous clinical studies. All data submitted demonstrate that DILAPAN-S is as safe and effective, and performs as well as or better than the predicate device.

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

Not Found

Predicate Device(s)

K880196

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 884.4260 Hygroscopic Laminaria cervical dilator.

(a)
Identification. A hygroscopicLaminaria cervical dilator is a device designed to dilate (stretch open) the cervical os by cervical insertion of a conical and expansible material made from the root of a seaweed (Laminaria digitata orLaminaria japonica). The device is used to induce abortion.(b)
Classification. Class II (performance standards).

0

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

April 17, 2015

Medicem Technology SRO % Susanne Parks US Regulatory Consultant 206 Ellington Road Graham, NC 27253

Re: K143447 Trade/Device Name: Dilapan-S Regulation Number: 21 CFR 884.4260 Regulation Name: Hygroscopic luminaria cervical dilator Regulatory Class: II Product Code: PKN Dated: March 11, 2015 Received: March 17, 2015

Dear Susanne Parks,

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

1

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,

Benjamin R. Fisher -S

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

2

Indications for Use

510(k) Number (if known) K143447

Device Name Dilapan-S

Indications for Use (Describe)

Dilapan-S is to be used whenever cervical softening and dilation is desired. Some examples are:

    1. Cervical stenosis
    • a. related to dysmenorrhea
    • b. considered a possible cause of infertility
    • c. resulting from cauterization or conization
    1. Placement and removal of intrauterine devices
    1. Induction of labor
    1. Radium placement
    1. Drainage of uterine cavity
    1. Endometrial biopsy
    1. Uterine curettage
    1. Suction cannula aspiration
    1. Operative hysteroscopy

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

☑ Remediation Use (Part 21 CFR 201 Subpart D)☐ Same Tier Contract Use (21 CFR 201 Subpart C)
----------------------------------------------------------------------------------------------------------------------------------------------------------

Prescription Use (Part 21 CFR 801 Subpart D)

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

CONTINUE ON A SEPARATE PAGE IF NEEDED.

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."

3

Image /page/3/Picture/0 description: The image shows the logo for Medicem Technology. The logo features a stylized letter 'M' in red and blue, resembling a ribbon or wave. Below the symbol, the word 'medicem' is written in a bold, sans-serif font, with 'TECHNOLOGY' in a smaller font size underneath.

510(k) Summary

1. 510(k) owner

NameMedicem Technology s.r.o.
AddressKarlovarska Trida 20
Kamenne Zehrovice
Czech Republic 27301
Telephone Number00420775403437
fax00420317070380
Contact NameAdam Vlcek
Date 510(k) summary preparedApril 17, 2015

2. Device Information

Trade NameDILAPAN-S
Common NameCervical Dilator
Classification NameHygroscopic Laminaria cervical dilator (21
CFR 884.4260)
Regulation ClassClass II
Product CodePKN

3. Legally marketed device claiming substantial equivalence to

MedGyn Laminaria K880196

4. Description of Device:

DILAPAN-S is a hygroscopic cervical dilator that is manufactured from AQUACRYL, a proprietary hydrogel. The dilators are firm hygroscopic rods, similar in shape to natural laminaria tents. DILAPAN-S is capable of increasing in diameter on average from three (3) millimeters to 8.3-10

510(k) Summary Section 005 / Page 1 of 5

4

mm, or four (4) millimeters to 10-12.5 millimeters within 4-6 hours as they absorb moisture from the genital tract.

In clinical trials, DILAPAN-S has been shown to dilate the cervix gradually. It may not be necessary to use general or local anesthetics during the insertion process, thereby eliminating their associated risks to the patient. A Marker String is tied securely to the handle of the DILAPAN - S, and is provided to indicate location.

DILAPAN-S is capable of increasing its volume as it absorbs moisture from the genital tract through hygroscopic action. The volume of DILAPAN-S subsequently exerts radial pressure on the surrounding structures (uterine neck) to dilate progressively. Endocervical pressure on the uterine neck results in mechanical dilation and promotes cervical ripening through reversible cell dehydration and local endogenous prostaglandins release promoting collagen reorganization.

DILAPAN-S is available in boxes of 10 or 25 dilators and in the following dimensions: 4mm x 65mm, 4mm x 55mm, 3mm x 55mm. Each DILAPAN - S is individually wrapped in a single foil pouch and is sterilized by gamma radiation.

5. Intended Use

Dilapan-S is to be used whenever cervical softening and dilation is desired. Refer to section six for a comparison of the Indications for Use with the predicate.

6. Substantial Equivalence Discussion

6.1 Summary of Technological Charactersitics compared to the Predicate

DILAPAN-S has been designed as a synthetic bioanalogic dilator to improve upon the natural sea plant Laminaria Japonica contained in our predicate device. Below is a comparison:

DescriptorSubject device (K143447)Predicate device (K880196)
Device nameDilapan-SLaminaria
Regulation
number§884.4260§884.4260
Product codePKNHDY
IndicationsDilapan-S is to be used whenever
cervical softening and dilation is
desired. Some examples are:
  1. Cervical stenosis
    a. related to dysmenorrhea
    b. considered a possible cause of
    infertility
    c. resulting from cauterization or
    conization
  2. Placement and removal of
    intrauterine devices | Laminaria should be considered
    wherever cervical dilation and/or
    softening of the cervix is desired. Some
    examples are:
  3. Cervical stenosis
    a. Related to dysmenorrhea
    b.Considered a possible cause of
    infertility
    c. Resulting from cauterization or
    conization
  4. Placement and removal of |

5

3. Induction of laborintrauterine devices
4. Radium placement3. Induction of labor
5. Drainage of uterine cavity4. Radium placement
6. Endometrial biopsy5. Drainage of uterine cavity
7. Uterine curettage6. Endometrial biopsy
8. Suction cannula aspiration7. Uterine curettage
9. Operative hysteroscopy8. Suction cannula aspiration
Mode of actionSame as the predicate device1) By its absorption of fluid from the surrounding cervical tissue it expands in its diameter and dilates the cervical canal by exerting a radial pressure.
2) By pressure on cervical tissue it stimulates the endogenous prostaglandin production by initiating thearachidonic acid cascade causing collagen degradation which softens the cervix
DesignRod of aquacryl is glued into a polypropylene handle. Signal String from surgical suture is attached to the handle.Dried laminaria tent is drilled and attached to a 75-95 mm signal string
Size3x55 mm2 mm (Extra Small or Thin)
4x55 mm3 mm (Small or Thin)
4x65 mm4 mm (Medium)
5 mm (Large or Thick)
6 mm (Extra Large or Thick)
8 mm (Jumbo)
10 mm (Extra Jumbo)
Maximal time in situSame as the predicate device24 hours
Key performance specificationsTime in situ (hours)Expected dilation (in mm)Maximal dilation and softening occurs within about 12 hours
3 mm (dry)4 mm (dry)
27.2-8.37.8-10.0
48.4-9.510.0-11.2
69.0-10.011.1-12.5
249.6-11.312.7-14.6
MaterialActive part - Synthetic hydrogel (Aquacryl 90)
Signal string - Surgical suture
Handle - PolypropyleneActive part - Dried seaweed of Laminaria Japonica
Signal string - Unknown material

The subject and predicate devices have the same general Indications for Use (IFU) and .

6

examples of specific procedures, except that the subject device has an additional example - operative hysteroscopy. The difference does not raise any new types of questions because operative hysteroscopy is an established gynecological procedure. The difference raises a safety and effectiveness concern, but the clinical literature supports use of Dilapan-S for operative hysteroscopy.

  • . Technological characteristics - Mode of action Both subject and predicate devices are hygroscopic cervical dilators. They have the following same modes of action
      1. By absorption of fluid from the surrounding cervical tissue, they expand in diameter and dilate the cervical canal by exerting a radial pressure.
      1. By putting pressure on cervical tissue, they stimulate the endogenous prostaglandin production by initiating the thearachidonic acid cascade, causing collagen degradation, which softens the cervix.
  • . Technological characteristics - Design

The subject device has three components (active part, handle, and signal string) whereas the predicate device has two components (active part and signal string). The difference raises a concern on the joint strength of the rod (active part)-handle and handle-signal string. However, joint strength is not a new type of question, because it is also associated with the predicate device and other hygroscopic cervical dilators. Also, there are wellestablished methods to evaluate joint strength. The company has provided sufficient mechanical engineering data to demonstrate that the subject device is safe and effectiveness.

  • Technological characteristics Size .
    The subject device has three sizes with two diameters (3 mm and 4 mm), whereas the predicate device is available with seven (7) different diameters (2-10 mm). The difference does not raise any concerns because the subject device has a larger expansion force and can be used with multiple units at the same time. Clinical performance data show that the subject device, with narrowed dry diameter range, is as safe and effective as the laminaria devices.

  • Technological characteristics Key performance specifications . Comparison of this parameter cannot be done, because we do not have data on the predicate device. However, clinical performance data show that the subject device is safe and effective.

  • . Technological characteristics - Material The subject device is made of synthetic hydrogel (Aquacryl 90) whereas the predicate device is manufactured with laminaria materials. The difference raises safety and effectiveness concerns; however, there are no new types of questions. The safety can be addressed by well-accepted biocompatibility testing, and the company has provided sufficient biocompatibility information. The effectiveness can be addressed by bench and clinical testing. The company has provided sufficiency mechanical performance data and clinical literature to establish the effectiveness of the subject device.

Summary of Non-Clinical and Clinical Performance Data to support determination of 6.2 substantial equivalence

Page 4 of 5

7

DILAPAN-S has been subjected to all biocompatibility tests as required by ISO 10993-1. Validation for sterilization including shelf life studies have been performed.

Comparison testing was performed with Laminaria. Swell testing,expansion force, comparisons of diameter variations and speed of swelling was assessed. Dilapan-S swells to greater diameters and faster rates than Laminaria, and also exerts greater forces during swelling.

The safe and effective use of DILAPAN-S has been previously shown in numerous clinical studies.

All data submitted demonstrate that DILAPAN-S is as safe and effective, and performs as well as or better than the predicate device.