K Number
K143705
Device Name
NeedleCam HD Visualization System
Date Cleared
2015-02-20

(53 days)

Product Code
Regulation Number
888.1100
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
NeedleCam HD™ Visualization System Indications for Use: The NeedleCam HD™ Visualization System is indicated to be used by a trained physician to provide illumination and visualization of an interior cavity of the body through a natural or surgical opening in diagnostic and operative arthroscopic and endoscopic procedures. Examples of surgical use include but are not limited to procedures on the knee, shoulder, ankle, elbow, wrist, temporomandibular joint (TMJ), spinal, ophthalmic, ENT, and the cervix.
Device Description
NeedleCam HDTM Visualization System is comprised of an Image Capture Box, a Camera Handpiece (including an LED light source) that captures still images and full resolution video, and External Power Supply. The camera has a quick-release optical connector that adapts to a wide variety of Bio Vision Technologies' surgical endoscopes. The device is used with an endoscope to visualize and illuminate an interior cavity of the body through a natural or surgical opening in diagnostic and operative arthroscopic and endoscopic procedures.
More Information

No
The document describes a standard endoscopic visualization system with image processing capabilities, but there is no mention of AI or ML algorithms being used for analysis, interpretation, or other functions.

No.
The device is indicated for visualization and illumination during diagnostic and operative procedures, not for directly treating a disease or condition.

Yes
The "Intended Use / Indications for Use" section explicitly states that the system is used "in diagnostic and operative arthroscopic and endoscopic procedures," indicating its involvement in the diagnostic process.

No

The device description explicitly lists hardware components such as an Image Capture Box, Camera Handpiece (including an LED light source), and External Power Supply.

Based on the provided information, the NeedleCam HD™ Visualization System is not an IVD (In Vitro Diagnostic) device.

Here's why:

  • IVD devices are used to examine specimens derived from the human body (like blood, urine, tissue) outside of the body. The NeedleCam HD™ Visualization System is used to visualize the interior of the body in situ (in its original place).
  • The intended use clearly states it's for providing illumination and visualization of an interior cavity of the body through a natural or surgical opening. This is a direct visualization tool used during surgical and diagnostic procedures on the patient.
  • The device description reinforces this by explaining it's used with an endoscope to visualize and illuminate an interior cavity of the body.

Therefore, the NeedleCam HD™ Visualization System falls under the category of a surgical/endoscopic visualization system, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The NeedleCam HD™ Visualization System is indicated to be used by a trained physician to provide illumination and visualization of an interior cavity of the body through a natural or surgical opening in diagnostic and operative arthroscopic and endoscopic procedures. Examples of surgical use include but are not limited to procedures on the knee, shoulder, ankle, elbow, wrist, temporomandibular joint (TMJ), spinal, ophthalmic, ENT, and the cervix.

Product codes

HRX, GCJ

Device Description

NeedleCam HDTM Visualization System is comprised of an Image Capture Box, a Camera Handpiece (including an LED light source) that captures still images and full resolution video, and External Power Supply. The camera has a quick-release optical connector that adapts to a wide variety of Bio Vision Technologies' surgical endoscopes. The device is used with an endoscope to visualize and illuminate an interior cavity of the body through a natural or surgical opening in diagnostic and operative arthroscopic and endoscopic procedures.

Mentions image processing

Yes

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Optical

Anatomical Site

Interior cavity of the body through a natural or surgical opening. Examples of surgical use include but are not limited to procedures on the knee, shoulder, ankle, elbow, wrist, temporomandibular joint (TMJ), spinal, ophthalmic, ENT, and the cervix.

Indicated Patient Age Range

Not Found

Intended User / Care Setting

trained physician / Hospital / Doctor's office

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)

Establishment of equivalence is based on similarities of intended use, design, physical characteristics and geometry between the BioVision NeedleCam HD™ Visualization System and its predicate device -BioVision SurgView™ Visualization System (K082293).

Safety testing was completed to ANSI/AAMI ES 60601-1:2005 (3rd edition) on the BioVision NeedleCam HD™ Visualization System. Additionally software validation was completed on the system.

Clinical testing was not used to prove substantial equivalence. Establishment of equivalence is based on similarities of intended use, design, physical characteristics and geometry between the BioVision Needle Cam HD and its predicate device.

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

Not Found

Predicate Device(s)

K082293

Reference Device(s)

K141326

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 888.1100 Arthroscope.

(a)
Identification. An arthroscope is an electrically powered endoscope intended to make visible the interior of a joint. The arthroscope and accessories also is intended to perform surgery within a joint.(b)
Classification. (1) Class II (performance standards).(2) Class I for the following manual arthroscopic instruments: cannulas, currettes, drill guides, forceps, gouges, graspers, knives, obturators, osteotomes, probes, punches, rasps, retractors, rongeurs, suture passers, suture knotpushers, suture punches, switching rods, and trocars. 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 § 888.9.

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

February 20, 2015

BioVision Technologies, LLC Mr. David Sanso President 221 Corporate Circle, Unit H Golden, Colorado 80401

Re: K143705

Trade/Device Name: NeedleCam HD" Visualization System Regulation Number: 21 CFR 888.1100 Regulation Name: Arthroscope Regulatory Class: Class II Product Code: HRX, GCJ Dated: January 29, 2015 Received: January 30, 2015

Dear Mr. Sanso:

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 device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set

1

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.

Jennifer R. Stevenson -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

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DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

510(k) Number (if known) K143705

Device Name NeedleCam HDTM Visualization System

Indications for Use (Describe) NeedleCam HDTM Visualization System

Indications for Use: The NeedleCam HD™ Visualization System is indicated to be used by a trained physician to provide illumination and visualization of an interior cavity of the body through a natural or surgical opening in diagnostic and operative arthroscopic and endoscopic procedures. Examples of surgical use include but are not limited to procedures on the knee, shoulder, ankle, elbow, wrist, temporomandibular joint (TMJ), spinal, ophthalmic, ENT, and the cervix.

This is the same intended use as for a previously cleared device - the BioVision Technologies SurgView™ Integrated Visualization System (K082293).

| Mother France

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)

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Visualizing Better Care

Image /page/3/Picture/1 description: The image shows the logo for BioVision Technologies, LLC. The logo features the word "BIO" in gray, with an eye symbol incorporated into the "O". Below "BIO" is the word "VISION" in teal, underlined with a teal line. To the right of "VISION" is the text "Technologies, LLC" in a smaller font, also in teal.

221 Corporate Circle, Suite Golden, Colorado 80401 USA Phone: 303-237-9608 • Fax: 303-237-0757 www.biovisiontech.com

Needle Cam HD™ Visualization System Special 510(k) Submission

SPECIAL 510(k) SUMMARY

Submission Information

  • Date Prepared: December 22, 2014 Applicant: BioVision Technologies, LLC. Address: 221 Corporate Circle Unit H
  • Telephone Number: 303-237-9608
  • Submitter's Contact: David Sanso, President

Device Information

Proprietary Name:NeedleCam HD™ Visualization System
Common Name:Arthroscope/Endoscope
Classification Name:Arthroscope / Endoscope and Accessories
Regulation Number:21 CFR §888.1100, HRX
21 CFR §876.1500, GCJ
Regulatory Class:II

Golden, Colorado 80401

Predicate Device

BioVision Technologies SurgView™ Integrated Visualization System (K082293)

Device Description

Name of the Device: NeedleCam HD™ Visualization System

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NeedleCam HDTM Visualization System is comprised of an Image Capture Box, a Camera Handpiece (including an LED light source) that captures still images and full resolution video, and External Power Supply. The camera has a quick-release optical connector that adapts to a wide variety of Bio Vision Technologies' surgical endoscopes. The device is used with an endoscope to visualize and illuminate an interior cavity of the body through a natural or surgical opening in diagnostic and operative arthroscopic and endoscopic procedures.

The BioVision endoscopes and supplemental instruments that were approved with the predicate SurgView Visualization System have not been changed.

Statement of Intended Use

The system is indicated to be used by a trained physician to provide illumination and visualization of an interior cavity of the body through a natural or surgical opening in diagnostic and operative arthroscopic and endoscopic procedures. Examples of surgical use include but are not limited to procedures on the knee, shoulder, ankle, elbow, wrist, temporomandibular joint (TMJ), spinal, ophthalmic, ENT, and the cervix.

NeedleCam HD System Components and Accessories

The NeedleCam HD Visualization System is intended to be used with BioVision endoscopes. The following is a listing of the current compatible scopes, along with the applicable 510(k) clearance numbers.

Part NumberDescription510(k) Number
BVTKIT72-0L065OnPoint 0 deg, 65mm Scope kit (including scope, cannula, obturator, trocar and plug)K082293
BVTKIT72-0L165BioVision NeedleView 0 deg, 65mm Scope kit (including scope, cannula, obturator, trocar and plug)K082293
BVTKIT72-0L1A0BioVision NeedleView 0 deg, 100mm Scope kit (including scope, cannula, obturator, trocar and plug)K082293
BVTKIT72-1R165BioVision NeedleView 10 deg, 65mm Scope kit (including scope, cannula, obturator, trocar and plug)K082293
BVTKIT72-1R1A0BioVision NeedleView 10 deg, 100mm Scope kit (including scope, cannula, obturator, trocar and plug)K082293
BVTKIT72-1R265InnerVue II 10 deg, 65mm Scope kit (including scope, cannula, obturator, trocar and plug)K082293
BVTKIT72-1R2A0InnerVue II 10 deg, 100mm Scope kit (including scope, cannula, obturator, trocar and plug)K082293

It is the responsibility of the user to verify that this copy is of the latest revision. This document is maintained on electronic media, the current revision of this document is located on BioVision Technologies' network.

This document is the property of BioVision Technologies and is proprietary and confidential. Distribution of external copies must have prior consent from BioVision Technologies.

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| BVTKIT75-3R165 | BioVision NeedleView 30 deg, 65mm Scope kit
(including scope, cannula, obturator, trocar and plug) | K082293 |
|----------------|------------------------------------------------------------------------------------------------------------------------|---------|
| BVTKIT75-3R1A0 | BioVision NeedleView 30 deg, 100mm Scope kit
(including scope, cannula, obturator, trocar and plug) | K082293 |
| BVTKIT82-34001 | BioVision NeedleView CH 3.4mm Scope Kit
(including scope, cannula, dilator, tuohy needles,
scalpel and guidewire | K141326 |

Comparison to Predicate Device

The table below shows relevant similarities and differences between the NeedleCam HD™ Visualization System and its predicate device - SurgView™ Integrated Visualization System (K082293).

APPLICANT DEVICE:NeedleCam HD™ Visualization System
PREDICATE DEVICE:SurgView™ Visualization System (K082293)
NOTE:Relevant similarities are identified in bold text.
Relevant differences are identified in underlined text
I. GENERAL CHARACTERISTICSPREDICATE DEVICE
ITEMFEATURENeedleCam HD Visualization SystemSurgView™ Visualization System K082293
1Device DescriptionNeedleCam HD Visualization System is a
video endoscope/arthroscope imaging system
consisting of the following components:
  1. An Image Capture Box that includes image
    processor and external power supply)

  2. Camera handpiece including a LED light
    source.

  3. A semi-rigid Fiberoptic Scope in a variety
    of diameters, lengths, and viewing angles.
    Supplemental instruments include a
    cannula, trocar, obturator, and cannula
    plug.

  4. Media Capture USB System

  5. Video Outputs for external monitor | The SurgView™ Visualization System is a
    video endoscope/arthroscope imaging system
    consisting of the following components:

  6. A Light Source/Display/Image Capture
    device that includes an internal monitor,
    image processor, Xenon light source and
    internal power supply.

  7. Camera handpiece.

  8. A semi-rigid Fiberoptic Scope in a variety
    of diameters, lengths, and viewing angles.
    Supplemental instruments for the scope
    include a cannula, trocar, obturator, and
    cannula plug.

  9. Media Capture CF Card System

  10. Video output for external monitor. |
    | 2 | Intended Use | Needle Cam HD™ Visualization System is
    indicated to be used by a trained physician to
    provide illumination and visualization of an
    interior cavity of the body through a natural
    or surgical opening in diagnostic and
    operative arthroscopic and endoscopic
    procedures. Examples of surgical use include
    but are not limited to procedures on the
    knee, shoulder, ankle, elbow, wrist, shoulder,
    temporomandibular joint (TMJ), spinal,
    ophthalmic, ENT, and cervix. | The SurgView™ Visualization System is
    indicated to be used by a trained physician to
    provide illumination and visualization of an
    interior cavity of the body through a natural
    or surgical opening in diagnostic and
    operative arthroscopic and endoscopic
    procedures. Examples of surgical use include
    but are not limited to procedures on the
    knee, shoulder, ankle, elbow, wrist, shoulder,
    temporomandibular joint (TMJ), spinal,
    ophthalmic, ENT, and cervix. |
    | 3 | Materials Used | Plastic enclosure, media capture board,
    plastic camera cable.
    Scopes & instruments - Stainless Steel for
    Scope Shaft; Fiber Optics for light
    transmission | Plastic enclosure, metal plate, media capture
    board, plastic camera cable, and fiber optic
    cable.
    Scopes & instruments - Stainless Steel for
    Scope Shaft; Fiber Optics for light
    transmission |
    | 4 | Labeling (Single
    Use/Reusable) | Image capture box and camera handpiece:
    Reusable.
    Scopes & instruments: Sterile, Single Use | Image capture box and camera handpiece:
    Reusable.
    Scopes & instruments: Sterile, Single Use |
    | 5 | Image acquisition | Image acquisition is achieved through an
    endoscope attached to a camera handpiece.
    The endoscope is in the sterile field while the
    handpiece remains non-sterile. A barrier is
    provided to preserve the sterile field. | Image acquisition is achieved through an
    endoscope attached to a camera handpiece.
    The endoscope is in the sterile field while the
    handpiece remains non-sterile. A barrier is
    provided to preserve the sterile field. |
    | 6 | Connectivity | The endoscope, camera handpiece, cable,
    illumination source and image processor
    connections allow functional coupling of the
    components while providing safe and reliable
    connections, in particular those related to
    electrical safety for the user and patient. The
    endoscope attached to the camera handpiece
    using a quick release connection. The LED
    light source is included in the camera
    handpiece. The camera cable connects to the
    image capture device using a single electrical
    connector. | The endoscope, camera handpiece, cable,
    illumination source and image processor
    connections allow functional coupling of the
    components while providing safe and reliable
    connections, in particular those related to
    electrical safety for the user and patient. The
    endoscope attached to the camera handpiece
    using a quick release connection. The
    fiberoptic bundle is integrated with the camera
    cable. The camera cable connects to the light
    source/image capture device using a single
    hybrid (electrical/optical) connector. |
    | 7 | Image processing | The image is digitally processed to allow
    further manipulation, capture, printing, and
    multiple displays. | The image is digitally processed to allow
    further manipulation, capture, printing, and
    multiple displays. |
    | 8 | Image display (s) | External monitor connection | Internal monitor display with external monitor
    connection. |
    | 9 | Data Entry | Session information entered via external
    keyboard | Session information entered via external
    keyboard |
    | 10 | Data storage | Image and video storage to USB device | Image and video storage to Compact Flash™ cards. |
    | 11 | Where used | Hospital / Doctor's office | Hospital / Doctor's office |
    | II. CHARACTERISTICS OF THE LIGHT SOURCE | | | |
    | ITEM | FEATURE | NeedleCam HD™ Visualization System | SurgView™ Visualization System K082293 |
    | 1 | Illumination | Illumination is achieved via an internal LED light source. The LED light source is an integral part of the device. The LED is internal to the camera handpiece. LED and Xenon usable light output is equivalent. | Illumination is achieved via a fiberoptic bundle attached to the endoscope. The Xenon light source is an integral part of the device. The Xenon light source is internal to the image capture box. LED and Xenon usable light output is equivalent. |
    | 2 | Type of light source | LED | Xenon |
    | 3 | Lamp power rating | 1W | 35W |
    | 4 | Rated lamp life | 20,000 hours | 3,000 hours |
    | 5 | Luminous intensity as measured at scope output | 4-6 lumens | 4-6 lumens |
    | III. CHARACTERISTICS OF THE CAMERA | | | |
    | ITEM | FEATURE | NeedleCam HD™ Visualization System | SurgView™ Visualization System |
    | 1 | Camera sensor | ¼" CCD | ¼" CCD |
    | 2 | Sensor resolution | 768(H) x 494(V) pixels | 768(H) x 494(V) pixels |
    | 3 | Camera resolution | 480 lines, interlaced | 480 lines, interlaced |
    | 4 | Camera sterility | Non sterile. Drape is used for sterile field preservation. | Non sterile. Drape is used for sterile field preservation. |
    | 5 | Endoscope coupler | Built-in | Built-in |

PREDICATE COMPARISON CHART

It is the responsibility of the user to verify that this copy is of the latest revision. This document is mantained on electronic media, the current revision of this document is located on BioVision Technologies' network.

This document is the property of BioVision Technologies and is proprietary and confidential. Distribution of external copies must have prior consent from BioVision Technologies.

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It is the responsibility of the user to verify that this copy is of the latest revision. This document is maintained on electronic media. the current revision of this document is located on BioVision Technologies' network.

This document is the property of BioVision Technologies and is proprietary and confidential. Distribution of external copies must have prior consent from BioVision Technologies.

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Conclusion: Based on the evaluation of the performance characteristics, construction, manufacturing processes, and indications of use, BioVision Technologies has concluded that the BioVision NeedleCam HD ™ Visualization System is substantially equivalent to the predicate device listed in this submission.

The upgrades were completed to incorporate the improved light source options provided by LED lighting. The industry standard for media storage has moved from CF cards to USB technology. Additionally, analog television technology has been replaced by digital television technology.

It is the responsibility of the user to verify that this copy is of the latest revision. This document is maintainedia, the current revision of this document is located on BioVision Technologies' network.

This document is the property of BioVision Technologies and is proprietary and confidential. Distribution of external opies must have prior consent from BioVision Technologies.

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Summary of Technologies

The technological characteristics of the Bio Vision NeedleCam HD™ Visualization System are similar to its predicate device - BioVision SurgView™ Visualization System (K082293). The indications and contraindications listed in this submission are in congruence between these devices. The modifications are incremental changes to the predicate image capture box and camera handpiece that do not affect safety and effectiveness of the modified device. The modifications are the following:

    1. Update the image capture box to the current standard USB storage device;
    1. Update the existing video format to the current digital format.
    1. The camera handpiece has been upgraded with an LED light source.

We believe these modifications are eligible for the Special 510 (k) process since they have the same fundamental scientific technology and intended use as the predicate device.

Performance Testing

Establishment of equivalence is based on similarities of intended use, design, physical characteristics and geometry between the BioVision NeedleCam HD™ Visualization System and its predicate device -BioVision SurgView™ Visualization System (K082293).

Safety testing was completed to ANSI/AAMI ES 60601-1:2005 (3™ edition) on the BioVision NeedleCam HD™ Visualization System. Additionally software validation was completed on the system.

Clinical Testing

Clinical testing was not used to prove substantial equivalence. Establishment of equivalence is based on similarities of intended use, design, physical characteristics and geometry between the BioVision Needle Cam HD and its predicate device.

Conclusion

Based on the evaluation of the performance characteristics, construction, manufacturing processes, and indications of use, Bio Vision Technologies has concluded that the BioVision Needle Cam HD™ Visualization System is substantially equivalent to the predicate device listed above. In all cases, the characteristics of this device are identical or similar to the predicate device as they relate to the intended uses or application. BioVision Technologies has also determined that the modification is an incremental change to the existing device that does not affect safety and effectiveness of the device.

It is the responsibility of the user to verify that this copy is of the latest revision. This document is maintainedia, the current revision of this document is located on BioVision Technologies' network.

This document is the property of BioVision Technologies and is proprietary and confidential. Distribution of external copies must have prior consent from BioVision Technologies.

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