K Number
K152743
Device Name
M/L-10 CLIP APPLIER STERILIZATION TRAY (Catalog#3706)
Date Cleared
2016-02-08

(138 days)

Product Code
Regulation Number
880.6850
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Microline Surgical M/L-10 Clip Applier Sterilization Tray (Catalog# 3706) is intended to protect the M/L-10 Clip Applier handpiece (Catalog #1002) and to facilization process by allowing steam penetration and air removal. When used in conjunction with 2 layers of FDA-cleared 1-ply polypropylene sterilization wrap, sterility of the enclosed sterilization tray (Catalog# 3706) is maintained until used. The Microline Surgical M/L-10 Clip Applier Sterilization Tray (Catalog# 3706) is used to secure the M/L-10 Clip Applier handpiece (Catalog #1002) which measures at 17.13" length, and 0.90"width in dimensional measurements, as the intended load during the transport, sterilization and storage between its intended uses. The ML-10 Clip Applier Sterilization Tray (Catalog# 3706) has been validated with the M/L-10 Clip Applier handpiece (Catalog #1002) wrapped in 2 layers of FDA-cleared 1-ply polypropylene wrap weighing a calculated total weight of 1663.10 grams. The M/L-10 Clip Applier Sterilization Tray (Catalog# 3706) has been validated with the following Steam Sterilization Parameters: Pre-vacuum, Time: 4 minutes at Temperature of 132 °C. The Gravity Cycle parameters include: Time: 15 minutes and Temperature of 132 °C.
Device Description
Microline Surgical MIL-10 Clip Applier Sterilization Tray (Catalog #3706) intended purpose is to secure the M/L-10 Clip Applier device during its transportation, sterilization, and storage purposes. The subject device ML - 10 Clip Applier Sterilization #3706) consists of a case, a cover and brackets. The MIL-10 Clip Applier Sterilization Tray (Catalog #3706) Lid is 19.875" (Width) x .450" (Height); and the Base is 19.875" (Length) x 5.50" (Width) x 1.450" (Height) in dimensions. The ML-10 Clip Applier Sterilization Tray (Catalog #3706) cover and lid (case) are constructed of Stainless Steel material, which could be reused with Steam Sterilization method. The brackets are constructed from Aluminum, Stainless Steel, and biomedical grade Silicone. The ML-10 Clip Applier Sterilization Tray surface is coated with Nylon Coating Powder. The sterilization tray cover is secured to the case by means of assembled hardware and a locking tab, designed as part of the case and cover have an evenly distributed hole pattern in relation to the tray size to support the steam sterilization process. The brackets are designed to secure the ML-10 Clip Applier for sterilization purpose. The subject device MIL-10 Clip Applier Sterilization Tray is non-patient and non-blood/fluid contact during its intended use. The ML - 10 Clip Applier Sterlization Tray (Catalog #3706) is a metal tray and packaged in bubble wrap, single wall, 32 lbsfinch edge, crushed corrugated brown cardboard shipping box, which does not need any special handling requirements during shipment.
More Information

Not Found

No
The device is a sterilization tray, a passive mechanical device for holding and sterilizing a clip applier. The description focuses on materials, dimensions, and sterilization parameters, with no mention of software, algorithms, or data processing.

No
The device is a sterilization tray for a clip applier, designed to protect the applier during transport, sterilization, and storage. It does not directly treat or diagnose a medical condition.

No

The device description clearly states its purpose is to "secure the M/L-10 Clip Applier device during its transportation, sterilization, and storage purposes." It is a sterilization tray, not a device used to diagnose medical conditions.

No

The device is a physical sterilization tray made of stainless steel, aluminum, and silicone, designed to hold a clip applier during sterilization and storage. It is clearly a hardware device.

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

Here's why:

  • Intended Use: The intended use is to protect, secure, and facilitate the sterilization of a surgical clip applier handpiece. This is a function related to the preparation and maintenance of a surgical instrument, not the diagnosis of a disease or condition using in vitro methods.
  • Device Description: The description details a metal tray with a lid and brackets designed to hold a surgical instrument during sterilization and storage. This aligns with a medical device accessory for sterilization, not an IVD.
  • Lack of IVD Characteristics: The text does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological samples (blood, urine, tissue, etc.)
    • Detecting or measuring analytes
    • Providing information for diagnosis, monitoring, or screening of diseases
    • Reagents, calibrators, or controls

The device's purpose is purely related to the physical handling and sterilization of a surgical instrument.

N/A

Intended Use / Indications for Use

Microline Surgical M/L-10 Clip Applier Sterilization Tray (Catalog# 3706) is intended to protect the M/L-10 Clip Applier handpiece (Catalog #1002) and to facilitate the sterilization process by allowing steam penetration and air removal. When used in conjunction with 2 layers of FDA-cleared 1-ply polypropylene sterilization wrap, sterility of the enclosed sterilization tray (Catalog# 3706) is maintained until used.

The Microline Surgical M/L-10 Clip Applier Sterilization Tray (Catalog# 3706) is used to secure the M/L-10 Clip Applier handpiece (Catalog #1002) which measures at 17.13" length, and 0.90"width in dimensional measurements, as the intended load during the transport, sterilization and storage between its intended uses.

The ML-10 Clip Applier Sterilization Tray (Catalog# 3706) has been validated with the M/L-10 Clip Applier handpiece (Catalog #1002) wrapped in 2 layers of FDA-cleared 1-ply polypropylene wrap weighing a calculated total weight of 1663.10 grams. The M/L-10 Clip Applier Sterilization Tray (Catalog# 3706) has been validated with the following Steam Sterilization Parameters: Pre-vacuum, Time: 4 minutes at Temperature of 132 °C. The Gravity Cycle parameters include: Time: 15 minutes and Temperature of 132 °C.

Product codes (comma separated list FDA assigned to the subject device)

KCT

Device Description

Microline Surgical MIL-10 Clip Applier Sterilization Tray (Catalog #3706) intended purpose is to secure the M/L-10 Clip Applier device during its transportation, sterilization, and storage purposes.

The subject device ML - 10 Clip Applier Sterilization #3706) consists of a case, a cover and brackets. The MIL-10 Clip Applier Sterilization Tray (Catalog #3706) Lid is 19.875" (Width) x .450" (Height); and the Base is 19.875" (Length) x 5.50" (Width) x 1.450" (Height) in dimensions. The ML-10 Clip Applier Sterilization Tray (Catalog #3706) cover and lid (case) are constructed of Stainless Steel material, which could be reused with Steam Sterilization method. The brackets are constructed from Aluminum, Stainless Steel, and biomedical grade Silicone. The ML-10 Clip Applier Sterilization Tray surface is coated with Nylon Coating Powder. The sterilization tray cover is secured to the case by means of assembled hardware and a locking tab, designed as part of the case and cover have an evenly distributed hole pattern in relation to the tray size to support the steam sterilization process. The brackets are designed to secure the ML-10 Clip Applier for sterilization purpose. The subject device MIL-10 Clip Applier Sterilization Tray is non-patient and non-blood/fluid contact during its intended use. The ML - 10 Clip Applier Sterlization Tray (Catalog #3706) is a metal tray and packaged in bubble wrap, single wall, 32 lbsfinch edge, crushed corrugated brown cardboard shipping box, which does not need any special handling requirements during shipment.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Hospital, Operating Room (OR) Use only.

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)

Microline Surgical, Inc., has successfully completed a full sterilization using Steam Sterilization method in accordance to AAMI TIR12:2010 - Designing, testing, and labeling reusable medical devices for reprocessing in health care facilities; and EN ISO 17664:2004 - Sterilization of medical devices - Information to be provided by the manufacturer for the processing of resterilizable medical devices. The acceptance criteria required that the sterilization methods demonstrate a sterility assurance level (SAL) of 106 using the biological indicator (BI) overkill method, which met as required. The sterilization testing and limits of reuse of the device, design tolerance andysis and shelf-life validation were completed. The subject device MIL-10 Clip Applier Sterilization Tray (Catalog #3706), is substantially equivalent to its predicate device in terms of fundamental technology, materials and design and meets the identical design inputs and output requirements. As the subject device, ML-10 Clip Applier Sterilization Tray (Catalog #3706) will be fully contract manufactured, assembled and packaged by contract manufacturer MEDIN Corporation (Registration Number: 3011296511), any new validation testing including biocompatibility, bench testing including new validation or documentation pertaining to design for assembly and packaging by Microline Surgical, Inc., were not deemed necessary.

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

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K980065

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 880.6850 Sterilization wrap.

(a)
Identification. A sterilization wrap (pack, sterilization wrapper, bag, or accessories, is a device intended to be used to enclose another medical device that is to be sterilized by a health care provider. It is intended to allow sterilization of the enclosed medical device and also to maintain sterility of the enclosed device until used.(b)
Classification. Class II (performance standards).

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

February 8, 2016

Microline Surgical, Inc. Anu Gaur, Ph.D., MBA, MSRA, RAC Regulatory Affairs Manager 50 Dunham Road, Suite 1500 Beverly, Massachusetts 01915

Re: K152743

Trade/Device Name: M/L-10 Clip Applier Sterilization Tray (Catalog #3706) Regulation Number: 21 CFR 880.6850 Regulation Name: Sterilization Wrap Regulatory Class: Class II Product Code: KCT Dated: December 17, 2015 Received: December 18, 2015

Dear Dr. Anu Gaur:

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

1

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/Resourcesfor You/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,

Tejashri Purohit-Sheth, M.D.

Tejashri Purohit-Sheth, M.D. Clinical Deputy Director DAGRID/ODE/CDRH FOR

Erin I. Keith, M.S. Director Division of Anesthesiology, General Hospital, Respiratory, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known) K152743

Device Name

M/L- 10 Clip Applier Sterilization Tray (Catalog# 3706)

Indications for Use (Describe)

Microline Surgical M/L-10 Clip Applier Sterilization Tray (Catalog# 3706) is intended to protect the M/L-10 Clip Applier handpiece (Catalog #1002) and to facilization process by allowing steam penetration and air removal. When used in conjunction with 2 layers of FDA-cleared 1-ply polypropylene sterilization wrap, sterility of the enclosed sterilization tray (Catalog# 3706) is maintained until used.

The Microline Surgical M/L-10 Clip Applier Sterilization Tray (Catalog# 3706) is used to secure the M/L-10 Clip Applier handpiece (Catalog #1002) which measures at 17.13" length, and 0.90"width in dimensional measurements, as the intended load during the transport, sterilization and storage between its intended uses.

The ML-10 Clip Applier Sterilization Tray (Catalog# 3706) has been validated with the M/L-10 Clip Applier handpiece (Catalog #1002) wrapped in 2 layers of FDA-cleared 1-ply polypropylene wrap weighing a calculated total weight of 1663.10 grams. The M/L-10 Clip Applier Sterilization Tray (Catalog# 3706) has been validated with the following Steam Sterilization Parameters: Pre-vacuum, Time: 4 minutes at Temperature of 132 °C. The Gravity Cycle parameters include: Time: 15 minutes and Temperature of 132 °C.

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)☐ Prescription Use (Part 21 CFR 801 Subpart D)☑ Over-The-Counter Use (21 CFR 801 Subpart C)
☐ Prescription Use (Part 21 CFR 801 Subpart D)
☑ Over-The-Counter Use (21 CFR 801 Subpart C)

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Image /page/3/Picture/0 description: The image shows the logo for Microline Surgical. The logo has the word "MICROLINE" in gray, with a teal four-leaf clover symbol in the middle of the word. Below the word "MICROLINE" is the word "SURGICAL" in gray.

Traditional 510(k) Summary [As Required by 21 CFR § 807.92]

| 510(k) Submitter: | Microline Surgical, Inc.
50 Dunham Road, Suite 1500
Beverly, MA 01915
USA |
|------------------------------------|-------------------------------------------------------------------------------------------------------------------------|
| Establishment Registration Number: | 1223422 |
| Contact Representative: | Anu Gaur, Ph.D., MBA, MSRA, RAC
Requlatory Affairs Manager
Phone: 978-867-1726
Fax: 978-922-9209 |
| Date Prepared: | February 1, 2016 |
| Trade Name: | M/L-10 Clip Applier Sterilization Tray
[Catalog # 3706] |
| Common Name: | Sterilization Cassette |
| Classification: | Class II, in accordance to 21 CFR § 880.6850
Sterilization Wrap Containers, Trays, Cassettes &
Other Accessories. |
| Classification Product Code(s): | КСТ |
| Regulation Medical Specialty: | General Hospital |
| Predicate Device(s): | C/T Med-Systems Cassette System (K980065) |

Device Description:

Microline Surgical MIL-10 Clip Applier Sterilization Tray (Catalog #3706) intended purpose is to secure the M/L-10 Clip Applier device during its transportation, sterilization, and storage purposes.

The subject device ML - 10 Clip Applier Sterilization #3706) consists of a case, a cover and brackets. The MIL-10 Clip Applier Sterilization Tray (Catalog #3706) Lid is 19.875" (Width) x .450" (Height); and the Base is 19.875" (Length) x 5.50" (Width) x 1.450" (Height) in dimensions. The ML-10 Clip Applier Sterilization Tray (Catalog #3706) cover and lid (case) are constructed of Stainless Steel material, which could be reused with Steam Sterilization method. The brackets are constructed from Aluminum, Stainless Steel, and biomedical grade Silicone. The ML-10 Clip Applier Sterilization Tray surface is coated with Nylon Coating Powder. The sterilization tray cover is secured to the case by means of assembled hardware and a locking tab, designed as part of the case and cover have an evenly distributed hole pattern in relation to the tray size to support the steam sterilization process. The brackets are designed to secure the ML-10 Clip Applier for sterilization purpose. The subject device MIL-10 Clip Applier Sterilization Tray is non-patient and non-blood/fluid contact during its intended use. The ML - 10 Clip Applier Sterlization

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Image /page/4/Picture/0 description: The image shows the logo for Microline Surgical. The logo consists of the word "MICROLINE" in gray, with a teal four-leaf clover symbol in the center. Below the word "MICROLINE" is the word "SURGICAL" in a smaller, gray font.

Tray (Catalog #3706) is a metal tray and packaged in bubble wrap, single wall, 32 lbsfinch edge, crushed corrugated brown cardboard shipping box, which does not need any special handling requirements during shipment.

Statement of Intended Use:

Indications for Use:

Microline Surgical MIL-10 Clip Applier Sterilization Tray (Catalog# 3706) is intended to protect the ML-10 Clip Applier handpiece (Catalog #1002) and to facilitate the sterilization process by allowing steam penetration and air removal. When used in conjunction with 2 layers of FDA-cleared 1-ply polypropylene sterility of the enclosed sterilization tray (Cataloq# 3706) is maintained until used.

The Microline Surgical MIL-10 Clip Applier Sterilization Tray (Catalog# 3706) is used to secure the MIL-10 Clip Applier handpiece (Catalog #1002) which measures at 17.13" length, and 0.90" width in dimensional measurements, as the intended load during the transport, sterilization and storage between its intended uses.

The M/L-10 Clip Applier Sterilization Tray (Catalog# 3706) has been validated with the M/L-10 Clip Applier handpiece (Catalog #1002) wrapped in 2 layers of FDA-cleared 1-ply polypropylene wrap weighing a calculated total weight of 1663.10 grams. The MIL-10 Clip Applier Sterilization Tray (Catalog# 3706) has been validated with the following Steam Sterilization Parameters: Pre-vacuum, Time: 4 minutes at Temperature of 132 °C. The Gravity Cycle parameters include: Time: 15 minutes and Temperature of 132 °C.

Contraindications:

The M/L-10 Clip Applier Sterilization Tray (3706) is not intended for use except as indicated.

Comparison to Predicate Device:

Microline Surgical, Inc., has determined substantial equivalence of the subject device ML-10 Clip Applier Sterilization Tray (Catalog #3706) with its legally marketed predicate device C/T Med-System (K980065) based on the principles of safety and effectiveness applicable to the 510(k) review including the applicable standard and the least burdensome approach. The subject device M1-10 Clip Applier Sterilization Tray (Catalog #3706) is substantially equivalent to its predicate device C/T Med-Systems Cassette System (K980065) including criteria;

  • Selection of the applicable predicate device; O
  • Similarities in the intended use and indication for use; O
  • Similarities in materials for construction of device; o
  • Similarities in performance testing criteria; O
  • O Similarities in the technological characteristics and fundamental technology.
  • Does not raise new questions of safety and effectiveness; and O
  • Demonstrates at least as safe and effective as its legally marketed predicate device. O

The differences between the predicate and the subject device M/L-10 Clip Applier Sterilization Tray (Catalog #3706) is the following:

  • Internal configuration of the MIL-10 Clip Applier Sterilization Tray to secure the MIL-10 Clip Applier device. O
    In summary, the subject device MIL-10 Clip Applier Sterilization Tray (Catalog #3706) is similar in its design, materials, manufacturing, performance, safety, effectiveness, labeling, sterilization, and fundamental technological characteristics as applicable to its legally marketed predicate device C/T Med-Systems Cassette System (K980065).

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Image /page/5/Picture/0 description: The image shows the logo for Microline Surgical. The logo consists of the word "MICROLINE" in a gray sans-serif font, with a teal four-leaf clover symbol in the center. Below the word "MICROLINE" is the word "SURGICAL" in a smaller, gray sans-serif font. The TM symbol is located to the right of the word "LINE".

Summary of Technological Characteristics:

The Microline Surgical M/L-10 Clip Applier Sterilization Tray (Catalog #3706) intended purpose is to secure the M/L-10 Clip Applier device during its transportation, and storage purposes. The subject device ML-10 Clip Applier Sterilization Tray (Catalog #3706) is technologically similar to its legally marketed predicate device C/T Med-Systems Cassette System (K980065). The following pertains to the technological characteristics comparison presented in a tabular format.

CharacteristicsPredicate DeviceSubject Device (Proposed)
Trade NameC/T Med-Systems Cassette SystemMicroline Surgical M/L-10 Clip Applier
Sterilization Tray (Catalog #3706)
510(k) NumberK980065This Submission
510(k) Clearance DateMay 11, 1998Not Applicable
ClassificationClass II
21 CFR § 880.6850Class II
21 CFR § 880.6850
Classification NameSterilization Wrap Containers, Trays,
Cassettes & other Accessories.Sterilization Wrap Containers, Trays,
Cassettes & other Accessories.
Classification Product CodeKCTKCT
Common NameSterilization CassetteSterilization Cassette
Regulation Medical SpecialtyGeneral HospitalGeneral Hospital
Environment of UseHospital, Operating Room (OR),
Physician and dental office or place
where instruments are sterilized.Hospital, Operating Room (OR) Use
only.
Intended Use
(Indication for Use)General dental/medical instrument
cassettes intended to hold instruments
and accessories in place throughout the
entire instrument use, cleaning and
sterilization cycle. These cassettes are
suitable for Gravity Steam, Pre-vacuum
steam and EO sterilization.Microline Surgical M/L-10 Clip Applier
Sterilization Tray (Catalog# 3706) is
intended to protect the M/L-10 Clip
Applier handpiece (Catalog #1002)
and to facilitate the sterilization
process by allowing steam penetration
and air removal. When used in
conjunction with 2 layers of FDA-
cleared 1-ply polypropylene
sterilization wrap, sterility of the
enclosed sterilization tray (Catalog#
  1. is maintained until used.

The Microline Surgical M/L-10 Clip
Applier Sterilization Tray (Catalog#
3706) is used to secure the M/L-10
Clip Applier handpiece (Catalog
#1002) which measures at 17.13"
length, 4.94" height, and 0.90"width in
dimensional measurements, as the
intended load during the transport,
sterilization and storage between its
intended uses.

The M/L-10 Clip Applier Sterilization
Tray (Catalog# 3706) has been |
| | | validated with the M/L-10 Clip Applier
handpiece (Catalog #1002) wrapped in |
| | | 2 layers of FDA-cleared 1-ply |
| | | polypropylene wrap weighing a |
| | | calculated total weight of 1663.10 |
| | | grams. The M/L-10 Clip Applier |
| | | Sterilization Tray (Catalog# 3706) has |
| | | been validated with the following |
| | | Steam Sterilization Parameters: Pre-
vacuum, Time: 4 minutes at |
| | | Temperature of 132 °C. The Gravity |
| | | Cycle parameters include: Time: 15 |
| | | minutes and Temperature of 132 °C. |
| | Technological Characteristics | |
| Primary Configuration | Metal Tray | Metal Tray |
| Primary Materials | Stainless Steel and Aluminum | Stainless Steel, Aluminum and |
| (Construction) | | Biomedical Grade Silicone. |
| | Tray Coating: Nylon Coating Powder | Tray Coating: Nylon Coating Powder |
| Dimensions | Lid:19.875" (Length) x 5.632" (Width) x
.450" (Height) inches | Identical |
| | Base:19.875" (Length) x 5.50" (Width) x | |
| | 1.450" (Height) inches | |
| Air Permeability | Yes | Yes |
| Intended for Reuse | Yes | Yes |
| Material Thickness | .036" | Identical |
| Hole Size | Ø 0.250" | Identical |
| Hole Pattern | Lid: | Identical |
| | Six (6) rows evenly spaced with | |
| | Twenty-five (25) Holes, with Fifty (50) | |
| | centrally removed to account for the
Company Logo and Trade Name. | |
| | Base: | |
| | Six (6) rows evenly spaced with | |
| | Twenty-five (25) Holes, with Twenty- | |
| | one (21) removed to account for the | |
| | brackets. | |
| Brackets | Two (2) Silicone, Two (2) Stainless | Identical |
| | Steel and One (1) Aluminum. | |
| Feet | None | None |
| Weight
Sterilization Method(s) | 1663.10 grams
Steam Sterilization
& Ethylene Oxide (EtO) | Identical
Steam Sterilization only |
| Sterilization Cycle | Prevacuum Steam: | Prevacuum Steam: |
| Parameters | 132°C - 4 minutes | 132°C – 4 minutes |
| | Dry for 20 minutes | Dry for 20 minutes |
| | | |
| | Gravity Steam: | Gravity Steam: |
| | 132°C -15 minutes | 132°C -15 minutes |
| | Dry for 30 minutes | Dry for 45 minutes |
| Sterility
(Disposable or Multiple Use) | Multiple Use | Multiple Use |
| Patient Contact | No | No |
| Blood/Fluid Contact | No | No |
| Special Conditions
(Shipping and Handling) | No | No |
| Manufacturer | Contract Manufacturer:
MEDIN Corporation
11 Jackson Road,
Totowa, NJ 07512
USA
(Registration Number: 3011296511) | Identical |
| Proposed Brand Labeling
(Relabeling, Repackaging and
Market Distribution) | Not Applicable | Microline Surgical, Inc.
50 Dunham Road, Suite 1500
Beverly, MA 01915
USA |
| Differences in Technological Characteristics | | |
| Tray Internal Configuration | Not Applicable | M/L-10 Clip Applier Sterilization Tray
internal configuration to secure the
M/L-10 Clip Applier device only. |

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Image /page/6/Picture/0 description: The image shows the logo for Microline Surgical. The word "MICROLINE" is in large, gray, sans-serif font. In the center of the word is a teal-colored circle with a four-leaf clover design inside. Below the word "MICROLINE" is the word "SURGICAL" in a smaller, gray, sans-serif font.

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Image /page/7/Picture/0 description: The image shows the logo for Microline Surgical. The logo consists of the word "MICROLINE" in gray, with a teal circle containing four leaf-like shapes in the center of the word. Below "MICROLINE" is the word "SURGICAL" in a smaller, gray font.

Performance Characteristics:

Microline Surgical, Inc., has successfully completed a full sterilization using Steam Sterilization method in accordance to AAMI TIR12:2010 - Designing, testing, and labeling reusable medical devices for reprocessing in health care facilities; and EN ISO 17664:2004 - Sterilization of medical devices - Information to be provided by the manufacturer for the processing of resterilizable medical devices. The acceptance criteria required that the sterilization methods demonstrate a sterility assurance level (SAL) of 106 using the biological indicator (BI) overkill method, which met as required. The sterilization testing and limits of reuse of the device, design tolerance andysis and shelf-life validation were completed. The subject device MIL-10 Clip Applier Sterilization Tray (Catalog #3706), is substantially equivalent to its predicate device in terms of fundamental technology, materials and design and meets the identical design inputs and output requirements. As the subject device, ML-10 Clip Applier Sterilization Tray (Catalog #3706) will be fully contract manufactured, assembled and packaged by contract manufacturer MEDIN Corporation (Registration Number: 3011296511), any new validation testing including biocompatibility, bench testing including new validation or documentation pertaining to design for assembly and packaging by Microline Surgical, Inc., were not deemed necessary.

Substantially Equivalent Conclusion:

Conclusively, based upon the similarities in fundamental technology, materials of construction and the intended use, Microline Surgical, Inc., has determined that the subject device ML-10 Clip Applier Sterilization Tray (Catalog #3706) is deemed substantially equivalent (SE) to its legally marketed predicate device C/T Med-System (K98065). Similar to its predicate device, the subject device ML-10 Clip Applier Sterilization Tray is a Class II device per 21 CFR § 880.6850 (Product Code KCT) and under this classification category identified as Sterilization Wrap Containers, Trays, Cassettes & other Accessories. The subject device MIL-10 Clip Applier Sterilization Tray (Catalog #3706) does not raise new questions of safety and effectiveness; and demonstrates at least as safe and effective as its legally marketed predicate device.

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Image /page/8/Picture/0 description: The image shows the logo for Microline Surgical. The word "MICROLINE" is in gray, with a teal circle containing a four-pointed star in the middle. Below that, the word "SURGICAL" is also in gray.

Substantial Equivalence Statement:

The performance testing data for the subject device M/L-10 Clip Applier Sterilization Tray (Catalog #3706) demonstrates the subject device is as safe, as effective, and performs as well as the predicate device (K980065).