K Number
K152856
Device Name
Helios III
Date Cleared
2016-06-02

(247 days)

Product Code
Regulation Number
878.4810
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Incision, excision, ablation, vaporization of soft tissue for general dermatology (1064 nm) Removal or lightening of unwanted hair with or without adjuvant preparation (1064nm) Tattoo Removal: Dark ink (blue and black) (1064 nm) Tattoo Removal: light ink (red, sky blue, green) (532 nm) port wine birthmarks (532 nm) telangiectasias (532 nm) spider angioma (532 nm) cherry angioma (532 nm) spider nevi (532 nm) cafe-au-lait birthmarks (532 nm) solar lentiginos, senile lentiginos, becker's nevi, freckles, nevus spilus (532 mm) nevus of ota (1064 nm)
Device Description
The Helios III laser system is based on the Nd:YAG (1064 nm) and frequency doubled KTP Nd:YAG (532 nm) laser technology. Three basic elements of operations are as follows: 1) A Nd:YAG crystal is used as a gain medium which produces a laser beam. 2) A resonator then amplifies the beam. 3) A lamp that contains Xe gas is used, as a pumping light source. The lamp requires a high-pressure power source device for operation. When the electric energy generated from the high-pressure power source is induced into the electrode of the lamp, it converts into light energy. This converted light energy pumps the Nd–YAG crystal – a gain medium – and the light exhausted from the crystal is amplified into a specific wavelength light. As it passes between the resonant gases, laser beam radiates to an output unit. The regulation of laser output and repetition rate can be set by the user via GUI (Graphic User Interface) and controlled by microprocessor, which interfaces with the power supply.
More Information

Not Found

No
The device description focuses on traditional laser technology and microprocessor control, with no mention of AI or ML terms or concepts.

Yes

The device performs procedures such as incision, excision, ablation, and vaporization of soft tissue, as well as removal or lightening of unwanted hair and tattoos, which are therapeutic interventions aimed at treating or improving a condition.

No

Explanation: The device description and intended use indicate that this is a laser system designed for therapeutic procedures like incision, excision, ablation, vaporization, and tattoo/lesion removal, not for diagnosing medical conditions.

No

The device description clearly outlines a physical laser system with hardware components like a Nd:YAG crystal, resonator, lamp, and power source. While it mentions a GUI and microprocessor for control, the core function and components are hardware-based.

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

Here's why:

  • Intended Use/Indications for Use: The intended uses listed are all related to treating soft tissue and removing unwanted hair and tattoos on the human body. These are direct treatments applied to the patient, not tests performed on samples taken from the body.
  • Device Description: The description details a laser system that generates and applies light energy for therapeutic purposes. This is consistent with a medical device used for treatment, not a diagnostic device that analyzes biological samples.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue, etc.), detecting specific analytes, or providing diagnostic information based on in vitro testing.

Therefore, the Helios III laser system, as described, is a therapeutic medical device, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

Incision, excision, ablation, vaporization of soft tissue for general dermatology (1064 nm) Removal or lightening of unwanted hair with or without adjuvant preparation (1064 nm) Tattoo Removal (1064nm,532nm) · dark ink: blue and black (1064nm) · light ink: red, sky blue, green (532nm) Treatment of Vascular Lesions: (532nm) • port wine birthmarks · telangiectasias · spider angioma • cherry angioma · spider nevi Treatment of Pigmented Lesions: (1064nm,532nm) · café-au-lait birthmarks (532nm) · solar lentiginos (532nm) · senile lentiginos (532nm) · becker's nevi (532nm) · freckles (532nm) • nevus spilus (532nm ) • nevus of ota (1064nm)

Product codes

GEX

Device Description

The Helios III laser system is based on the Nd:YAG (1064 nm) and frequency doubled KTP Nd:YAG (532 nm) laser technology. Three basic elements of operations are as follows: 1) A Nd:YAG crystal is used as a gain medium which produces a laser beam. 2) A resonator then amplifies the beam. 3) A lamp that contains Xe gas is used, as a pumping light source. The lamp requires a high-pressure power source device for operation. When the electric energy generated from the high-pressure power source is induced into the electrode of the lamp, it converts into light energy. This converted light energy pumps the Nd–YAG crystal – a gain medium – and the light exhausted from the crystal is amplified into a specific wavelength light. As it passes between the resonant gases, laser beam radiates to an output unit. The regulation of laser output and repetition rate can be set by the user via GUI (Graphic User Interface) and controlled by microprocessor, which interfaces with the power supply.

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

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Non-clinical testing of Helios III included visual and mechanical inspection, electrical and mechanical safety testing, functional performance testing, etc., in bench. Some of these tests include visual inspection, earthbond testing, software testing, transit testing, leakage current testing and measurements. Test reports have been submitted.

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

Not Found

Predicate Device(s)

K133254, K083203

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

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

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

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Image /page/0/Picture/1 description: The image is a black and white logo for the U.S. Department of Health & Human Services. The logo features a stylized caduceus symbol, which is a staff with two snakes coiled around it. The caduceus is a symbol of medicine and healing. The logo also includes the words "DEPARTMENT OF HEALTH & HUMAN SERVICES · USA" in a circular arrangement around the caduceus symbol.

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

June 2, 2016

Laseroptek Co. Ltd. Mr. Kevin J. Choi 28 Stafford Drive West Windsor, NJ 08550

Re: K152856 Trade/Device Name: Helios III Regulation Number: 21 CFR 878.4810 Regulation Name: Laser surgical instrument for use in general and plastic surgery and in dermatology Regulatory Class: Class II Product Code: GEX Dated: April 5, 2016 Received: April 12, 2016

Dear Mr. Choi:

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 -A

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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Indications for Use

510(k) Number (if known) K152856

Device Name

Helios III O-Switched Nd:YAG Laser System

Indications for Use (Describe)

Incision, excision, ablation, vaporization of soft tissue for general dermatology (1064 nm) Removal or lightening of unwanted hair with or without adjuvant preparation (1064nm) Tattoo Removal: Dark ink (blue and black) (1064 nm) Tattoo Removal: light ink (red, sky blue, green) (532 nm) port wine birthmarks (532 nm) telangiectasias (532 nm) spider angioma (532 nm) cherry angioma (532 nm) spider nevi (532 nm) cafe-au-lait birthmarks (532 nm) solar lentiginos, senile lentiginos, becker's nevi, freckles, nevus spilus (532 mm) nevus of ota (1064 nm)

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)

CONTINUE ON A SEPARATE PAGE IF NEEDED.

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3

This 510(k) Summary of safety and effectiveness is submitted in accordance with the requirements of 21 CFR §807.92

Submitter's Information
Applicant:Laseroptek Co. Ltd.
Address:204 Hyundai I Valley
223-12 Sangdaiwon, Jungwon
Sungnam-Si, Gyeonggido, 462-714
Rep. of Korea (South Korea)
Contact Person:Hong Chu, Ph.D. (President & CEO)
Telephone / Fax / E-mail:Tel) +82.31.737.9885
E-mail) hchu@laseroptek.com
Submitter:Kevin Choi
Address:28 Stafford Drive, West Windsor, NJ 08850
Contact Person:Kevin J. Choi
Telephone / Fax / E-Mail:Tel) 310-634-4480
E-mail) kjchoi1128@hotmail.com
Preparation Date:07/17/2015
Device Trade Name:Helios III
Common Name:Q-Switched Nd:YAG Laser
Classification Name:Instruments, Surgical, Powered, Laser 79-GEX
(21 CFR §878-4810)
Legally Marketed Predicate Devices:• Cynosure, Inc.'s Revlite Q-Switched Nd:YAG
Laser System (K133254)
• Laseroptek Co. Ltd.'s Helios II Q-Switched

Nd:YAG Laser System (K083203)

4

Intended Use of Helios III: The Helios III Q-Switched Nd:YAG Laser System delivers pulse wave laser light in the contact or noncontact mode for; Incision, excision, ablation, vaporization of soft tissue for general dermatology (1064 nm) Removal or lightening of unwanted hair with or without adjuvant preparation (1064 nm) Tattoo Removal (1064nm,532nm) · dark ink: blue and black (1064nm) · light ink: red, sky blue, green (532nm) Treatment of Vascular Lesions: (532nm) • port wine birthmarks · telangiectasias · spider angioma • cherry angioma · spider nevi Treatment of Pigmented Lesions: (1064nm,532nm) · café-au-lait birthmarks (532nm) · solar lentiginos (532nm) · senile lentiginos (532nm) · becker's nevi (532nm) · freckles (532nm) • nevus spilus (532nm ) • nevus of ota (1064nm) Device Description: The Helios III laser system is based on the Nd:YAG (1064 nm) and frequency doubled KTP Nd:YAG (532 nm) laser technology. Three basic elements of operations are as follows: 1) A Nd:YAG crystal is used as a gain medium which produces a laser beam. 2) A resonator then amplifies the beam. 3) A lamp that contains Xe gas is used, as a pumping

5

light source. The lamp requires a high-pressure power source device for operation. When the electric energy generated from the high-pressure power source is induced into the electrode of the lamp, it converts into light energy. This converted light energy pumps the Nd–YAG crystal – a gain medium – and the light exhausted from the crystal is amplified into a specific wavelength light. As it passes between the resonant gases, laser beam radiates to an output unit.
The regulation of laser output and repetition rate can be set by the user via GUI (Graphic User Interface) and controlled by microprocessor, which interfaces with the power supply.
Performance Data:Non-clinical testing of Helios III included visual and mechanical inspection, electrical and mechanical safety testing, functional performance testing, etc., in bench. Some of these tests include visual inspection, earthbond testing, software testing, transit testing, leakage current testing and measurements. Test reports have been submitted.
Substantial EquivalenceHelios III's intended use is identical to the intended use of the predicate devices: Cynosure, Inc.'s Revlite Q-Switched Nd:YAG Laser System (K133254) and Laseroptek Co. Ltd.'s Helios II Q-Switched Nd:YAG Laser System (K083203)
Comparison of indications for use and performance specifications are provided in the following tables.

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510(k) Summary Helios III Q-Switched Nd:YAG Laser

Predicate DevicePredicate DeviceProposed Device
510(K) NumberK133254K083203K152856
ManufacturerCynosure (HOYA ConBio)Laseroptek Co. Ltd.Laseroptek Co. Ltd.
Device NameRevLite Q-Switched Nd:YAG Laser SystemHelios II Q-Switched Nd:YAG Laser SystemHelios III Q-Switched Nd:YAG Laser System
Intended Use /
Indications for Us:Tattoo Removal (dark ink: blue and black)Tattoo Removal (dark ink: blue and black)Tattoo Removal (dark ink: blue and black)
Dermal pigmented lesions, including, but
not limited to: Nevus of Ota, Lentigines,
Nevi, Melasma and Café-au-laitDermal pigmented legions: Nevus of Ota,
Café-au-lait birthmarks, solar lentiginos,
senile lentiginos, becker's nevi, freckles,
and nevus spilusDermal pigmented legions: Nevus of Ota,
Café-au-lait birthmarks, solar lentiginos,
senile lentiginos, becker's nevi, freckles,
and nevus spilus
Removal or lightening of hair with or
without adjuvant preparationRemoval or lightening of hair with or
without adjuvant preparationRemoval or lightening of hair with or
without adjuvant preparation
Skin resurfacing for acne scars and wrinklesIncision, excision, ablation, vaporization of
soft tissue for general dermatologyIncision, excision, ablation, vaporization of
soft tissue for general dermatology
Benign cutaneous lesions: including, but
not limited to; striae and scars (excludes
the 650 nm wavelength)Tattoo Removal (light ink: red, sky blue,
green)Tattoo Removal (light ink: red, sky blue,
green)
Reduction of red pigmentation in
hypertrophic and deloid scars where
vascularity is an integral part of the scar
(excludes the 650 nm wavelength)Treatment of vascular lesions: port wine,
birthmarks, telangiectasias, spider
angioma, cherry angioma, and spider neviTreatment of vascular lesions: port wine,
birthmarks, telangiectasias, spider
angioma, cherry angioma, and spider nevi
Tattoo Removal (light ink: red, sky blue,
green)
Vascular lesions including but not limited
to: port wine, birthmarks, telangiectasias,
spider angioma, cherry angioma, spider
nevi
Epidermal pigmented lesions; including,
but not limited to: café-au-lait birthmarks,
solar lentiginos, senile lentiginos, Becker's
nevi, Freckles, Nevus spilus, seborrheic
keratosis
Skin resurfacing for acne scars and wrinkles
Benign cutaneous lesions; including, but
not limited to: striae and scars (excludes
the 650 nm wavelength)
Reduction of red pigmentation in
hypertrophic and deloid scars where
vascularity is an integral part of the scar
(excludes the 650 nm wavelength)

Table 1: Approved Indication of Uses for Helios III Predicate Devices

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Predicate DevicePredicate DeviceProposed Device
510(K) NumberK133254K083203K152856
ManufacturerCynosure (HOYA ConBio)Laseroptek Co. Ltd.Laseroptek Co. Ltd.
Device NameRevLite Q-Switched Nd:YAG Laser SystemHelios II Q-Switched Nd:YAG Laser SystemHelios III Q-Switched Nd:YAG Laser System
Clearance Date:3/5/20144/28/2009Not Available
Classification / Regulation21 CFR 878.4810 (GEX)21 CFR 878.4810 (GEX)21 CFR 878.4810 (GEX)
Laser MediumNd:YAGNd:YAGNd:YAG
Operating ParametersQ-SwitchedQ-SwitchedQ-Switched
Wavelength1064 nm / 532 nm1064 nm / 532 nm1064 nm / 532 nm
Pulse Characteristics:
Maximum Pulse Duration7 – 20 ns8 ns10 ns
Energy Delivered1.6 J1 J (0.5 J @ 532 nm) / pulse1.3 J (0.5J @ 532 nm) / pulse
Fluence1 – 8 J/cm2 @ 3 – 8 mm spot size1 – 8 J/cm2 @ 1 to 7 mm spot size1 - 8 J/cm2 @ 1 to 8 mm spot size
Spot Sizes2 – 8.5 mm range with 0.1 mm increments1 – 7 mm(1064) 5 mm
(532) 4 mm
(Collimator) 8 mm
(Zoom) 1~7 mm
Repetition RateSingle shot, 1 - 10 HzSingle Shot, 1 - 10 HzSingle Shot, 1 - 10 Hz
Average Power (Max):10 W (5 W @ 532 nm)10 W (5 W @ 532 nm)13 W (5W @ 532 nm)
Physical Characteristics:
System Dimensions31.8"(H) X 12" (W) X 28.5" (D)37.2"(H) X 13"(W) X 37.2 (D)36.8"(H) X 11.7"(W) X 32.2" (D)
System Weight131 lbs.154 lbs.176 lbs.
Electrical RequirementsAC 230 V, 50/60 HzAC 230 V, 50/60 HzAC 230 V, 50/60 Hz
Maximum Power20W20 W20W

Table 2: Performance Specification Comparison with Predicate Devices

Conclusion

The Helios III Q-Switched Nd:YAG Laser System is substantially equivalent to other existing systems in commercial distribution for treatment of the intended use indications share very similar / exactly same performance specification parameters as noted in above table.