K Number
K171752
Device Name
X-SURGE
Manufacturer
Date Cleared
2017-10-17

(126 days)

Product Code
Regulation Number
878.4400
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The GENICON X-Surge instrumentation line is intended for use in endoscopic surgical procedures. It is a family of instruments which includes graspers, dissectors, which are intended to be used to grasp, manipulate, cut, and cauterize soft tissue.
Device Description
The GENICON X-Surge monopolar laparoscopic instruments are sterile packaged Single Use Mono-Polar attachments intended for use in combination with a compatible reposable handle. It is designed to include graspers, dissectors, and scissors, intended to grasp, manipulate, cut, and cauterize soft tissue. The device diameter has a range of 3 - 5mm, and connects to a handle with the appropriate configuration. The handle has a male cautery connector that will be utilized for cauterizing soft tissue when attached to standard monopolar cautery cables and their generators. The disposable shaft and tips are composed of an aluminum outer shaft, and a stainless steel drive rod which connects to the scissor blades and interacts with the handle activation rod. The outer insulation consists of fluorinated ethylene which is an insulation with functional material properties that are improved over Polytetrafluoroethylene PTFE, and is less rigid than Radel insulation. The disposable shafts and tips are to be supplied sterile in single unit trays with Tyvek lid, similar to the current GENICON electrosurgical instrumentation line. The Reposable handle is sterilized by the user using an autoclave process and is then connected to the sterile disposable shaft or tip. Once the procedure is completed, the instrument ends are disassembled from the handle, and are disposed of appropriately, and the handle is cleaned and sterilized for the next procedure.
More Information

Not Found

No
The device description and performance studies focus on mechanical and electrical properties for surgical manipulation and cauterization, with no mention of AI or ML.

No.
The device is described as an instrumentation line for endoscopic surgical procedures, intended for grasping, manipulating, cutting, and cauterizing soft tissue. While these actions are part of medical treatment, the device itself is a surgical tool, not a therapeutic device designed to treat a condition or disease directly or indirectly.

No

The device is intended for endoscopic surgical procedures to grasp, manipulate, cut, and cauterize soft tissue. It is an instrument used for treatment, not diagnosis.

No

The device description clearly outlines physical components such as shafts, tips, handles, and connectors, and the performance studies focus on physical characteristics and electrical performance of these hardware components. There is no mention of software as a component or its function.

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

Here's why:

  • Intended Use: The intended use is for "endoscopic surgical procedures" to "grasp, manipulate, cut, and cauterize soft tissue." This describes a surgical instrument used directly on a patient's body during a procedure.
  • Device Description: The description details a surgical instrument with graspers, dissectors, and scissors, designed for use in laparoscopic surgery. It connects to a handle and can be used for cauterization. This is consistent with a surgical tool, not a device used to test samples outside the body.
  • Lack of IVD Characteristics: There is no mention of analyzing samples (like blood, urine, tissue samples) in vitro (outside the body) to diagnose a condition, monitor treatment, or screen for diseases. The device's function is entirely focused on manipulating and treating tissue in vivo (within the body).

Therefore, the GENICON X-Surge instrumentation line is a surgical device, not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

Indeathis surgical procedures. It is a family of instruments which includes graspers, dissectors, which are intended to be used to grasp, manipulate, cut, and cauterized soft tissue.

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

GEI

Device Description

The GENICON X-Surge monopolar laparoscopic instruments are sterile packaged Single Use Mono-Polar attachments intended for use in combination with a compatible reposable handle. It is designed to include graspers, dissectors, and scissors, intended to grasp, manipulate, cut, and cauterize soft tissue. The device diameter has a range of 3 - 5mm, and connects to a handle with the appropriate configuration. The handle has a male cautery connector that will be utilized for cauterizing soft tissue when attached to standard monopolar cautery cables and their generators.

The disposable shaft and tips are composed of an aluminum outer shaft, and a stainless steel drive rod which connects to the scissor blades and interacts with the handle activation rod. The outer insulation consists of fluorinated ethylene which is an insulation with functional material properties that are improved over Polytetrafluoroethylene PTFE, and is less rigid than Radel insulation. The disposable shafts and tips are to be supplied sterile in single unit trays with Tyvek lid, similar to the current GENICON electrosurgical instrumentation line. The Reposable handle is sterilized by the user using an autoclave process and is then connected to the sterile disposable shaft or tip. Once the procedure is completed, the instrument ends are disassembled from the handle, and are disposed of appropriately, and the handle is cleaned and sterilized for the next procedure.

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 tests were conducted to verify that the X-Surge met all design specifications as the substantially equivalent predicate device and any additional test needed to show equivalence. Testing included in this submission include the following: Biocompatibility Testing (Cytotoxicity Test, Skin Sensitization/Irritation Test, Acute System Toxicity Test) in conformance with ISO 10993-5:2009, ISO 10993-10:2010, ISO 10993-11:2010. Medical Electrical Equipment testing for both single use and reusable in conformance with IEC 60601-1, IEC 60601-2. Aging Study under ETO. Aging Study under Gamma. Autoclave testing verification.

In addition the GENICON X-Surge instrumentation line has been compared to the predicate device through performance studies to test cutting performance and electrical safety and effectiveness.
Cut performance across different mediums using the predicate as a baseline was completed in order to compare any instances of slipping, overall cut length across testing mediums, and scissor geometry including: scissor length, scissor width, and opening and closing dimensions. Testing showed the X-Surge device performed equivalent or better than the predicate Genicon product.
Electrical performance of the device was completed following FDA guidance "Premarket Notification (510(k)) Submissions for Electrosural Devices for General Surgery" issued August 15, 2016. This requires testing on three different tissue types at minimum, default, and maximum generator power in order to simulate thermal spread across different tissue types. The spread is then measured under magnification, and recorded to be compared with the predicate product. Results showed an equivalent or less area of thermal spread under the same conditions across the different tissue types and power settings.
The GENICON X-Surge instrumentation line was also compared to the predicate device through bench testing which included visual & operational use, ergonomic forces (i.e. attachment, activation, etc.). Testing on performance and general ergonomic use showed that the X-Surge device met the same requirements as the predicate product in terms of closure force, opening angle, finger spacing, and rotation knob interaction.

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.

K061417

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

§ 878.4400 Electrosurgical cutting and coagulation device and accessories.

(a)
Identification. An electrosurgical cutting and coagulation device and accessories is a device intended to remove tissue and control bleeding by use of high-frequency electrical current.(b)
Classification. Class II.

0

October 17, 2017 GENICON, Inc. Ms. Katlyn Kachman Director of Quality 6869 Stapoint Court Suite 114 Winter Park, Florida 32792

Re: K171752

Trade/Device Name: X-Surge Regulation Number: 21 CFR 878.4400 Regulation Name: Electrosurgical cutting and coagulation device and accessories Regulatory Class: Class II Product Code: GEI Dated: October 2, 2017 Received: October 3, 2017

Dear Ms. Kachman:

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, 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 of medical 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.

1

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 (DICE) 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 (DICE) 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, Jennifer R. Stevenson -S3 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

2

Indications for Use

510(k) Number (if known) K171752

Device Name X-Surge

Indications for Use (Describe)

Indeathis surgical procedures. It is a family of instruments which includes graspers, dissectors, which are intended to be used to grasp, manipulate, cut, and cauterized soft tissue.

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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Image /page/3/Picture/0 description: The image shows the logo for GENICON. The logo is in blue and features the company name in a bold, sans-serif font. A curved line in shades of blue and green runs beneath the name, adding a dynamic element to the design.

K171752 Page 1 of 3

K171752 510(k) Summary

  1. Contact Information GENICON 6869 Stapoint Court, Suite 114, Winter Park, FL 32792 Phone (407) 657-4851 Fax (407) 677-9773 Katlyn Kachman, Director of Quality July 7, 2017
    1. Device Name
    • Trade Name X-Surge ●
    • Common Name Laparoscopic Instruments .
    • Classification Name Electrosurgical, Cutting & Coagulation & Accessories (21 CFR 878.4400, ● Product Code GEI)
    1. Substantially Equivalent Device

Legally Marketed (unmodified device) GENICON Electrosurgical Instrumentation, K061417

| Device | GENICON Electrosurgical Instrumentation 510(k)
K061417 | GENICON X-Surge 510(k): K171752 |
|---------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Intended Use | General & Plastic Surgery (GEI) | General & Plastic Surgery (GEI) |
| Component
Design | Current Electrosurgical Instrument
Assembly
Image: Current Electrosurgical Instrument Assembly
A. Insulated Shaft
B. Rotation Knob
C. Monopolar Post
D. Handle
E. Jaw assembly | Shaft and Handle assembly
Image: Shaft and Handle assembly
A. Insulated Shaft
B. Shaft Locking Knob
C. Rotation Knob
D. Monopolar Post
E. Handle
F. Jaw Assembly

Tip and Handle assembly
Image: Tip and Handle assembly
A. Insulated Tip
B. Insulated Shaft
C. Rotation Knob
D. Monopolar Post
E. Handle
F. Jaw Assembly |
| Design | The GENICON disposable electrosurgical
instruments are single use sterile instruments made
from biocompatible plastic and stainless steel with
a working length of 33cm. Current may be supplied
by an approved electrosurgical generator which
provides the ability for the coagulation of tissue
when used with an appropriate ground electrode. | GENICON X-Surge instrumentation line is composed of
single use sterile instruments (Reposable handle option
available), made from biocompatible plastic, aluminum
and stainless steel. When combined the working length is
20cm to 45cm. Current may be supplied by an approved
electrosurgical generator which provides the ability for the
coagulation of tissue when used with an appropriate
ground electrode. |

4

Image /page/4/Picture/0 description: The image shows the logo for Genicon. The word "GENICON" is written in large, bold, blue letters. Underneath the word is a curved line that is blue on top and fades into green on the bottom. The logo is simple and professional.

K171752 Page 2 of 3

Diameter3mm to 5mmSAME
MaterialsPatient Contact - AISI Stainless Steel, Radel
Non-Patient Contact - Polycarbonate, Nylon, ABS,
HDPE/LDPEPatient Contact - AISI Stainless Steel, FEP
Non-Patient Contact - Aluminum, Polycarbonate, Nylon,
ABS, HDPE/LDPE, TPE
TestingFully assembled device was tested for cut and
coagulation performance on three tissue samples
of different origin. The test was performed at the
lowest, default, and highest settings of a typical
surgery center, and results were recorded.Performance of the X-Surge product showed that the
device performed equivalent or better and is therefore
substantially equivalent in performance to the predicate
device.
PerformanceGENICON Disposable Electrosurgical
Instrumentation is indicated for use in endoscopic
surgical procedures. It is a family of instruments
which includes graspers, dissectors, and scissors,
which are intended to be used to grasp,
manipulate, cut, and cauterize soft tissue.SAME
SterilizationIrradiation or Ethylene OxideSAME
Prescription OnlyYESSAME
BiocompatibilityConforms to ISO10993SAME

4. Device Description

The GENICON X-Surge monopolar laparoscopic instruments are sterile packaged Single Use Mono-Polar attachments intended for use in combination with a compatible reposable handle. It is designed to include graspers, dissectors, and scissors, intended to grasp, manipulate, cut, and cauterize soft tissue. The device diameter has a range of 3 - 5mm, and connects to a handle with the appropriate configuration. The handle has a male cautery connector that will be utilized for cauterizing soft tissue when attached to standard monopolar cautery cables and their generators.

The disposable shaft and tips are composed of an aluminum outer shaft, and a stainless steel drive rod which connects to the scissor blades and interacts with the handle activation rod. The outer insulation consists of fluorinated ethylene which is an insulation with functional material properties that are improved over Polytetrafluoroethylene PTFE, and is less rigid than Radel insulation. The disposable shafts and tips are to be supplied sterile in single unit trays with Tyvek lid, similar to the current GENICON electrosurgical instrumentation line. The Reposable handle is sterilized by the user using an autoclave process and is then connected to the sterile disposable shaft or tip. Once the procedure is completed, the instrument ends are disassembled from the handle, and are disposed of appropriately, and the handle is cleaned and sterilized for the next procedure.

    1. Intended Use
      The GENICON X-Surge instrumentation line is intended for use in endoscopic surgical procedures. It is a family of instruments which includes graspers, dissectors, which are intended to be used to grasp, manipulate, cut, and cauterize soft tissue.
    1. Technological Characteristics of the Subject Device Compared to the Predicate Device
      There are no new technologies being added to the device from the predicate in terms of finished device. The device has the same intended use and application as the predicate device. The X-Surge device will have an additional connection point. The X-Surge device will also have a detachable shaft/tip from the handle, but the same technology is used when discussing function of the device. In both instances electrical current will be passed through an insulated shaft and applied to the appropriate tip assembly to grasp, manipulate, cut, and cauterize soft tissues.

5

Image /page/5/Picture/0 description: The image shows the logo for Genicon. The word "GENICON" is written in large, bold, blue letters. Underneath the word is a curved line that is blue on top and fades into green on the bottom. The logo is simple and modern.

K171752 Page 3 of 3

7. Non-Clinical Tests

Non clinical tests were conducted to verify that the X-Surge met all design specifications as the substantially equivalent predicate device and any additional test needed to show equivalence. Testing included in this submission include the following:

  • · Biocompatibility Testing
    • o Cytotoxicity Test -
    • Skin Sensitization/Irritation Test o
    • Acute System Toxicity Test o
  • · Medical Electrical Equipment testing
    • For both single use and reusable o
  • Aging Study under ETO
  • Aging Study under Gamma
  • Autoclave testing verification

ISO 10993-11:2010 IEC 60601-1, IEC 60601-2

ISO 10993-5:2009

ISO 10993-10:2010

In addition the GENICON X-Surge instrumentation line has been compared to the predicate device through performance studies to test cutting performance and electrical safety and effectiveness.

Cut performance across different mediums using the predicate as a baseline was completed in order to compare any instances of slipping, overall cut length across testing mediums, and scissor geometry including: scissor length, scissor width, and opening and closing dimensions. Testing showed the X-Surge device performed equivalent or better than the predicate Genicon product.

Electrical performance of the device was completed following FDA guidance "Premarket Notification (510(k)) Submissions for Electrosural Devices for General Surgery" issued August 15, 2016. This requires testing on three different tissue types at minimum, default, and maximum generator power in order to simulate thermal spread across different tissue types. The spread is then measured under magnification, and recorded to be compared with the predicate product. Results showed an equivalent or less area of thermal spread under the same conditions across the different tissue types and power settings.

The GENICON X-Surge instrumentation line was also compared to the predicate device through bench testing which included visual & operational use, ergonomic forces (i.e. attachment, activation, etc.). Testing on performance and general ergonomic use showed that the X-Surge device met the same requirements as the predicate product in terms of closure force, opening angle, finger spacing, and rotation knob interaction.

8. Clinical Tests

There were no clinical trials performed on the GENICON X-Surge instrumentation line.

    1. Conclusions
      The subject device has identical indications for use as the predicate device. The technological characteristics, non-clinical testing and performance and bench testing of the GENICON X-Surge instrumentation line show that the device is as safe, as effective, and meets the same performance standard. Therefore, the proposed GENICON X-Surge instrumentation is substantially equivalent to the predicate.