K Number
K182354
Device Name
SafeAir Telescopic Smoke Pencil
Manufacturer
Date Cleared
2018-12-14

(107 days)

Product Code
Regulation Number
878.4400
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
SafeAir Telescopic Smoke Pencil is designed for general electrosurgical applications, including cutting and coagulation, and for removing smoke generated by electrosurgery when used in conjunction with an effective smoke evacuation system. The pencil enables the operator to remotely conduct an electrosurgical current from the output connector of an electrosurgical unit to the operative site for the desired surgical effect.
Device Description
SafeAir Telescopic Smoke Pencil is designed for general electrosurgical applications and for removing smoke generated by electrosurgery when used in conjunction with an effective smoke evacuation system. The pencil enables the operator to remotely conduct an electrosurgical current from the output connector of an electrosurgical unit to the operative site for the desired surgical effect. SafeAir Telescopic Smoke Pencil has got telescopic function which allows to extend the length of pencil by up to 120 mm. Extension is possible after twisting the green lock-ring.
More Information

Not Found

No
The provided text describes a standard electrosurgical pencil with a telescopic feature and smoke evacuation capabilities. There is no mention of AI, ML, image processing, or any data-driven decision-making components. The performance studies listed are standard tests for electrosurgical devices, not AI/ML model validation.

Yes
The device is used for electrosurgical applications (cutting and coagulation) to achieve a surgical effect, which is a therapeutic intervention.

No
The device is described for electrosurgical applications (cutting and coagulation) and smoke evacuation, which are therapeutic and supportive functions, not diagnostic.

No

The device description clearly describes a physical electrosurgical pencil with a telescopic function, indicating it is a hardware device, not software only.

Based on the provided information, the SafeAir Telescopic Smoke Pencil is not an IVD (In Vitro Diagnostic) device.

Here's why:

  • Intended Use/Indications for Use: The description clearly states its purpose is for "general electrosurgical applications, including cutting and coagulation, and for removing smoke generated by electrosurgery." This involves direct surgical intervention on a patient's body.
  • Device Description: The description reinforces its function as a tool to "remotely conduct an electrosurgical current... to the operative site for the desired surgical effect." This is a surgical instrument.
  • Lack of IVD Characteristics: IVD devices are used to examine specimens (like blood, urine, tissue) taken from the human body to provide information about a physiological state, health, disease, or congenital abnormality. The SafeAir Telescopic Smoke Pencil does not perform any such analysis of specimens.

Therefore, the SafeAir Telescopic Smoke Pencil is a surgical device, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

SafeAir Telescopic Smoke Pencil is designed for general electrosurgical applications, including cutting and coagulation, and for removing smoke generated by electrosurgery when used in conjunction with an effective smoke evacuation system. The pencil enables the operator to remotely conduct an electrosurgical current from the output connector of an electrosurgical unit to the operative site for the desired surgical effect.

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

GEI

Device Description

SafeAir Telescopic Smoke Pencil is designed for general electrosurgical applications and for removing smoke generated by electrosurgery when used in conjunction with an effective smoke evacuation system. The pencil enables the operator to remotely conduct an electrosurgical current from the output connector of an electrosurgical unit to the operative site for the desired surgical effect.

SafeAir Telescopic Smoke Pencil has got telescopic function which allows to extend the length of pencil by up to 120 mm. Extension is possible after twisting the green lock-ring.

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 Performance Data: LiNA completed a number of non-clinical performance tests. The SafeAir Telescopic Smoke Pencil meets all the requirements for overall design, sterilization, biocompatibility, and electrical safety results confirming that the design output meets the design inputs and specifications for the device. The SafeAir Telescopic Smoke Pencil passed all applicable testing in accordance with internal requirements, national standards, and international standards shown below to support substantial equivalence of the subject device:

  • Biocompatibility testing per ISO 10993-1, ISO 10993-10, ISO 10993-10, ISO 10993-12.
  • Electrical safety testing per AAMI / ANSI ES60601-1, IEC 60601-1-2, IEC 60601-2-2.
  • Sterilization per ISO 11135, ISO 11737-2.
  • Packaging, Aging and Transport testing per ASTM F88-06, ASTM F1929-98, ASTM F1980-16, ASTM D4169-16.
  • Thermal Spread Testing.
  • Flammability Testing.
  • Smoke Evacuation Testing.

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.

Stryker Neptune E-SEP Smoke Evacuation Pencil (K160693)

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

Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo, which is a blue square with the letters "FDA" in white. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

December 14, 2018

LiNA Medical ApS % Kevin MacDonald Clinical/Regulatory Consultant MacDonald Regulatory Consulting 4297 D Street Sacramento, California 95819

Re: K182354

Trade/Device Name: SafeAir Telescopic Smoke Pencil Regulation Number: 21 CFR 878.4400 Regulation Name: Electrosurgical Cutting and Coagulation Device and Accessories Regulatory Class: Class II Product Code: GEI Dated: November 16, 2018 Received: November 19, 2018

Dear Kevin MacDonald:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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

1

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) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/CombinationProducts/GuidanceRegulatoryInformation/ucm597488.htm); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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 comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/) and CDRH Learn (http://www.fda.gov/Training/CDRHLearn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (http://www.fda.gov/DICE) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely.

Image /page/1/Picture/5 description: The image shows a digital signature. The signature is from Long H. Chen -S, and the date of the signature is 2018.12.14. The time of the signature is 14:56:52 -05'00'. The signature is for something.

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) K182354

Device Name SafeAir Telescopic Smoke Pencil

Indications for Use (Describe)

SafeAir Telescopic Smoke Pencil is designed for general electrosurgical applications, including cutting and coagulation, and for removing smoke generated by electrosurgery when used in conjunction with an effective smoke evacuation system. The pencil enables the operator to remotely conduct an electrosurgical current from the output connector of an electrosurgical unit to the operative site for the desired surgical effect.

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.

This section applies only to requirements of the Paperwork Reduction Act of 1995.

DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.

The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:

Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff@fda.hhs.gov

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

3

K182354 510(k) Summary SafeAir Telescopic Smoke Pencil

1. Submission Sponsor:

LiNA Medical ApS Formervangen 5 DK-2600 Glostrup, Denmark Natalia Szychulska Regulatory Affairs Officer Email: nhe@lina-medical.com Office number: +48 61 222 21 43

2. Submission Correspondent:

Kevin MacDonald U.S. Regulatory Consultant Email: kma@lina-medical.com Office number: 1-415-609-9875

3. Date prepared:

December 11, 2018

4. Device Identification

Type of 510(k) Submission:Traditional
Trade or Proprietary Name:SafeAir Telescopic Smoke Pencil
Regulation Number:21 CFR 878.4400
Product Code:GEI, Electrosurgical Cutting And Coagulation Device And Accessories
Class of Device: ClassII
Panel:General and Plastic Surgery
Reason for Submission:New device
Prior Related Submissions:No prior submissions for the device
Multiple Devices:n/a

4

K182354

5. Legally Marketed Predicate Device(s)

Stryker Neptune E-SEP Smoke Evacuation Pencil (K160693)

6. Indication for Use Statement

SafeAir Telescopic Smoke Pencil is designed for general electrosurgical applications, including cutting and coagulation, and for removing smoke generated by electrosurgery when used in conjunction with an effective smoke evacuation system. The pencil enables the operator to remotely conduct an electrosurgical current from the output connector of an electrosurgical unit to the operative site for the desired surgical effect

7. Device Description

SafeAir Telescopic Smoke Pencil is designed for general electrosurgical applications and for removing smoke generated by electrosurgery when used in conjunction with an effective smoke evacuation system. The pencil enables the operator to remotely conduct an electrosurgical current from the output connector of an electrosurgical unit to the operative site for the desired surgical effect.

SafeAir Telescopic Smoke Pencil has got telescopic function which allows to extend the length of pencil by up to 120 mm. Extension is possible after twisting the green lock-ring.

Model number
SHK-TSP-USSafeAir Telescopic Smoke Pencil

8. Substantial Equivalence Discussion

Both the SafeAir Telescopic Smoke Pencil and the Stryker Neptune E-SEP Smoke Evacuation Pencil (K160693) are manufactured by LiNA Medical in Poland. The subject and predicate devices are substantially equivalent in terms of technological characteristics and intended use. The primary difference is the telescopic feature present on the SafeAir Telescopic Smoke Pencil (Subject device).

Substantial Equivalence Table
CharacteristicPredicate Device
Stryker Neptune E-SEP Smoke Evacuation
Pencil K160693Subject Device
SafeAir Telescopic Smoke Pencil
Product CodeGEISame
Regulatory ClassIISame
Regulation NameElectrosurgical Cutting And Coagulation Device
And AccessoriesSame
Regulation Number21 CFR 878.4400Same
PrescriptionYesSame
Intended UseThe Neptune E-SEP is an Integrated Smoke
Evacuation Pencil (pencil) designed for generalSafeAir Telescopic Smoke Pencil is
designed for general electrosurgical
Substantial Equivalence Table
CharacteristicPredicate Device
Stryker Neptune E-SEP Smoke Evacuation
Pencil K160693Subject Device
SafeAir Telescopic Smoke Pencil
electrosurgical applications including cutting
and coagulation, and for removing smoke
generated by electrosurgery when used in
conjunction with an effective smoke
evacuation system. The pencil enables the
operator to remotely conduct an
electrosurgical current from the output
connector of an electrosurgical unit (generator)
to the operative site for the desired surgical
effectapplications, including cutting and
coagulation, and for removing smoke
generated by electrosurgery when
used in conjunction with an effective
smoke evacuation system. The pencil
enables the operator to remotely
conduct an electrosurgical current
from the output connector of an
electrosurgical unit to the operative
site for the desired surgical effect.
Overall DesignDesigned to integrate smoke evacuation into
electrosurgery by combining both features into
a single handpieceDesigned to integrate smoke
evacuation into electrosurgery by
combining both features into a single
handpiece. Incorporates a
telescoping feature allowing the
length top extended up to 120mm
Power SupplyMonopolar GeneratorSame
Voltage Rating5.5 kV peakSame
Electrical ConnectorUS-3-PinSame
Electrical Safety
TestingISO 60601-1
ISO 60601-1-2
ISO 60601-2-2Same
SterilitySterile Single Use, EtO, SAL 10-6Same
PackagingIndividually packaged pencil and electrode in
Tyvek pouch, sold 10 per boxSame
Electrode Rod303 SSTSame
Electrode Rod
Diameter2.36mmSame
Electrode Connector
ShapePentagonHeat shrink sheath
Electrode Connector
MaterialABS Polylac PA-757PTFE Heat shrink
Electrode shaft
insulation (overmold)ABS Polylac PA-757None
Electrode Tip
Material303 SSTSame
Electrode Tip CoatingNoneSame
Electrode Tip
Working length70-165mm70mm
Electrode Tip
InsulationNoneNone
Substantial Equivalence Table
CharacteristicPredicate Device
Stryker Neptune E-SEP Smoke Evacuation
Pencil K160693Subject Device
SafeAir Telescopic Smoke Pencil
Adjustable Suction
Sleeve MaterialAcrylonitrile Butadiene Styrene with barium
sulfateTrianmx731 transparent
Evacuation Tubing
Dimension10 mm dia x 3 m lengthSame
Smoke Evacuation
System connector8mm, 22mSame
Handpiece Housing
MaterialAcrylonitrile Butadiene Styrene with
Thermoplastic ElastomerSame
Handpiece
Dimensions15mm dia x 190mm length18 mm x 200 mm length
Operation Function
SwitchesCUT/COAG buttons available in both Rocker-
switch and Pushbutton-switch configurationCUT/COAG buttons available in
Pushbutton configuration
AccessoriesHolster-Clip providedNone
Tissue contacting
MaterialsCompliant with ISO 10993-1Same
Range of ElectrodesNeptune® E-SEP TM 165mm Blade
Electrode, Coated and Insulated
Neptune® E-SEP TM 125mm Blade
Electrode, Coated and Insulated
Neptune® E-SEP TM 70mm Blade
Electrode, Coated and Insulated
Neptune E-SEP 165mm blade electrode
Neptune E-SEP loop t-bar electrode W20
D15 L60
Neptune E-SEP conization electrode W20
D20 L120
Neptune E-SEP 125mm blade electrode
Neptune E-SEP conization electrode W13
D20 L120
Neptune E-SEP 70mm Blade electrode
Neptune E-SEP 70mm needle electrode
Neptune E-SEP 5mm ball electrode
Neptune E-SEP loop t-bar electrode W20
D20 L120
Neptune E-SEP loop t-bar electrode W20Same
Substantial Equivalence Table
CharacteristicPredicate Device
Stryker Neptune E-SEP Smoke Evacuation
Pencil K160693Subject Device
SafeAir Telescopic Smoke Pencil
Neptune E-SEP 165mm blade electrode
coated
Neptune E-SEP conization electrode W13
D15 L120
Neptune E-SEP loop u-bar electrode W20
D20 L120
Neptune E-SEP conization electrode W16
D18 L 120
Neptune E-SEP loop t-bar electrode W10
D10 L120
Neptune E-SEP 70mm blade electrode
coated
Neptune E-SEP loop t-bar electrode W20
D15 L120
Neptune E-SEP 3mm ball electrode
Neptune E-SEP conization electrode W16
D8 L120
Neptune E-SEP 125mm blade electrode
coated
Neptune E-SEP loop t-bar electrode W15
D12 L120

5

6

7

The SafeAir Telescopic Smoke Pencil shares the same intended use, device operation, overall technical and functional capabilities as the predicate device. In addition, the SafeAir Telescopic Smoke Pencil is similar in design and function to the Stryker Neptune E-SEP Smoke Evacuation Pencil (K160693) in terms of mode of operation and use. In reference to manufacturing, the SafeAir Telescopic Smoke Pencil and the Stryker Neptune E-SEP Smoke Evacuator Pencil are manufactured in the LiNA Medical's Poland manufacturing facility under the same environmental conditions.

9. Non-Clinical Performance Data

As part of demonstrating safety and effectiveness of the SafeAir Telescopic Smoke Pencil and in showing substantial equivalence to the predicate devices that are subject to this 510(k) submission, LiNA completed a number of non-clinical performance tests. The SafeAir Telescopic Smoke Pencil meets all the requirements for overall design, sterilization, biocompatibility, and electrical safety results confirming that the design output meets the design inputs and specifications for the device.

The SafeAir Telescopic Smoke Pencil was subjected to safety performance testing in accordance with the FDA's Premarket Notification [510(k)] Submissions for Electrosurgical Devices for General Surgery -Guidance for Industry and Food and Drug Administration Staff. Issued: August 15, 2016.

The SafeAir Telescopic Smoke Pencil passed all applicable testing in accordance with internal requirements, national standards, and international standards shown below to support substantial equivalence of the subject device:

8

  • Biocompatibility testing per ISO 10993-1, ISO 10993-10, ISO 10993-10, ISO 10993-12
  • . Electrical safety testing per AAMI / ANSI ES60601-1, IEC 60601-1-2, IEC 60601-2-2
  • . Sterilization per ISO 11135, ISO 11737-2
  • Packaging, Aging and Transport testing per ASTM F88-06, ASTM F1929-98, ASTM F1980-16, ASTM D4169-16
  • Thermal Spread Testing
  • Flammability Testing
  • Smoke Evacuation Testing

10. Clinical Performance Data

Based on the similarities in design, intended use and comparability in design verification results to the predicate device, human clinical testing was not required to establish substantial equivalence. These types of devices, including the predicate devices, have been a long market history with demonstrated safety and effectiveness for the use of the device. The non-clinical testing detailed in this submission supports the substantial equivalence determination.

11. Statement of Substantial Equivalence

Based on the similarities in design, intended use statement and comparative verification test results, the SafeAir Telescopic Smoke Pencil raises no new issues of safety and effectiveness when compared to the predicate device, Stryker Neptune E-SEP Smoke Evacuation Pencil.

The SafeAir Telescopic Smoke Pencil function differs only in the telescopic feature which does not impact the intended use or significantly impact the technological features and therefore is determined to be substantially equivalent to the referenced predicate device.