K Number
K193591
Device Name
ARC 400
Date Cleared
2020-04-02

(101 days)

Product Code
Regulation Number
878.4400
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The High Frequency (HF) device is intended exclusively for the generation of electrical power for monopolar and bipolar cutting and coagulation of tissue structures in surgical operations.
Device Description
The ARC 400 (REF: 900-400) is an electrosurgical device. It generates high frequency (HF) electrical current for the purpose of cutting (e.g. removing tissue) or coagulating (e.g. control bleeding) human tissue. It is used with compatible bipolar instruments (e.g. K953509) or with monopolar instruments (e.g. K982743) in combination with a neutral electrode (e.g. K173877). The ARC 400 offers 34 modes that represent four main categories: monopolar cutting (12 modes), monopolar coagulation (9 modes), bipolar cutting (4 modes) and bipolar coagulation (9 modes).
More Information

No
The summary describes a standard electrosurgical device with various modes for cutting and coagulation, and there is no mention of AI or ML in the device description, intended use, or performance studies.

Yes
Explanation: The device is intended for "cutting and coagulation of tissue structures in surgical operations," which are therapeutic interventions.

No

The device is an electrosurgical unit used for cutting and coagulating tissue during surgical operations. It generates electrical power for therapeutic purposes, not for diagnosing conditions.

No

The device description explicitly states it is an "electrosurgical device" that "generates high frequency (HF) electrical current" and is used with "compatible bipolar instruments" and "monopolar instruments" in combination with a "neutral electrode." This clearly indicates a hardware-based device that delivers electrical energy to tissue, not a software-only device.

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

Here's why:

  • Intended Use: The intended use is for "generation of electrical power for monopolar and bipolar cutting and coagulation of tissue structures in surgical operations." This describes a device used on the patient during surgery, not a device used to examine specimens outside the body.
  • Device Description: The description details an "electrosurgical device" that generates electrical current for cutting and coagulating human tissue. This is consistent with a surgical tool, not an IVD.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue samples, etc.), detecting analytes, or providing diagnostic information based on in vitro testing.

IVD devices are used to examine specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. This device's function is purely therapeutic/surgical.

N/A

Intended Use / Indications for Use

The High Frequency (HF) device is intended exclusively for the generation of electrical power for monopolar and bipolar cutting and coagulation of tissue structures in surgical operations.

Product codes

GEI

Device Description

The ARC 400 (REF: 900-400) is an electrosurgical device. It generates high frequency (HF) electrical current for the purpose of cutting (e.g. removing tissue) or coagulating (e.g. control bleeding) human tissue. It is used with compatible bipolar instruments (e.g. K953509) or with monopolar instruments (e.g. K982743) in combination with a neutral electrode (e.g. K173877).

The ARC 400 offers 34 modes that represent four main categories: monopolar cutting (12 modes), monopolar coagulation (9 modes), bipolar cutting (4 modes) and bipolar coagulation (9 modes).

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)

To demonstrate safety and effectiveness of the ARC 400 and to show substantial equivalence to the predicate device (AUTOCON III 400), BOWA completed successfully the following non-clinical performance tests:
Electrical safety testing: ES 60601-1 / 19-4
Electromagnetic Compatibility testing: IEC 60601-1-2 / 19-8
Particular requirements for the basic safety and essential performance of high frequency surgical equipment: IEC 60601-2-2 / 6-389
Performance testing: Applicable parts of FDA Guidance Document "Premarket Notification (510(k)) Submissions for Electrosurgical Devices for General Surgery" May 2016
Usability testing: IEC 62366 / 5-114

The results confirm that the design inputs and performance specifications for the ARC 400 are met. The device passed the testing in accordance with FDA and international recognized standards, national standards, and internal requirements as shown above, supporting its safety and its substantial equivalence to the AUTOCON III 400.

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

Not Found

Predicate Device(s)

K171717

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

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 contains the logo of the U.S. Food and Drug Administration (FDA). The logo consists of two parts: on the left, there is a symbol representing the Department of Health & Human Services-USA, and on the right, there is the text "FDA U.S. FOOD & DRUG ADMINISTRATION" in blue. The FDA logo is a symbol of the agency's mission to protect and promote public health through the regulation and supervision of food safety, tobacco, pharmaceuticals, medical devices, and other related products.

April 2, 2020

BOWA-electronics GmbH & Co. KG % Roxana CERNESCU Consultant QA/RA Emergo Global Consulting, LLC 2500 Bee Cave Road Building 1, Suite 300 Austin, Texas 78746

Re: K193591

Trade/Device Name: ARC 400 Regulation Number: 21 CFR 878.4400 Regulation Name: Electrosurgical Cutting and Coagulation Device and Accessories Regulatory Class: Class II Product Code: GEI Dated: December 20, 2019 Received: April 2, 2020

Dear Roxana CERNESCU:

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.

1

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) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) 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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). 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 (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely.

Long Chen, Ph.D. Assistant Director DHT4A: Division of General Surgery Devices OHT4: Office of Surgical and Infection Control Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known) K193591

Device Name ARC 400 Electrosurgical Unit

Indications for Use (Describe)

The High Frequency (HF) device is intended exclusively for the generation of electrical power for monopolar and bipolar cutting and coagulation of tissue structures in surgical operations.

Type of Use (Select one or both, as applicable)

X 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

510(k) Summary

ARC 400 Electrosurgical Unit

1. Submission Sponsor

BOWA-electronic GmbH & Co. KG Heinrich-Hertz-Strasse 4 - 10 Gomaringen 72810 GERMANY Contact: Wolf-Ruediger FRITZ Title: Head of Quality Management / Regulatory Affairs Director

2. Submission Correspondent

Emergo Global Consulting, LLC 2500 Bee Cave Road Building 1, Suite 300 Austin, TX 78746 Office Phone: (512) 327-9997 Email: LST.AUS.ProjectManagement@ul.com Contact: Roxana CERNESCU Title: Senior Consultant QA/RA

3. Date Prepared

February 6, 2020

4. Device Identification

Proprietary Name:ARC 400
Part Number:900-400
Common/Usual Name:Electrosurgical Device
Classification Name:Electrosurgical cutting and coagulation device and accessories
Regulation Number:21 CFR 878.4400
Product Code:GEI
Class:2
Classification Panel:General & Plastic Surgery

5. Legally Marketed Predicate Device(s)

Device name:AUTOCON III 400
510(k) number:K171717
Manufacturer:KARL STORZ SE & Co. KG

4

6. Indication for Use Statement

The High Frequency (HF) device is intended exclusively for the generation of electrical power for monopolar and bipolar cutting and coagulation of tissue structures in surgical operations.

7. Device Description

The ARC 400 (REF: 900-400) is an electrosurgical device. It generates high frequency (HF) electrical current for the purpose of cutting (e.g. removing tissue) or coagulating (e.g. control bleeding) human tissue. It is used with compatible bipolar instruments (e.g. K953509) or with monopolar instruments (e.g. K982743) in combination with a neutral electrode (e.g. K173877).

The ARC 400 offers 34 modes that represent four main categories: monopolar cutting (12 modes), monopolar coagulation (9 modes), bipolar cutting (4 modes) and bipolar coagulation (9 modes).

8. Substantial Equivalence Discussion

The following table compares the ARC 400 to the AUTOCON III 400 with respect to technological characteristics, principles of operation and performance. This forms the basis for the determination of substantial equivalence to the predicate device.

AttributeSubject DevicePredicate Device
ARC 400AUTOCON III 400
510(k) NumberK193591K171717
ManufacturerBOWA-electronic GmbH & Co.
KGKARL STORZ Endoscopy
Product CodeGEIGEI
Regulation Number21 CFR 878.440021 CFR 878.4400
Mechanism of ActionThe device generates high
frequency current
350 kHz / 1 MHzThe device generates high
frequency current
350 kHz / 1 MHz
System voltage100 - 127 V100 - 127 V
Monopolar Cutting Modes (12)
Max. Power400 W (at 200 Ω)400 W (at 200 Ω)
Output Frequency350 kHz350 kHz
Max. Voltage Output1600 Vp1600 Vp
Crest Factor1.5, 3.51.5, 3.5
AttributeSubject DevicePredicate Device
ARC 400AUTOCON III 400
Wave FormsSinusoidal ConstantSinusoidal Constant
Sinusoidal ModulatedSinusoidal Modulated
Sinusoidal AlternatingSinusoidal Alternating
Cut/Coag/Pause PhasesCut/Coag/Pause Phases
Monopolar Coagulation Modes (9)
Max. Power250W (at 500 Ω)250W (at 500 Ω)
Output Frequency350 kHz350 kHz
Max. Voltage Output5000 Vp5000 Vp
Crest Factor1.6 - 7.41.6 - 7.4
Wave FormsSinusoidal ConstantSinusoidal Constant
Sinusoidal ModulatedSinusoidal Modulated
Pulse ModulatedPulse Modulated
Bipolar Cutting Modes (4)
Max. Power400 W (at 75 Ω)400 W (at 75 Ω)
Output Frequency350 kHz350 kHz
Max. Voltage Output500 Vp500 Vp
Crest Factor1.5 – 1.61.5 - 1.6
Wave FormsSinusoidal ConstantSinusoidal Constant
Bipolar Coagulation Modes (9)
Max. Power350 W (at 25 Ω)350 W (at 25 Ω)
Output Frequency350 kHz350 kHz
Max. Voltage Output550 Vp550 Vp
Crest Factor1.5 – 3.81.5 - 3.8
Wave FormsSinusoidal ConstantSinusoidal Constant
Pulse ModulatedPulse Modulated

Table 5A - Comparison of Characteristics

5

6

9. Non-Clinical Performance Data

To demonstrate safety and effectiveness of the ARC 400 and to show substantial equivalence to the predicate device (AUTOCON III 400), BOWA completed successfully the following non-clinical performance tests:

Electrical safety testingES 60601-1 / 19-4
Electromagnetic Compatibility testingIEC 60601-1-2 / 19-8
Particular requirements for the basic safety and essential performance of high frequency surgical equipmentIEC 60601-2-2 / 6-389
Performance testingApplicable parts of FDA
Guidance Document
"Premarket Notification (510(k))
Submissions for Electrosurgical
Devices for General Surgery"
May 2016
Usability testingIEC 62366 / 5-114

The results confirm that the design inputs and performance specifications for the ARC 400 are met. The device passed the testing in accordance with FDA and international recognized standards, national standards, and internal requirements as shown above, supporting its safety and its substantial equivalence to the AUTOCON III 400.

10. Statement of Substantial Equivalence

The ARC 400 has the same intended use as the AUTOCON III 400, and the same technological characteristics. The non-clinical test results, such as performance data, electrical safety and electromagnetic compatibility data have demonstrated the ARC 400 is as safe and effective as the predicate device. Therefore it is concluded, that the ARC 400 fulfills the requirements of a substantially equivalent device and that no new questions of safety and effectiveness were raised.