K Number
K200931
Device Name
RF Surgical Generator
Manufacturer
Date Cleared
2020-11-24

(231 days)

Product Code
Regulation Number
878.4400
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
RF Surgical Generator FW-120A is an electrosurgical generator containing monopolar and bipolar technology. It is intended for use with accessories during surgical procedures where the surgeon requires electrosurgical cutting and coagulating.
Device Description
RF Surgical Generator FW-120A, is a compact source of high power RF energy, enhanced capability of radiosurgery generator, which can be employed for a variety of radiosurgery procedures, such as cut and coagulate living human tissue. The device which is consisted of a generator, an IEC Neutral Plate, and a Two Pedal Footswitch, provides 5 modes and corresponding output power ranges that is user/operator selectable based on the surgical procedure undertaken. The action is achieved by front panel selection of waveforms and power level. All selection is affected through push buttons and indicators which give the operator feedback of status. Power level for each mode is indicated by front panel digital displays The device is provided with safety features of automatically system initialize self-check after power on and continuously monitored during the device running. The device will provide error information and/ or alerts when detect following faults, such as a) Accessary fail connection, b) Overheating of Main Unit, c) Neutral plates Contact resistance exceed the limit, d) System initialize error. The error monitoring is interlocked with the controls to prevent operation when fault condition happened in the unit. The generator is configured for Monopolar and Biopolar output and the final output power could be controlled by pedal foot switch and/or hand switches. Recommended Monopolar Handpieces 510(k) No.: K092634. Recommended IEC Neutral Plate 510(k) No.: K102372.
More Information

No
The description focuses on standard electrosurgical generator functionality, safety features, and compliance with relevant standards. There is no mention of AI or ML in the intended use, device description, or performance studies.

No.
The device is an electrosurgical generator designed to cut and coagulate tissue during surgical procedures, which is an active intervention rather than a therapeutic treatment in itself.

No
The device description states its purpose is for "electrosurgical cutting and coagulating" living human tissue during surgical procedures, which are therapeutic actions, not diagnostic ones.

No

The device description explicitly states it is a "RF Surgical Generator FW-120A," which is a hardware device containing monopolar and bipolar technology. It also mentions physical components like a generator, IEC Neutral Plate, and a Two Pedal Footswitch. While it contains software, it is not a software-only medical device.

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

Here's why:

  • Intended Use: The intended use clearly states it's for "surgical procedures where the surgeon requires electrosurgical cutting and coagulating." This describes a device used directly on living tissue during surgery, not for testing samples outside the body.
  • Device Description: The description details a "source of high power RF energy" used to "cut and coagulate living human tissue." This aligns with surgical intervention, not in vitro testing.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue samples, etc.), reagents, or any of the typical components or processes associated with in vitro diagnostics.

The device is an electrosurgical generator, which is a type of medical device used for surgical procedures.

N/A

Intended Use / Indications for Use

RF Surgical Generator FW-120A is an electrosurgical generator containing monopolar and bipolar technology. It is intended for use with accessories during surgical procedures where the surgeon requires electrosurgical cutting and coagulating.

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

GEI

Device Description

RF Surgical Generator FW-120A, is a compact source of high power RF energy, enhanced capability of radiosurgery generator, which can be employed for a variety of radiosurgery procedures, such as cut and coagulate living human tissue.

The device which is consisted of a generator, an IEC Neutral Plate, and a Two Pedal Footswitch, provides 5 modes and corresponding output power ranges that is user/operator selectable based on the surgical procedure undertaken. The action is achieved by front panel selection of waveforms and power level. All selection is affected through push buttons and indicators which give the operator feedback of status. Power level for each mode is indicated by front panel digital displays

The device is provided with safety features of automatically system initialize self-check after power on and continuously monitored during the device running. The device will provide error information and/ or alerts when detect following faults, such as a) Accessary fail connection, b) Overheating of Main Unit, c) Neutral plates Contact resistance exceed the limit, d) System initialize error. The error monitoring is interlocked with the controls to prevent operation when fault condition happened in the unit.

The generator is configured for Monopolar and Biopolar output and the final output power could be controlled by pedal foot switch and/or hand switches. Recommended Monopolar Handpieces 510(k) No.: K092634. Recommended IEC Neutral Plate 510(k) No.: K102372.

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)

Verification testing, including electrical safety/electromagnetic compatibility, software verification/validation were performed for RF Surgical Generator.

  • RF Surgical Generator has been evaluated the safety and performance by lab bench testing a) according to the following standards:
    • ANSI AAMI ES60601-1:2005/(R)2012 and A1:2012, C1:2009(R)2012 and A A2:2010/(R)2012 (Consolidated Text) Medical electrical equipment - Part 1: General requirements for basic safety and essential performance (IEC 60601-1:2005, MOD)
    • △ IEC 60601-1-2, Medical electrical equipment - Part 1-2: General requirements for basic safety and essential performance - Collateral standard: Electromagnetic compatibility -Requirements and tests, 2014
    • IEC 60601-2-2, Medical Electrical Equipment - Part 2-2: Particular Requirements for The Basic Safety And Essential Performance Of High Frequency Surgical Equipment And High Frequency Surgical Accessories, Edition 6.0 2017-03

  • b) RF Surgical Generator has been evaluated the basic mechanical and functional capabilities to determine substantial equivalence to the predicate device. According to the guidance document Premarket Notification (510(k)) Submissions for Electrosurgical Devices for General Surgery, the device has been tested for applicable items such as thermal damage, CQM and so on. In particular, tests have been carried out with respect to the following subject areas.
      1. System Performance and waveform outputs test.
      1. Thermal effects testing: the thermal damage of the tissue due to the HF current was measured in terms of size (length, width and depth) of the thermal zone in all applicable modes: porcine muscle, liver, and kidney.
  • c) RF Surgical Generator has performed software verifications to ensure the device worked appropriately as a moderated concern level software according to the Guidance for the Content of Premarket Submissions for Software Contained in Medical Devices.

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.

K013255

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.

K092634, K102372

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 for the U.S. Food & Drug Administration (FDA). The logo consists of two parts: on the left, there is a symbol representing the Department of Health & Human Services, and on the right, there is the text "FDA U.S. FOOD & DRUG ADMINISTRATION" in blue. The text is arranged in two lines, with "FDA" being larger and bolder than the rest of the text.

November 24, 2020

Fulwell LLC % Jet Li Regulation Manager Guangzhou KEDA Biological Tech Co., Ltd. 6F, No.1 TianTai road, Science City, LuoGang District Guangzhou, Guangdong China

Re: K200931

Trade/Device Name: RF Surgical Generator Regulation Number: 21 CFR 878.4400 Regulation Name: Electrosurgical Cutting And Coagulation Device And Accessories Regulatory Class: Class II Product Code: GEI Dated: September 23, 2020 Received: September 28, 2020

Dear Jet Li:

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.

for 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 Ouality Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known) K200931

Device Name RF Surgical Generator, Model: FW-120A

Indications for Use (Describe)

RF Surgical Generator FW-120A is an electrosurgical generator containing monopolar and bipolar technology. It is intended for use with accessories during surgical procedures where the surgeon requires electrosurgical cutting and coagulating.

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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3

510(k) Summary (K200931)

This summary of 510(k) safety and effectiveness information is being submitted in accordance with the requirements of 21 CFR 878.4400, and there were no prior submissions for the subject device.

1 Submitter Information

Sponsor: Fulwell LLC Address: 3411 NW 48 Street, Miami, FL 33142 USA Contact Person: Mrs. Perla Melisa Mcliberty Title: Deputy General Manager Phone: +1-305-535-3568 E-mail: register@fulwell.us.com

Application Correspondent: Jet Li Company: Guangzhou KEDA Biological Technology Co., Ltd E-mail: med-jl@foxmail.com Phone: 86-18588874857 Address: 6F, No.1 TianTai road, Science City, LuoGang District, GuangZhou City, China

Subject Device Information 2

Type of 510(k) submission: Traditional Trade/Device Name: RF Surgical Generator Model: FW-120A Classification Name: Electrosurgical, Cutting & Coagulation & Accessories Review Panel: General & Plastic Surgery Product Code: GEI Regulation Number: 21 CFR 878.4400 Regulation Class: 2

3 Predicate Device Information

Sponsor: ELLMAN INTL., INC. Trade/Device Name: Surgitron 120 IEC 510K number: K013255 Classification Name: Electrosurgical, Cutting & Coagulation & Accessories Review Panel: General & Plastic Surgery Product Code: GEI Regulation Number: 21 CFR 878.4400 Requlation Class: 2

4

Device Description 4

RF Surgical Generator FW-120A, is a compact source of high power RF energy, enhanced capability of radiosurgery generator, which can be employed for a variety of radiosurgery procedures, such as cut and coagulate living human tissue.

The device which is consisted of a generator, an IEC Neutral Plate, and a Two Pedal Footswitch, provides 5 modes and corresponding output power ranges that is user/operator selectable based on the surgical procedure undertaken. The action is achieved by front panel selection of waveforms and power level. All selection is affected through push buttons and indicators which give the operator feedback of status. Power level for each mode is indicated by front panel digital displays

The device is provided with safety features of automatically system initialize self-check after power on and continuously monitored during the device running. The device will provide error information and/ or alerts when detect following faults, such as a) Accessary fail connection, b) Overheating of Main Unit, c) Neutral plates Contact resistance exceed the limit, d) System initialize error. The error monitoring is interlocked with the controls to prevent operation when fault condition happened in the unit.

The generator is configured for Monopolar and Biopolar output and the final output power could be controlled by pedal foot switch and/or hand switches. Recommended Monopolar Handpieces 510(k) No.: K092634. Recommended IEC Neutral Plate 510(k) No.: K102372.

5 Intended Use/Indication for use

RF Surgical Generator FW-120A is an electrosurgical generator containing monopolar and bipolar technology. It is intended for use with accessories during surgical procedures where the surgeon requires electrosurgical cutting and coagulating.

6 Performance data

Verification testing, including electrical safety/electromagnetic compatibility, software verification/validation were performed for RF Surgical Generator.

  • RF Surgical Generator has been evaluated the safety and performance by lab bench testing a) according to the following standards:
    • ANSI AAMI ES60601-1:2005/(R)2012 and A1:2012, C1:2009(R)2012 and A A2:2010/(R)2012 (Consolidated Text) Medical electrical equipment - Part 1: General requirements for basic safety and essential performance (IEC 60601-1:2005, MOD)
    • △ IEC 60601-1-2, Medical electrical equipment - Part 1-2: General requirements for basic safety and essential performance - Collateral standard: Electromagnetic compatibility -Requirements and tests, 2014
    • IEC 60601-2-2, Medical Electrical Equipment - Part 2-2: Particular Requirements for The Basic Safety And Essential Performance Of High Frequency Surgical Equipment And

5

High Frequency Surgical Accessories, Edition 6.0 2017-03

  • b) RF Surgical Generator has been evaluated the basic mechanical and functional capabilities to determine substantial equivalence to the predicate device. According to the guidance document Premarket Notification (510(k)) Submissions for Electrosurgical Devices for General Surgery, the device has been tested for applicable items such as thermal damage, CQM and so on.
    In particular, tests have been carried out with respect to the following subject areas.

    1. System Performance and waveform outputs test.
  1. Thermal effects testing: the thermal damage of the tissue due to the HF current was measured in terms of size (length, width and depth) of the thermal zone in all applicable modes: porcine muscle, liver, and kidney.
  • c) RF Surgical Generator has performed software verifications to ensure the device worked appropriately as a moderated concern level software according to the Guidance for the Content of Premarket Submissions for Software Contained in Medical Devices. .

7 Comparison to Predicate Device

Compare with predicate device, the subject device is very similar in design principle, intended use, indications for use, functions, material and the applicable standards. The differences between subject device and predicate device do not raise any new questions of safety or effectiveness.

| Elements of

comparisonSubject DevicePredicate DeviceVerdict
ManufacturerFulwell LLCELLMAN INTL., INC.--
510K numberK200931K013255--
Product NameRF Surgical Generator
FW-120ASurgitron 120 IEC
Also known as Surgitron 4.0 Dual RF--
Classification
NameElectrosurgical, Cutting & Coagulation
& AccessoriesElectrosurgical, Cutting & Coagulation
& AccessoriesSE
Regulation
Class22SE
Regulation
Number21 CFR 878.440021 CFR 878.4400SE
OTC & RxRxRxSE
Indications for Use
Indications for
UseRF Surgical Generator FW-
120A is an electrosurgical
generator containing
monopolar and bipolar
technology. It is intended for
use with accessories during
surgical procedures where the
surgeon requires
electrosurgical cutting and
coagulating.Cutting: snoring, submucosal palatal
shrinkage, traditional uvulopalatoplasty
(RAUP), myringotomy with effective
hemorrhage control, epistaxis
treatment, turbinate shrinkage, skin
incisions, biopsy, cysts, abscesses,
tumors, cosmetic repairs, development
of skin flaps, skin tags and
blepharoplasty.
Blend cutting and coagulation: snoring,
submucosal palatal shrinkageSE,
Minor
Difference.
We remove
the specified
indication
for use for
subject
device; it do
not raise
safety and
traditional uvulopalatoplasty (RAUP),
myringotomy with effective hemorrhage
control, epistaxis treatment, turbinate
shrinkage, skin tags, papilloma keloids,
keratosis, verrucae, basal cell
carcinoma, nevi, fistulas, epithelioma,
cosmetic repairs, cysts, abscesses,
development of skin flaps.
Hemostasis: control of bleeding,
epilation, telangiectasia.
Fulguration: basal cell carcinoma,
papilloma, cyst destruction, tumors,
verrucae, hemostasis.
Bipolar: pinpoint precise coagulation,
pinpoint hemostasis in any field (wet or
dry), snoring, submucosal palatal
shrinkage, traditional uvulopalatoplasty
(RAUP), myringotomy with effective
hemorrhage control, epistaxis treatment
and turbinate shrinkage.effectivenes
s issue.
Device Design
Working
Theory■ Monopolar: RF generator connects
its accessories of a handpiece and an
IEC Neutral Plate (adhered to patient
skin) to form a cyclic circuit, the RF
current generated from the generator
and through the Monopolar handpiece
to achieve CUT or COAG, then return
to generator by the IEC Neutral Plate.
■ Bipolar: RF current generated from
the generator and the cyclic circuit
formed between the two tips of the
bipolar forceps, the RF power through
the two tips to work on patient obtaining
COAG.■ Monopolar: RF generator connects
its accessories of a handpiece and an
IEC Neutral Plate (adhered to patient
skin) to form a cyclic circuit, the RF
current generated from the generator
and through the Monopolar handpiece
to achieve CUT or COAG, then return
to generator by the IEC Neutral Plate.
■ Bipolar: RF current generated from
the generator and the cyclic circuit
formed between the two tips of the
bipolar forceps, the RF power through
the two tips to work on patient obtaining
COAG.SE
AppearanceImage: FW-120AImage: Ellman Surgitron Dual 11SE
Note 1
Interface
AccessoriesTwo Pedal Footswitch, Handpieces, IEC
Neutral Plate, Power CordTriple Footswith, Handpieces, Neutral
Pad, Power CordSE
Note 1
Operation
ModeCutting, Blend cutting and coagulation,
Hemostasis, Fulguration, BipolarCutting, Blend cutting and coagulation,
Hemostasis, Fulguration, BipolarSE
WaveformsCutting:4.0MHz Sinusoid
Blend cutting and coagulation: 4.0MHz
with fully rectified envelope
Hemostasis: 4.0MHz with partially
rectified envelope
Fulguration: 4.0MHz with modulated
Bipolar: 1.7MHzCutting:4.0MHz CW Sin-Wave
Blend cutting and coagulation: 4.0MHz
with rectified full-wave envelope
Hemostasis: 4.0MHz with square wave
rectified envelope
Fulguration: 4.0MHz Sin-Wave
Modulated
Bipolar: 1.7MHz for Fulgurating Spark-
GapSE
Note 2
ActivationCutting: via footswitch or finger switch
Blend cutting and coagulation: via
footswitch or finger switch
Hemostasis: via footswitch or finger
switch
Fulguration: via footswitch or finger
switchCutting: via footswitch or finger switch
Blend cutting and coagulation: via
footswitch or finger switch
Hemostasis: via footswitch or finger
switch
Fulguration: via footswitch or finger
switchSE

6

7

K200931
-----------

| Rated Duty

Cycle10s on, 30s off10s on, 30s offSE
Energy typeRFRFSE
Feedback
systemIndicators, audio alarm, Error codesIndicators, audio alarm, Error codesSE
Neutral
Electrode
monitor
resistanceMAX 1000ΩMAX 1000ΩSE
Input Pow erNominal line voltage and frequency:
120Vac~ ±10%, 60 Hz.
/230Vac~ ±10%, 50 Hz.
Input current at max output pow er:
3.3/1.5A.Voltage: 240/220/120/100V, ±10%
240/230/120/100V, ±10%
Frequency: 50Hz
Current: For 240~220V: 3.3A,
For 120~100V: 1.5ASE
Note 1
Output Pow erCutting: 120W@500Ω
Blend cutting and coagulation:
80W@500Ω
Hemostasis: 60W@500Ω
Fulguration: 40W@500Ω
Bipolar: 120W@200ΩCutting: 120W@500Ω
Blend cutting and coagulation:
80W@500Ω
Hemostasis: 40W@500Ω
Fulguration: 40W@500Ω
Bipolar: 120W@200ΩSE
Note 2
FusesT 2.0A, 250V, Tw o pieces for 230Vac
T 4.0A, 250V, Two pieces for 120Va2* T 2.0AL, for 250V
2* T 4.0AL, for 110VSE
Note 1
Electric shock
protectionClass IClass IlbSE
Note 1
Defibrillation
protectionType BFType BFSE
Dimensions235mm120mm340mm(WHD)9"5"13" (WHD)
≈228mm127mm330mmSE
Note 1
Weight11Kg18lbs, ≈8.16kgSE
Note 1
Working
condition-10°C- +40°C
30% - 75%-10°C- +40°C
30% - 75%SE
Transport and
Storage-10°C- +50°C, 10% - 95%
500hPa-1060hPA-10°C- +50°C, 10% - 95%
500hPa-1060hPASE
SterilityNon-sterileNon-sterileSE
FDA-Recognized Standards
Safety
PerformanceANSI AAMI ES60601-1
IEC 60601-2-2UL2601, IEC 601-1, IEC 601-2-2
BS15724:2.2SE
Note 2
EMC
PerformanceIEC 60601-1-2/SE
Note 3

Note 1

Although the subject device design and specification parameters, such as appearance / dimensions / weight / power supply / electric shock protection, have a little difference to the predicate device, these minor differences do not affect the device' mainly function, which are has been testing the electrical safety via the IEC 60601 standards tests, and these differences will not create any new safety risks to the performance and safety.

Note 2

Although the waveform and output power of subject device has a little different to predicate device, the performance test has proved that the performance of subject device is substantial equivalence

8

to the predicate device. So the differences do not affect the safety and effectiveness.

Note 3

Although the complied standards of electrical safety and EMC performance are different to the predicate device, it's only because the version of predicate device's complied standards are invalidated and been updated. The subject device has complied to the necessary standards as existing similar products, so the differences do not affect the safety and effectiveness.

9 Conclusion

The subject device RF Surgical Generator has all features of the predicate device for intended use. Thus, the subject device is substantially equivalent to the predicate device.

10 Summary Prepared Date

22 Nov. 2020