K Number
K203522
Device Name
Surn5 Electrosurgical Argon Beam Generator and Accessories
Manufacturer
Date Cleared
2021-02-22

(83 days)

Product Code
Regulation Number
878.4400
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Surns Electrosurgical Argon Beam Generator and Accessories are indicated for monopolar or bipolar surgery to achieve argon beam and cut or coagulation for the tissue. It is intended to be used with monopolar handpiece and dispersive electrode or bipolar handpiece and footswitches.
Device Description
Surn5 electrosurgical argon beam Generator and accessories have Monopolar Pure cut, Monopolar Bland Cut, Argon Beam, Bipolar functions. Surn5 electrosurgical argon beam Generator and accessories consists of HF generator and accessories. The device generates HF power, which is transmitted to the tissue through the output Pencil. Operator selects the output function and power with the front panel. The indicator is used to indicate the setup status and output status of the device. The output is controlled by foot or hand switch.
More Information

Not Found

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

Yes
The device is described as an electrosurgical argon beam generator used for monopolar or bipolar surgery to achieve argon beam and cut or coagulation for tissue, which are therapeutic interventions.

No

The device is described as an electrosurgical argon beam generator used for monopolar or bipolar surgery to achieve argon beam and cut or coagulation for tissue. Its function is to generate HF power for surgical procedures, not to diagnose conditions.

No

The device description explicitly states it consists of an "HF generator and accessories" and generates "HF power," which are hardware components. The performance studies also include testing for electrical safety and electromagnetic compatibility, further indicating a hardware 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 the device is for "monopolar or bipolar surgery to achieve argon beam and cut or coagulation for the tissue." This describes a surgical procedure performed directly on a patient's tissue, not a test performed on a sample taken from the body (which is the definition of an in vitro diagnostic).
  • Device Description: The description details how the device generates and transmits HF power to tissue through an output pencil, controlled by foot or hand switches. This is consistent with a surgical device, not an IVD.
  • 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.

Therefore, the Surns Electrosurgical Argon Beam Generator and Accessories is a surgical device, not an IVD.

N/A

Intended Use / Indications for Use

The Surns Electrosurgical Argon Beam Generator and Accessories are indicated for monopolar or bipolar surgery to achieve argon beam and cut or coagulation for the tissue. It is intended to be used with monopolar handpiece and dispersive electrode or bipolar handpiece and footswitches.

Product codes

GEI

Device Description

Surn5 electrosurgical argon beam Generator and accessories have Monopolar Pure cut, Monopolar Bland Cut, Argon Beam, Bipolar functions. Surn5 electrosurgical argon beam Generator and accessories consists of HF generator and accessories. The device generates HF power, which is transmitted to the tissue through the output Pencil. Operator selects the output function and power with the front panel. The indicator is used to indicate the setup status and output status of the device. The output is controlled by foot or hand switch.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

tissue

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 the safety and effectiveness of Surn5 Electrosurgical Argon Beam Generator and Accessories show substantial equivalence to the predicate device (Surn5 Electrosurgical Argon Beam Generator and Accessories), Medrange completed successfully the following non-clinical performance tests:
General Safety Testing: IEC 60601-1:2005+C1+C2+A1:2012 Medical electrical equipment, Part 1 General requirements for basic safety and essential performance
EMC Safety Testing: IEC 60601-1-2:2014 (Edition 4.0) Medical electrical equipment, Part 1-2 General requirements for basic safety and essential performance Collateral Standard: Electromagnetic disturbances - Requirements and tests
HF Safety Testing: IEC 60601-2-2:2017 Medical electrical equipment, Part 2-2 Particular requirements of the basic safety and essential performance of high frequency - Surgical equipment and high frequency surgical accessories
Performance Testing: Applicable parts of FDA Guidance Document “Premarket Notification (510(k)) Submissions for Electrosurgical Devices for General Surgery”, May 2016
Usability Testing: IEC 60601-1-6:2010, AMD1:2013 Medical electrical equipment Part 1-6 General requirements for safety - Collateral Standard: Usability
The non-clinical test results, such as performance data, software data, electrical safety and electromagnetic compatibility data have demonstrated that Surn5 Electrosurgical Argon Beam Generator and Accessories are as safe and effective as the predicate device.

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

Not Found

Predicate Device(s)

K172671

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.

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February 22, 2021

Surnic Corporation Helen Xie RA Assistant 480 Apollo Street, Suite D. Brea, California 92821

Re: K203522

Trade/Device Name: Surn5 Electrosurgical Argon Beam Generator and Accessories Regulation Number: 21 CFR 878.4400 Regulation Name: Electrosurgical Cutting and Coagulation Device and Accessories Regulatory Class: Class II Product Code: GEI Dated: December 29, 2020 Received: December 31, 2020

Dear Helen Xie:

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 Actinclude 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/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-devices/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device (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) K203522

Device Name

Surn5 Electrosurgical Argon Beam Generator and Accessories

Indications for Use (Describe)

The Surns Electrosurgical Argon Beam Generator and Accessories are indicated for monopolar or bipolar surgery to achieve argon beam and cut or coagulation for the tissue. It is intended to be used with monopolar handpiece and dispersive electrode or bipolar handpiece and footswitches.

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)

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| K203522

Section 5
Version1
Pages3
DateFeb-19-2021

1. Submitter Information

Company:Surnic Corporation
Address:Suite D, 480 Apollo Street, Brea CA 92821
Contact:Helen Xie
Phone:1(909) 859 - 9055
Email:hx9055@gmail.com

2. Device Identification

Common name:Electrosurgical Generator and Accessories
Classification name:Electrosurgical, Cutting & Coagulation & Accessories
Trade name:Surn5 Electrosurgical Argon Beam Generator and Accessories
Model:Surn5
Device ClassClass II
Product Code:GEI
21CFR Regulation Number:878.4400

3. Predicate Device

Product HelixAR ABC Systems 510(K) K172671

4. Device Description

Surn5 electrosurgical argon beam Generator and accessories have Monopolar Pure cut, Monopolar Bland Cut, Argon Beam, Bipolar functions. Surn5 electrosurgical argon beam Generator and accessories consists of HF generator and accessories. The device generates HF power, which is transmitted to the tissue through the output Pencil. Operator selects the output function and power with the front panel. The indicator is used to indicate the setup status and output status of the device. The output is controlled by foot or hand switch.

5. Indication for use

The Surn5 Electrosurgical Argon Beam Generator and Accessories are indicated for monopolar or bipolar surgery to achieve argon beam and cut or coagulation for the tissue. It is intended to be used with monopolar handpiece and dispersive electrode or bipolar handpiece and footswitches.

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6. Substantial Equivalence Discussion

Technological characteristics

DeviceSubject devicePredicate device
ManufacturerSurnic CorporationConmed Corporation
ModelSurn5 Electrosurgical Argon Beam
Generator and AccessoriesHelixAR ABC System
510(k) NumberK203522K172671
ClassIIII
Product CodeGEIGEI
Regulation Number21 CFR 878.440021 CFR 878.4400
Mechanism of
ActionThe device generates high
Frequency current
400-600 kHzThe device generates high
Frequency current
385-600 kHz
System Voltage100-240VAC- 50/60Hz100-240VAC- 50/60Hz
4 Monopolar Cut Modes
Max. Power320 W (at 300Ω)300 W (at 300Ω)
Wave FormsSinusoidal
constant / modulated
Cut / Coag Pulse PhasesSinusoidal
constant / modulated
Cut / Coag Pulse Phases
8 Monopolar Coagulation Modes
Max. Power120 W (at 500Ω)120 W (at 500Ω)
Wave FormsSinusoidal
constant / modulated
Cut / Coag Pulse PhasesSinusoidal
constant / modulated
Cut / Coag Pulse Phases
Argon Beam
Max. Power150W (at 500Ω)150W (at 500Ω)
4 Bipolar Modes
Max. Power100 W (at 100Ω)90 W (at 300Ω)
Wave FormsSinusoidal constant / modulated
Pause PhasesSinusoidal constant / modulated
Pause Phases

5

K203522

7. Non-Clinical Performance Data

To demonstrate the safety and effectiveness of Surn5 Electrosurgical Argon Beam Generator and Accessories show substantial equivalence to the predicate device (Surn5 Electrosurgical Argon Beam Generator and Accessories), Medrange completed successfully the following non-clinical performance tests:

| General Safety Testing | IEC 60601-1:2005+C1+C2+A1:2012 Medical electrical equipment, Part 1
General requirements for basic safety and essential performance |
|------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| EMC Safety Testing | IEC 60601-1-2:2014 (Edition 4.0) Medical electrical equipment, Part 1-2
General requirements for basic safety and essential performance Collateral
Standard: Electromagnetic disturbances - Requirements and tests |
| HF Safety Testing | IEC 60601-2-2:2017 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 |
| Performance Testing | Applicable parts of FDA Guidance Document “Premarket Notification
(510(k)) Submissions for Electrosurgical Devices for General Surgery”, May
2016 |
| Usability Testing | IEC 60601-1-6:2010, AMD1:2013 Medical electrical equipment Part 1-6
General requirements for safety - Collateral Standard: Usability |

8. Statement of Substantial Equivalence

The Surn5 Electrosurgical Argon Beam Generator and Accessories have the same intended use as the HelixAR, and the same technological characteristics. The non-clinical test results, such as performance data, software data, electrical safety and electromagnetic compatibility data have demonstrated that Surn5 Electrosurgical Argon Beam Generator and Accessories are as safe and effective as the predicate device. Therefore it is concluded, that the Surn5 Electrosurgical Argon Beam Generator and Accessories fulfill the requirements of a substantially equivalent device and that no new questions of safety and effectiveness were raised.