K Number
K220399
Manufacturer
Date Cleared
2022-06-16

(125 days)

Product Code
Regulation Number
874.4680
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

WiScope® Digital Bronchoscope System is designed for physicians to access, visualize, and perform endoscopy and endotherapy in the airways and tracheobronchial tree.

Device Description

WiScope® Digital Bronchoscope System is designed for physicians to access, visualize, and perform endoscopy and endotherapy in the airways and tracheobronchial tree. This system includes a single-use digital bronchoscope and an image system.

  • The image system OTU-A is the currently marketed in the United States by OTU Medical Inc. under 510(k) # K181977.
  • The single-use bronchoscope is comprised of a control body with an articulation lever, a suction connector, a suction button, and a working channel port, and a flexible insertion tube with an on-tip camera module and LED lighting source.
AI/ML Overview

The provided document is a 510(k) summary for the WiScope® Digital Bronchoscope System. It details the device's characteristics, comparison to a predicate device, and non-clinical testing performed to demonstrate substantial equivalence. Crucially, it explicitly states "No clinical study is included in this submission" in section 10, "Performance Data-Clinical".

Therefore, based on the provided text, there is no information available regarding acceptance criteria based on clinical performance, nor any study that proves the device meets such criteria through clinical data. The submission relies entirely on non-clinical testing and comparison to a predicate device to demonstrate substantial equivalence.

However, I can extract the acceptance criteria for the non-clinical performance tests that were conducted and the reported non-clinical device performance.

Here's the breakdown based on the provided document:


Acceptance Criteria and Device Performance (Non-Clinical)

Given that "No clinical study is included in this submission," the acceptance criteria and performance data relate entirely to non-clinical testing and established industry standards for medical devices. The device is deemed to meet acceptance criteria if it passes these tests.

1. Table of Acceptance Criteria and Reported Device Performance

Test Category / CharacteristicAcceptance Criteria (Standard Compliance)Reported Device Performance
Electrical SafetyIEC 60601-1 and IEC 60601-2-18 compliance."All evaluation acceptance criteria were met."
Electromagnetic Compatibility (EMC)IEC 60601-1-2 compliance."All evaluation acceptance criteria were met."
BiocompatibilityISO 10993-1 compliance, specifically: Cytotoxicity (ISO 10993-5), Sensitization (ISO 10993-10), Intracutaneous reactivity test (ISO 10993-10)."All tests were passed." (for Cytotoxicity, Sensitization, Intracutaneous reactivity) Cytotoxicity: "Comply with ISO 10993-5, no cytotoxicity effect." Irritation: "Comply with ISO 10993-10, not an irritant." Sensitization: "Comply with ISO 10993-10, not a sensitizer."
Shelf LifeASTM F1980 compliance, including Performance test and Sterile Packaging Integrity."All tests were passed."
Sterile Barrier SystemsISO 11607-1:2019 compliance."Evaluated in accordance with ISO 11607-1:2019." (Implied acceptance met for submission)
Sterilization ProcessISO 11135:2014 compliance, demonstrating achievement of required SAL of 10-6 using half cycle overkill approach."The WiScope® Single-Use Digital Flexible Bronchoscope is sterile with a determination of lethal rate of the sterilization process to demonstrate achievement of the required SAL of 10° is in accordance to half cycle overkill approach." (Implied acceptance met)
Technological Characteristics / Performance (per ISO 8600 and relevant functions)Functions as intended, including: Appearance, Working length of the shaft, Minimum bending radius, Working channel diameter, Outer Shaft Diameter, Depth of field, Field of view, Direction of view, Rigid Distal Tip Temperature, Tensile Force Testing, Resolution, Illumination, Angulation range, Working channel free from leakage, Water proof, Suction. (Implied compliance with ISO 8600 standards where applicable for these parameters)"All tests were passed."
Simulated Shipping DistributionASTM D4169-16 compliance."All tests were passed."
Software DevelopmentISO 13485 compliance (development), IEC 62304:2006 compliance (verification and validation)."Software is developed according to ISO 13485 standard. It is verified and validated according to IEC 62304:2006." (Implied acceptance met)
Cybersecurity AssessmentFDA Cybersecurity Guidance compliance."Cybersecurity Assessment is completed according to FDA Cybersecurity Guidance." (Implied acceptance met)

Since the submission explicitly states "No clinical study is included in this submission," the following points directly related to clinical studies or AI/human-in-the-loop performance cannot be addressed from the provided text.

2. Sample size used for the test set and the data provenance: Not applicable for clinical data. For non-clinical, the sample sizes would refer to the number of devices or components tested, which is not specified but implied by the "All tests were passed" statements for various categories (e.g., biocompatibility testing of specific materials, sterilization validation on a batch of devices). Data provenance is not described for these non-clinical tests (e.g., where manufacturing/testing was performed).

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts: Not applicable, as there are no clinical studies or ground truth established by experts for such studies.

4. Adjudication method (e.g. 2+1, 3+1, none) for the test set: Not applicable for clinical studies.

5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance: Not applicable, as there is no clinical study and no mention of AI assistance. The device is a physical bronchoscope system.

6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done: Not applicable, as the device is a physical system, not an AI algorithm.

7. The type of ground truth used (expert concensus, pathology, outcomes data, etc): Not applicable for clinical data. For non-clinical tests, the "ground truth" is adherence to national and international testing standards (e.g., ISO, ASTM, IEC).

8. The sample size for the training set: Not applicable, as there is no AI component requiring a training set.

9. How the ground truth for the training set was established: Not applicable.

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Image /page/0/Picture/0 description: The image contains 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.

June 16, 2022

OTU Medical Inc. % Mingzi Hussey Regulatory Consultant Zi-medical 93 Springs Rd Bedford, Massachusetts 01730

Re: K220399

Trade/Device Name: WiScope Digital Bronchoscope System Regulation Number: 21 CFR 874.4680 Regulation Name: Bronchoscope (Flexible Or Rigid) And Accessories Regulatory Class: Class II Product Code: EOQ Dated: May 11, 2022 Received: May 11, 2022

Dear Mingzi Hussey:

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

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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 (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 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 Shu-Chen Peng, Ph.D. Assistant Director DHT1B: Division of Dental and ENT Devices OHT1: Office of Ophthalmic, Anesthesia, Respiratory, ENT and Dental Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known) K220399

Device Name WiScope® Digital Bronchoscope System

Indications for Use (Describe)

WiScope® Digital Bronchoscope System is designed for physicians to access, visualize, and perform endoscopy and endotherapy in the airways and tracheobronchial tree.

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

Registration Use (Part 21 CFR 601 Subpart E)Same-Tissue Controls Use (21 CFR 601 Subpart E)
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Prescription Use (Part 21 CFR 801 Subpart D)

| | Over-The-Counter Use (21 CFR 801 Subpart C)

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510(k) Summary

[As required by 21 CFR 807.92]

1. Submission Sponsor

OTU Medical Inc. 2231A Fortune Drive, San Jose, CA 95131 Phone: (408) 797-7313 Contact: Geping Liu Email: info@@otumed.com

2. Submission Correspondent

Mingzi Hussey Zi-medical, Inc. Address: 93 Springs Rd, Bedford, MA 01730 US Phone: 206-981-0675 Email: mingzi@zi-medical.com

3. Date Prepared

June 16th, 2022

4. Device Identification

Trade Name: WiScope® Digital Bronchoscope System Common Name/Classification Name: Bronchoscope (Flexible or Rigid) and accessories Product Code: EOQ Regulation Number: 21 CFR 874.4680 Regulation Class: Class II Review Panel: Ear Nose & Throat 510(k) Number: K220399

5. Predicate Devices

The proposed devices are substantially equivalent to the following predicate devices:

ApplicantDevice name510(k) NumberProduct code
Ambu Inc.Ambu® aScope™ 4 Broncho Slim 3.8/1.2K173727EOQ
Ambu® aScope™ 4 Broncho Regular 5.0/2.2
Ambu® aScope™ 4 Broncho Large 5.8/2.8
Ambu® aView™ Monitor

6. Device Description

WiScope® Digital Bronchoscope System is designed for physicians to access, visualize, and perform endoscopy and endotherapy in the airways and tracheobronchial tree. This

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system includes a single-use digital bronchoscope and an image system.

  • The image system OTU-A is the currently marketed in the United States by OTU Medical Inc. under 510(k) # K181977.
  • The single-use bronchoscope is comprised of a control body with an articulation lever, a suction connector, a suction button, and a working channel port, and a flexible insertion tube with an on-tip camera module and LED lighting source.

7. Indication for Use Statement

The subject device: WiScope® Digital Bronchoscope System is designed for physicians to access, visualize, and perform endoscopy and endotherapy in the airways and tracheobronchial tree.

The predicate device: The aScope 4 Broncho endoscopes have been designed to be used with the aView monitor, endotherapy accessories and other ancillary equipment for endoscopy within the airways and tracheobronchial tree.

The aScope 4 Broncho system are for use in a hospital environment.

The aScope 4 Broncho are single-use devices designed for use in adults. They have been evaluated for the following endotracheal tubes (ETT), double lumen tubes (DLT) and endoscopic accessories (EA) sizes:

MinimumETT innerdiameterMinimumDLT sizeEA minimumworkingchannel width
aScope 4BronchoSlim5.0mm35FrUp to 1.2 mm
aScope 4BronchoRegular6.0mm41FrUp to 2.0 mm
aScope 4BronchoLarge7.0 mm-Up to 2.6mm

WiScope® Digital Bronchoscope System and the primary predicate device are similar in terms of indication for use. WiScope® Digital Bronchoscope System is used in the airways and tracheobronchial tree, while predicate device is used within the airways and tracheobronchial tree. They are all for endoscopy and endotherapy procedures with endoscopic accessories.

8. Comparison of Technological Characteristics

The following table compares the proposed device with the predicate devices in terms of intended use, technological characteristics and principles of operation, and it provides detailed information for determining substantial equivalences.

Table 5A – General Comparison

ITEMProposed DevicePredicate Device
-----------------------------------------

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OTU Medical Inc. 2231A Fortune Drive, San Jose, CA 95131

Trade nameWiScope® DigitalBronchoscope System,OTU-BR01,OTU- BR02,OTU-BR03,OTU-A image system.Ambu® aScope™ 4 Broncho Slim 3.8/1.2Ambu® aScope™ 4 Broncho Regular 5.0/2.2Ambu® aScope™ 4 Broncho Large 5.8/2.8Ambu® aView™ Monitor
510(K)SubmitterOTU Medical Inc.Ambu Inc.
510(K) NumberK220399K173727
ClassificationRegulation21 CFR 874.468021 CFR 874.4680
Classificationand CodeClass II,EOQClass II,EOQ
Common nameBronchoscope (Flexible orRigid) and AccessoriesBronchoscope (Flexible or Rigid) and Accessories
BronchoscopeSingle-UseSingle-Use
Indications forUseWiScope® DigitalBronchoscope System isdesigned for physicians toaccess, visualize, and performendoscopy and endotherapyin the airways andtracheobronchial tree.The aScope 4 Broncho endoscopes have been designedto be used with the aView monitor, endotherapyaccessories and other ancillary equipment forendoscopy within the airways and tracheobronchialtree.The aScope 4 Broncho system are for use in a hospitalenvironment.The aScope 4 Broncho are single-use devices designedfor use in adults. They have been evaluated for thefollowing endotracheal tubes (ETT), double lumentubes (DLT) and endoscopic accessories (EA) sizes:MinimumETT innerdiameter MinimumDLT size EA minimumworkingchannel width aScope 4BronchoSlim 5.0mm 35Fr Up to 1.2 mm aScope 4BronchoRegular 6.0mm 41Fr Up to 2.0 mm aScope 4BronchoLarge 7.0 mm - Up to 2.6mm
Digital videotechnologyCMOSCMOS
IlluminationLEDLED
Field of View(Diagonal)100°85°

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OTU Medical Inc. 2231A Fortune Drive, San Jose, CA 95131

Working Length(mm)600mm600mm
Maximumdiameter ofinsertionportionOTU-BR01: 9.5Fr(3.25mm)OTU-BR02: 16Fr(5.4mm)OTU-BR03: 18.6Fr(6.2mm)1. aScope 4 Broncho Slim:4.3mm2.aScope 4 Broncho Regular:5.5mm3.aScope 4 Broncho Large:6.3mm
Insertion tubeouter diameterOTU-BR01: 2.85mm (8.6Fr)OTU-BR02: 5.1mm(15.3Fr)OTU-BR03: 5.9mm(17.7Fr)1. aScope 4 Broncho Slim:3.8mm2.aScope 4 Broncho Regular:5.0mm3.aScope 4 Broncho Large:5.8mm
WorkingChannelDiameterOTU-BR01: 3.6Fr(1.2mm)OTU-BR02: 6.6Fr(2.2mm)OTU-BR03: 8.4Fr(2.8mm)1.aScope 4 Broncho Slim:1.2mm2.aScope 4 Broncho Regular:2.0 mm3.aScope 4 Broncho Large:2.6 mm
Up/DownDeflectionUP: 180°DOWN: 180°1.aScope 4 Broncho Slim and aScope 4 Broncho Regular: UP: 180°DOWN: 180°2.aScope 4 Broncho Large: UP: 180°DOWN: 160°
Direction ofView
BrightnessControlYesYes
White BalanceYesYes
Output FormatsUSB/AV/HDMIUSB/HDMI
Image/VideoCaptureNoYes
SterilizationEOSAL: 10-6EOSAL: 10-6
PackagingWiScope® Single-Use DigitalFlexible Bronchoscope ispackaged by paper-plasticbag.Ambu® aScope™ 4 Broncho is packaged bypaper-plastic bag.
Label andLabelingMeet FDA's RequirementsMeet FDA's Requirements
Safety Testing*AAMI / ANSI ES60601-1:2012*AAMI / ANSI / IEC 60601-1-2:2014*IEC 60601-2-18:2009*AAMI / ANSI / ISO 10993-5:2009*ISO 10993-10:2010*ISO 11135:2014*ISO 10993-7:2008*ISO 11607-1:2019*ASTM F1980-16*ISO 11737-2:2019*ASTM D3078-2013*ASTM F1929-15*DIN 58953-6:2016*IEC 60601-1:2012*IEC 60601-2-18:2009*ISO 8600-1-2015*ISO 8600-3-1997*ISO 8600-4-2014*IEC 60601-1-2:2014*ISO 10993-1:2009*ISO 594-1:1986
*ASTM F88/F88M-15*ISO 8600-1-2015*ISO 8600-3-2019*ISO 8600-4-2014*ISO 8600-6-2005*ISO 594-1:1986
CytotoxicityComply with ISO 10993-5, no cytotoxicity effect
IrritationComply with ISO 10993-10, not an irritantComply with ISO 10993-1.
SensitizationComply with ISO 10993-10, not a sensitizer.

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WiScope® Single-Use Digital Flexible Bronchoscope has three models:

OTU-BR01, with slim size insertion tube (8.6Fr),

OTU-BR02, with regular size insertion tube(15.3Fr),

OTU-BR03, with large size insertion tube(17.7Fr).

The proposed device shares the similar indications for use, same device operation, and overall technical and functional capabilities as the predicate device. It also has the same standards and requirements as the predicate device.

9. Description of Non-clinical Testing

The non-clinical tests of the subject device and predicate device are in compliance with the following standards and guidance.

ITEMProposed DevicePrimary Predicate Device
Trade nameWiScope® Digital BronchoscopeSystem,Ambu® aScope™ 4 Broncho Slim
OTU-BR01,3.8/1.2
OTU-BR02,Ambu® aScope™ 4 Broncho Regular
OTU-BR03,5.0/2.2
OTU-A image system.Ambu® aScope™ 4 Broncho Large
5.8/2.8
Ambu® aView™ Monitor
Safety Testing*AAMI / ANSI ES60601-1:2012*IEC 60601-1:2012
*AAMI / ANSI / IEC 60601-1-2:2014*IEC 60601-2-18:2009
*IEC 60601-2-18:2009*ISO 8600-1-2015
*AAMI / ANSI / ISO 10993-5:2009*ISO 8600-3-1997
*ISO 10993-10:2010*ISO 8600-4-2014
*ISO 11135:2014*IEC 60601-1-2:2014
*ISO 10993-7:2008*ISO 10993-1:2009
*ISO 11607-1:2019*ISO 594-1:1986
*ASTM F1980-16
*ISO 11737-2:2019
*ASTM D3078-2013
*ASTM F1929-15

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*DIN 58953-6:2016
*ASTM F88/F88M-15
*ISO 8600-1-2015
*ISO 8600-3-2019
*ISO 8600-4-2014
*ISO 8600-6-2005
*ISO 594-1:1986

WiScope® Digital Bronchoscope System has been verified for its safety and effectivity based on the following performance data. These tests only used to evaluate non-clinical testing of the subject device.

Electrical safety of the system was evaluated in accordance with IEC 60601-1and IEC 60601-2-18. Electromagnetic compatibility was evaluated in accordance with IEC 60601-1-2. All evaluation acceptance criteria were met.

The biocompatibility evaluation for WiScope® Single-Use Digital Flexible Bronchoscope was conducted in accordance with ISO 10993-1.

  • · Cytotoxicity (ISO 10993-5)
  • · Sensitization (ISO 10993-10)
  • Intracutaneous reactivity test (ISO 10993-10)

Result: All tests were passed.

Shelf life for WiScope® Single-Use Digital Flexible Bronchoscope test is conducted based on ASTM F1980:

  • Performance test
  • · Sterile Packaging Integrity

Result: All tests were passed.

Sterile barrier systems for WiScope® Single-Use Digital Flexible Bronchoscope were evaluated in accordance with ISO 11607-1:2019.

Sterilization Process has been validated accordance with ISO 11135:2014.

Result: The WiScope® Single-Use Digital Flexible Bronchoscope is sterile with a determination of lethal rate of the sterilization process to demonstrate achievement of the required SAL of 10° is in accordance to half cycle overkill approach.

Technological characteristics for WiScope® Single-Use Digital Flexible Bronchoscope have been tested for its functions as intended including verification of performance characteristics per ISO 8600 and performances characteristics relevant to functions as intended:

  • Appearance
  • Working length of the shaft,
  • · Minimum bending radius
  • Working channel diameter
  • Outer Shaft Diameter

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OTU Medical Inc. 2231A Fortune Drive, San Jose, CA 95131

  • Depth of field
  • Field of view
  • Direction of view
  • Rigid Distal Tip Temperature
  • · Tensile Force Testing
  • Resolution
  • Illumination
  • · Angulation range
  • Working channel free from leakage
  • Water proof
  • Suction

Result: All tests were passed.

Simulated shipping distribution on aged devices test were conducted based on ASTM D4169-16. Result: All tests were passed.

Software is developed according to ISO 13485 standard. It is verified and validated according to IEC 62304:2006. Cybersecurity Assessment is completed according to FDA Cybersecurity Guidance.

The results of Non-Clinical Performance testing demonstrate that the WiScope® Digital Bronchoscope System is considered safe and effective for its intended use.

10. Performance Data-Clinical

No clinical study is included in this submission.

11. Conclusion

lt has been shown in this 510(k) submission that the differences between the proposed device and the predicate device do not raise different questions regarding safety and effectiveness. Performance testing and compliance with voluntary standards demonstrate that the proposed subject device is substantially equivalent to the relevant aspects of the predicate device in terms of design, components, materials, principals of operation, biocompatibility, performance characteristics, and intended use.

§ 874.4680 Bronchoscope (flexible or rigid) and accessories.

(a)
Identification. A bronchoscope (flexible or rigid) and accessories is a tubular endoscopic device with any of a group of accessory devices which attach to the bronchoscope and is intended to examine or treat the larynx and tracheobronchial tree. It is typically used with a fiberoptic light source and carrier to provide illumination. The device is made of materials such as stainless steel or flexible plastic. This generic type of device includes the rigid ventilating bronchoscope, rigid nonventilating bronchoscope, nonrigid bronchoscope, laryngeal-bronchial telescope, flexible foreign body claw, bronchoscope tubing, flexible biopsy forceps, rigid biopsy curette, flexible biopsy brush, rigid biopsy forceps, flexible biopsy curette, and rigid bronchoscope aspirating tube, but excludes the fiberoptic light source and carrier.(b)
Classification. Class II.