The da Vinci E-200 Electrosurgical Generator is intended to deliver high-frequency energy for cutting, coagulation and vessel sealing of tissues in da Vinci robotic procedures, and non-robotic open and laparoscopic procedures.

Device Description

The da Vinci E-200 is an electrosurgical unit (ESU) designed to provide high-frequency (HF) traditional monopolar, bipolar, and advanced bipolar outputs intended for cutting, coagulation and/or vessel sealing of tissues. The da Vinci E-200 is intended to be used with the IS4000/IS4200 da Vinci surgical systems and also operate as a standalone electrosurgical generator. When connected to the da Vinci surgical system, the E-200 provides HF output to da Vinci instruments. Control and status messages are passed between the E-200 and the da Vinci system through an Ethernet communication cable. The E-200 is also compatible with open and laparoscopic third-party handheld monopolar and bipolar instruments, fingerswitch equipped instruments (where applicable) and Intuitive provided auxiliary footswitches. The primary function of the E-200 Electrosurgical Generator is to allow a surgeon to deliver HF output to cut, seal, or coagulate human tissue during surgery. The user interface includes audible indicator tones, LED indicators on the front of the generator, and status messages provided on its LCD display.

AI/ML Overview

This document is a 510(k) premarket notification for the da Vinci E-200 Electrosurgical Generator, indicating that it is a medical device approval document and not a study on AI-assisted human reading, or a diagnostic AI device. Therefore, many of the requested criteria related to AI studies (e.g., sample size for test/training sets, ground truth establishment, expert adjudication, MRMC studies, standalone performance) are not applicable to this submission.

The document primarily focuses on demonstrating the substantial equivalence of the da Vinci E-200 Electrosurgical Generator to existing predicate devices through bench testing, in-vivo/ex-vivo models, and human factors evaluation, rather than evaluating an AI algorithm's performance in a diagnostic context.

However, I can extract and present the available information regarding the device's performance and acceptance criteria based on the provided text.

1. Table of Acceptance Criteria and Reported Device Performance

Since this is an electrosurgical generator rather than a diagnostic AI device, the "acceptance criteria" are related to its functional performance, safety, and equivalence to predicate devices, rather than typical diagnostic performance metrics (e.g., sensitivity, specificity, AUC). The document outlines various tests conducted to demonstrate the device meets its design requirements and is safe and effective.

Category of Testing	Acceptance Criteria (Implied by Test Name)	Reported Device Performance (Summary from Document)
Design Verification	Device meets hardware, EMC, electrical safety, software (including cybersecurity), system interface, instrument compatibility, packaging, and labeling requirements.	"The subject device, E-200 Electrosurgical Generator, was subjected to series of tests to evaluate performance and to demonstrate that the design outputs meet the design input requirements."
Design Validation (In-vivo porcine model)	Safety and efficacy of the E-200 generator, its accessories, and its interaction with intended robotic and third-party instruments/accessories in a simulated surgical setting. Device fulfills user needs and intended use is met.	"Design validation demonstrated that the design outputs fulfill the user needs and that the intended use have been met."
Thermal Effects Testing	Comparable thermal effects on tissue to the predicate ForceTRIAD generator (K110268).	"The E-200 generator was found to have acceptable thermal effects when compared to the ForceTRIAD generator."
Neutral Electrode Contact Quality Monitor (CQM) Study	Conformance to IEC standards for the CQM system. Validation of the use of Covidien E7507 neutral electrode.	"The study validated the use of the Covidien E7507 neutral electrode (commercially available product) with the E-200 generator for CQM functionality."
Vessel Sealing Bench Testing (E-200 vs. E-100)	HF output characteristics are substantially equivalent to the predicate E-100 device (K191280) with no differences expected to change vessel sealing performance.	"The test demonstrated that the HF output characteristics of the two generators are substantially equivalent and that there are no differences which would be expected to result in a change in the vessel sealing performance."
Capacitive Coupling Evaluation	No significant increase in unintended capacitively coupled energy delivery compared to the predicate Covidien ForceTriad generator.	"This validation demonstrated that the E-200 generator had no significant increase in unintended capacitively coupled energy delivery when compared to the predicate Covidien ForceTriad generator."
Human Factors Evaluation (Usability Validation Study)	Safe and effective use of the E-200 generator and associated accessories by intended users in the intended use environment.	"The usability validation study demonstrated that the E-200 electrosurgical generator could be used safely and effectively by the intended users in the intended use environment."

2. Sample Size Used for the Test Set and Data Provenance

Test Set Sample Size: The document does not specify a numerical sample size for individual tests like "Design Verification" (bench testing), "Thermal Effects Testing," or "CQM Study." For the in-vivo validation, it mentions a "porcine model," but no specific number of animals or cases. Similarly, "vessel sealing bench testing" and "capacitive coupling evaluation" do not specify sample sizes.
Data Provenance: The studies appear to be prospective bench tests and animal model studies conducted by the manufacturer, Intuitive Surgical, Inc. The document does not mention the country of origin for the data beyond implying it was conducted as part of the FDA submission process.

3. Number of Experts Used to Establish Ground Truth for the Test Set and Qualifications of those Experts

This concept is not applicable to this type of device submission. Ground truth in this context refers to the physical and electrical performance of an electrosurgical unit, verified through established engineering and medical device testing standards, rather than expert interpretation of medical images or data. Performance is measured against physical specifications and validated against in-vivo/ex-vivo results.

4. Adjudication Method for the Test Set

This concept is not applicable. Adjudication typically refers to resolving disagreements among human readers or labelers in diagnostic AI studies. The performance validation of an electrosurgical generator involves objective measurements and functional tests, not human interpretation that requires adjudication.

5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study was done

No, a Multi-Reader Multi-Case (MRMC) comparative effectiveness study was not done. This type of study is relevant for evaluating the impact of AI assistance on human reader performance in diagnostic tasks, which is not the purpose of this submission for an electrosurgical generator.

6. If a Standalone (i.e., algorithm only without human-in-the-loop performance) was done

Not applicable in the context of AI algorithm performance. The "standalone" operation mentioned in the document refers to the E-200 Electrosurgical Generator operating independently of the da Vinci robotic system, as a traditional ESU. It's a device operating standalone, not an AI algorithm.

7. The Type of Ground Truth Used

The "ground truth" for this device's performance is established by:

Design Input Requirements/Specifications: The device's performance is validated against its pre-defined engineering and functional requirements.
Industry and IEC Standards: Conformance to relevant electrical safety and performance standards.
Predicate Device Performance: Demonstrating comparable performance to legally marketed predicate devices (Covidien ForceTRIAD and Intuitive E-100) through direct comparative testing (e.g., thermal effects, HF output characteristics, capacitive coupling).
In-vivo/Ex-vivo Models: Actual physiological effects in tissue (e.g., cutting, coagulation, vessel sealing effectiveness) observed in animal (porcine) models and ex-vivo settings.
User Needs/Safe and Effective Use: Confirmed through human factors evaluation with intended users.

8. The Sample Size for the Training Set

Not applicable. This submission is for an electrosurgical generator, not an AI model, so there is no "training set."

9. How the Ground Truth for the Training Set was Established

Not applicable. As there is no AI model or training set, the concept of establishing ground truth for it does not apply.

Summary

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November 28, 2022

Intuitive Surgical Shamsa Karimi Senior Regulatory Affairs Specialist 1266 Kifer Road Sunnyvale, California 94086

Re: K223039

Trade/Device Name: da Vinci E-200 Electrosurgical 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 28, 2022 Received: September 29, 2022

Dear Shamsa Karimi:

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,

Zhijie Liao - Digitally signed by Zhijie Liao -S Date: 2022.11.28 14:53:05 -05'00' For Mark Trumbore, PhD 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

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Indications for Use

510(k) Number (if known) K223039

Device Name

da Vinci E-200 Electrosurgical Generator

Indications for Use (Describe)

Type of Use (Select one or both, as applicable)
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X Prescription Use (Part 21 CFR 801 Subpart D)

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

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510(k) Summary (K223039)

Submitter: Intuitive Surgical, Inc. 1266 Kifer Road Sunnyvale, CA 94086
Official Contact: Shamsa Karimi Sr. Regulatory Affairs Specialist Phone Number: 408-806-6720-Fax Number: 408-523-8907 Email: shamsa.karimi(@intusurg.com

Date Summary Prepared: November 23, 2022

Trade Name:	da Vinci E-200 Electrosurgical Generator
Common Name:	Electrosurgical Unit (ESU/Generator)
Classification:	II21 CFR 878.4400, Electrosurgical cutting and coagulation device andaccessories.
Product Code:	GEI (Electrosurgical, Cutting & Coagulation & Accessories)
Predicate Devices:	Covidien ForceTRIAD Electrosurgical Generator (K110268, primary)Intuitive E-100 Electrosurgical Generator (K191280, secondary)

Device Description:

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function of the E-200 Electrosurgical Generator is to allow a surgeon to deliver HF output to cut, seal, or coagulate human tissue during surgery. The user interface includes audible indicator tones, LED indicators on the front of the generator, and status messages provided on its LCD display.

Intended Use/Indications for Use:

Technological Characteristics:

The Energy modes supported by E-200 include traditional monopolar and bipolar as well as advanced bipolar energy modes as described below.

Monopolar Energy Modes

The generator provides five monopolar modes to support a range of tissue effects, which can be used with compatible monopolar da Vinci instruments or compatible third-party instruments. Descriptions of the generator monopolar energy modes are listed below. The power settings for all monopolar modes can be adjusted from 0-120 watts.

Monopolar Cut Modes ●

Pure: provides clean, precise tissue division with little or no hemostasis. Blend: is a blended waveform that provides tissue division properties with some hemostasis.

Monopolar Coagulation Modes ●

Precise: provides a balance of hemostasis and division capability for precise coagulation energy applications. The width of the tissue effect can be narrower than Fulgurate mode.

Fulgurate: provides coagulation with some tissue division.

Spray: provides coagulation with limited tissue division properties. The width of the tissue effect can be wider compared to Fulgurate mode.

Bipolar Energy Modes

The generator produces four traditional bipolar modes to support a range of tissue effects, which can be used with compatible bipolar da Vinci instruments or compatible third-party instruments. Descriptions of the bipolar energy modes are listed below. The power settings for bipolar energy can be adjusted from 0-95 watts.

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● Bipolar modes

Macro: provides high intensity output for tissue division or rapid hemostasis. Standard: provides moderate intensity output for traditional bipolar application. Low: provides low intensity output for precise control over tissue desiccation.

Low with Auto Stop: provides the same bipolar output as Low and automatically stops delivering bipolar radio frequency (RF) energy based on a pre-determined threshold. Low with Auto Stop is designed to reduce the potential for excessive thermal effect.

Advanced Bipolar Energy Modes

Advanced bipolar energy modes are designed for specific advanced energy instruments, and the algorithms used on the E-200 were developed to functionally replicate those used on the predicate device, the E-100 generator. Like the predicate device, the E-200 generator delivers two bipolar advanced energy modes for sealing and transection of vessels and tissue bundles, and also provides a traditional bipolar coagulation mode that can be used for general hemostasis without vessel sealing. Advanced energy modes are compatible only with da Vinci advanced energy instruments; SynchroSeal (K191280) and Vessel Sealer Extend (K183107).

Advanced Bipolar Modes ●

Coagulation Mode: It is a traditional bipolar mode used for general tissue coagulation and has a fixed target output power of 50 W.

Sealing Mode: It is designed to seal vessels and tissue bundles when used with the da Vinci Vessel Sealer Extend and SynchroSeal. The generator determines when the seal cvcle is complete thereby delivering the required amount of energy necessary to successfully seal vessels.
Sync Mode: It is specifically designed for use with SynchroSeal for single-step sealing and transection of vessels and tissue bundles. The Sync mode uses a unique algorithm to control the energy output delivery to the seal and cut electrodes on the instrument. The generator automatically determines when the Sync mode cycle is complete, resulting in a single-step hemostatic transection of vessels and soft tissue.

Performance Data:

The E-200 Electrosurgical Generator was evaluated using design verification (bench testing), human factors testing, packaging(includes transit testing), and validated using in-vivo and exvivo models to demonstrate that the design output meets both the design input requirements and the user needs, and the generator performs as intended.

Design Verification (bench testing):

The subject device, E-200 Electrosurgical Generator, was subjected to series of tests to evaluate performance and to demonstrate that the design outputs meet the design input requirements. The

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design verification testing provided confirmation that the device meets the requirements for the following:

Hardware requirements o
EMC and Electrical Safety requirements ●
Software requirements including Cybersecurity ●
System interface requirements .
Instrument compatibility requirements ●
Packaging and Labeling 0

Design Validation; in-vivo testing with a porcine model was used to evaluate the safety and efficacy of the E-200 generator, its accessories and its interaction with intended robotic systems, da Vinci and third-party instruments and accessories in a representative simulated surgical setting. Design validation demonstrated that the design outputs fulfill the user needs and that the intended use have been met.

Thermal effects testing was conducted to demonstrate the ability of the subject E-200 generator to create comparable thermal effects on tissue to the predicate ForceTRIAD generator (K110268), the primary predicate. The E-200 generator was found to have acceptable thermal effects when compared to the ForceTRIAD generator.

Neutral electrode contact quality monitor (CQM) study was conducted to evaluate the performance of the CQM system on the subject E-200 generator for conformance to the IEC standards. The study validated the use of the Covidien E7507 neutral electrode (commercially available product) with the E-200 generator for CQM functionality.

The E-200/E-100 vessel sealing bench testing compared the HF output characteristics of the E-200 to the predicate E-100 device (K191280). The test demonstrated that the HF output characteristics of the two generators are substantially equivalent and that there are no differences which would be expected to result in a change in the vessel sealing performance.

An evaluation of the capacitive coupling behavior of the E-200 generator was performed using third party laparoscopic monopolar accessories which included instruments and cannulas. This validation demonstrated that the E-200 generator had no significant increase in unintended capacitively coupled energy delivery when compared to the predicate Covidien ForceTriad generator.

Human Factors Evaluation:

The Usability Validation Study evaluated the use safety and usability of the E-200 generator along with its associated accessories with intended robotic systems in integrated and standalone

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configurations. The usability validation study demonstrated that the E-200 electrosurgical generator could be used safely and effectively by the intended users in the intended use environment.

Summary:

The evaluation of the E-200 Electrosurgical Generator raises no new questions of safety or effectiveness and demonstrates that the E-200 design outputs meet the design input requirements and user needs and is substantially equivalent to the predicate devices, Covidien ForceTRIAD Electrosurgical Generator (K110268) and Intuitive E-100 Electrosurgical Generator (K191280).

Regulation Number and Section

§ 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.