K Number
K964211
Device Name
DAVOL PLUME FILTER (5541420)
Date Cleared
1996-12-02

(41 days)

Product Code
Regulation Number
878.4810
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
To be connected to suction / vacuum assemblies to filter smoke particulates / aerosols, and retain aqueous fluids generated during laparoscopic electrosurgery or laser surgery.
Device Description
Hydrophobic multilayered filter with vacuum tubing for attachment to wall vacuum or suction source.
More Information

Contain™ Hydrophobic safety filter

Not Found

No
The description focuses on the physical filtration properties of the device and does not mention any computational or learning capabilities.

No
The device is described as a filter for smoke particulates and aerosols generated during surgery. Its function is to retain these by-products and fluids, not to treat a medical condition or restore health.

No

Explanation: The device description indicates it is a filter for smoke particulates, aerosols, and fluids generated during surgery, and its key metric is filtering efficiency. There is no mention of it being used to identify or analyze diseases or conditions.

No

The device description clearly indicates a physical filter and tubing, which are hardware components, not software.

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

Here's why:

  • Intended Use: The intended use is to filter smoke particulates and retain fluids generated during surgical procedures (laparoscopic electrosurgery or laser surgery). This is a surgical accessory used during a medical procedure on a patient.
  • Device Description: The description of a filter with vacuum tubing aligns with a device used for managing surgical byproducts.
  • Lack of IVD Characteristics: An IVD device is used to examine specimens (like blood, urine, tissue) in vitro (outside the body) to provide information for diagnosis, monitoring, or screening. The provided information does not mention any analysis of biological specimens.

Therefore, this device falls under the category of a surgical device or accessory, not an IVD.

N/A

Intended Use / Indications for Use

To be connected to suction / vacuum assemblies to filter smoke particulates / aerosols, and retain aqueous fluids generated during laparoscopic electrosurgery or laser surgery.

Product codes

Not Found

Device Description

Hydrophobic multilayered filter with vacuum tubing for attachment to wall vacuum or suction source.

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

Not Found

Key Metrics

Not Found

Predicate Device(s)

Contain™ Hydrophobic safety filter

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 878.4810 Laser surgical instrument for use in general and plastic surgery and in dermatology.

(a)
Identification. (1) A carbon dioxide laser for use in general surgery and in dermatology is a laser device intended to cut, destroy, or remove tissue by light energy emitted by carbon dioxide.(2) An argon laser for use in dermatology is a laser device intended to destroy or coagulate tissue by light energy emitted by argon.
(b)
Classification. (1) Class II.(2) Class I for special laser gas mixtures used as a lasing medium for this class of lasers. The devices subject to this paragraph (b)(2) are exempt from the premarket notification procedures in subpart E of part 807 of this chapter, subject to the limitations in § 878.9.

0

Davol Inc. Subsidiary of C. R. Bard, Inc 100 Sockanossett Crossroad O. Box 8500 ranston, RI 02920 01 463-7000

K964211

Image /page/0/Picture/2 description: The image shows a logo with the word "DAVOL" in the center of an oval shape. The oval is white, and the word "DAVOL" is written in black, sans-serif letters. The oval is surrounded by a thick, black border that is broken at the top and bottom.

DEC - 2 1996

Section VI. 510(k) Summary of Safety and Effectiveness (page 1 of 2)

Submitter Information: Company Name:

Davol Inc
100 Sockanossett Crossroads
Cranston, RI 02920
Phone:401-463-7000
Fax:401-463-3845
Contact:Christine Nichols
Date of Preparation:10/2/96

Device name:

Trade Name:Davol® Plume Filter (hydrophobic)
Common name:Laparoscopic Plume Filter
Classification name:Laparoscope, General & Plastic Surgery;
Gynecological (and accessories);
Endoscopic tube, smoke removal

Predicate Device Name:

Contain™ Hydrophobic safety filter

Device description:

Hydrophobic multilayered filter with vacuum tubing for attachment to wall vacuum or suction source.

Intended Use

To be connected to suction / vacuum assemblies to filter smoke particulates / aerosols, and retain aqueous fluids generated during laparoscopic electrosurgery or laser surgery.

Technological

Characteristics Summary:

The Davol® Plume Filter proposed in this submission is substantially equivalent to the currently marketed Contain™ Hydrophobic Safety Filter.

The 510(k) "Substantial equivalence decision making process (detailed) decision tree" was utilized to make a determination of substantial equivalence.

Image /page/0/Picture/19 description: The image shows the word "BARD" in a stylized, bold font. The letters are thick and blocky, with a unique design for the letter "A" that resembles a triangle. The overall appearance is clean and modern, with a focus on the geometric shapes of the letters.

1

Davol Inc Subsidiary of C. R. Bard, Inc. 100 Sockanossett Crossroad P.O. Box 8500 Cranston, RI 02920 401 463-7000

Image /page/1/Picture/1 description: The image shows a logo with the word "DAVOL" in a sans-serif font. The word is centered inside of a white oval. The white oval is surrounded by a thick black oval.

(510(k) Summary of Safety and Effectiveness Continued) (page 2 of 2)

1. Does the new device have the same indication statement?

  • YES. Both the Davol Plume filter and the Contain filter are intended to be connected to wall suction or suction assemblies to filter smoke particulates / aerosols and retain aqueous fluids generated during surgical procedures. The filter will retain 99.99% of all particles / aerosols 0.12 microns and greater, and all aqueous fluids up to normal vacuum pressures.
    1. Does the new device have the same technological characteristics, e.g. design, materials, etc?
    • YES. The Davol Plume filter is identical in design, function, and materials to the Contain filter currently manufactured and commercialized. A suction/vacuum tube will be provided pre-attached to the Davol Plume filter for user convenience in attaching to a suction/ vacuum source (users of the Contain filter presently have to supply the suction tube).

3. Are the Descriptive Characteristics precise enough to ensure equivalence?

  • YES. The Contain filter is identical to the Davol Plume filter proposed in this 510(k) submission. Therefore, the descriptive characteristics are enough to ensure equivalence.

Conclusion:

Based upon the above information, the Davol Plume filter is substantially equivalent to the Contain Hydrophobic safety filter.

Typed Name: Christine E. Nichols
Title: Regulatory Affairs Associate

Signature: THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARY AND TRADE SECRET, AND IS THE EXCLUSIVE PROPERTY OF NOVARTIS PHARMACEUTICALS CORPORATION. THIS DOCUMENT CANNOT BE DISCLOSED, REPRODUCED OR USED IN ANY MANNER WITHOUT THE EXPRESS WRITTEN CONSENT OF NOVARTIS PHARMACEUTICALS CORPORATION. ©2016 NOVARTIS

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Image /page/1/Picture/13 description: The image shows the word "BARD" in a bold, stylized font. The letters are thick and have a slightly rounded appearance. The word is presented in a single line and is the main focus of the image.