K Number
K972497
Device Name
KARL STORZ MONOPOLAR COAGULATING ELECTRODES/ KARL STORZ MONOPOLAR COAGULATING NEEDLE ELECTRODES
Date Cleared
1997-08-27

(55 days)

Product Code
Regulation Number
878.4400
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The KSEA Monopolar Coagulating and Needle Electrodes are designed to be used by qualified surgeons and physicians to cut, coagulate, and/or fulgurate tissue via high-frequency electrical current wave forms, during endoscopic general and plastic surgical procedures. The Monopolar Coagulating Electrodes are indicated for use in cutting, coagulating, and/or fulgurating tissue during endoscopic general and plastic electrosurgical procedures.
Device Description
The KSEA Monopolar Coagulating and Needle Electrodes are reusable surgical devices. The body-contact portions of the electrodes are composed of AISI series 420 surgical-grade stainless steel. The shafts are composed of AISI series 303 and 304 surgical-grade stainless steel, and are insulated with polytetrafluoroethylene (PTFE).
More Information

Not Found

Not Found

No
The summary describes a standard electrosurgical device and does not mention any AI or ML components or functionalities.

No
The device is used to cut, coagulate, and/or fulgurate tissue during surgical procedures, which are interventional actions, not therapeutic ones in the strict sense of restoring health or preventing disease through non-invasive means. It's a surgical tool.

No

Explanation: The device description clearly states its intended use is for "cut, coagulate, and/or fulgurate tissue" using high-frequency electrical current, which are therapeutic actions, not diagnostic ones. Diagnostic devices are used to identify or analyze medical conditions.

No

The device description explicitly states it is a reusable surgical device composed of stainless steel and PTFE, indicating it is a physical hardware device, not software only.

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

Here's why:

  • Intended Use: The intended use clearly states that the device is used by qualified surgeons and physicians to "cut, coagulate, and/or fulgurate tissue" during surgical procedures. This is a direct intervention on the patient's body.
  • Device Description: The device description details a surgical instrument made of stainless steel and PTFE, designed for physical interaction with tissue.
  • Lack of IVD Characteristics: There is no mention of the device being used to examine specimens (like blood, urine, tissue samples) in vitro (outside the body) to provide information about a physiological state, health, or disease.

IVD devices are used to perform tests on samples taken from the body to diagnose or monitor conditions. This device is a surgical tool used for treatment during a procedure.

N/A

Intended Use / Indications for Use

The KSEA Monopolar Coagulating and Needle Electrodes are designed to be used by qualified surgeons and physicians to cut, coagulate, and/or fulgurate tissue via high-frequency electrical current wave forms, during endoscopic general and plastic surgical procedures.

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

GEI

Device Description

The KSEA Monopolar Coagulating and Needle Electrodes are reusable surgical devices. The body-contact portions of the electrodes are composed of AISI series 420 surgical-grade stainless steel. The shafts are composed of AISI series 303 and 304 surgical-grade stainless steel, and are insulated with polytetrafluoroethylene (PTFE).

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

qualified surgeons and physicians

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)

Not Found

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.

Not Found

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.

Not Found

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

Karl Storz Endoscopy-America, Inc

Culver City, California 90230-760 Phone 110 568 11.75

上できる(800) 4.21 13

Image /page/0/Picture/3 description: The image shows a logo for "TORZ Endoscopy". The logo features the word "TORZ" in a stylized font, with the "O" represented by a circle with a smaller circle inside. Below the word "TORZ" is the word "Endoscopy" in a smaller, simpler font. The image is black and white and has a grainy texture.

K972+97

510(k) SUMMARY OF SAFETY AND EFFECTIVENESS

This summary of 510(k) safety and effectiveness information is being submitted in accordance with the requirements of the Safe Medical Devices Act (SMDA) of 1990 and 21 CFR 807.92. All data included in this document are accurate to the best of KSEA's knowledge.

| Applicant: | Karl Storz Endoscopy-America, Inc.
600 Corporate Pointe
Culver City, California 90230
(310) 558-1500 |
|------------------------|---------------------------------------------------------------------------------------------------------------|
| Contact: | Marlena Allen Piercy, Ph.D.
Senior Clinical Affairs Specialist |
| Device Identification: | Common Name:
Electrosurgical Coagulating Electrodes
Electrosurgical Needle Electrodes |
| | Trade Name (optional): |

KSEA Monopolar Coagulating Electrodes KSEA Monopolar Coagulating Needle Electrode

Indication: The KSEA Monopolar Coagulating and Needle Electrodes are designed to be used by qualified surgeons and physicians to cut, coagulate, and/or fulgurate tissue via high-frequency electrical current wave forms, during endoscopic general and plastic surgical procedures.

Device Description: The KSEA Monopolar Coagulating and Needle Electrodes are reusable surgical devices. The body-contact portions of the electrodes are composed of AISI series 420 surgical-grade stainless steel. The shafts are composed of AISI series 303 and 304 surgical-grade stainless steel, and are insulated with polytetrafluoroethylene (PTFE).

Substantial Equivalence: The KSEA Monopolar Coagulating and Needle Electrodes are substantially equivalent to the predicate devices since the basic designs and intended uses are the same. The minor difference between the K.SEA Monopolar Coagulating and Needle Electrodes and the predicate devices raise no new issues of safety and effectiveness, as the design differences have no effect on the performance, function, or intended uses of the devices.

Signed: Marlena Allen Piercy, Ph.D.
Senior Clinical Affairs Specialist

1

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

AUG 27 1997

Marlena Allen Piercy, Ph.D. Senior Clinical Affairs Specialist Karl Storz Endoscopy-America, Inc. 600 Corporate Pointe Culver City, California 92030-7600

K972497 Re:

Trade Name: Karl Storz Monopolar Coagulating Electrodes and Karl Storz Monopolar Coagulating Needle Electrodes Regulatory Class: II Product Code: GEI Dated: July 2, 1997 Received: July 3, 1997

Dear Dr. Piercy:

We have reviewed your Section 510(k) notification of intent to market the devices referenced above and we have determined the devices are substantially equivalent (for the indications for use stated in the enclosure) to 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). You may, therefore, market the devices, subject to the general controls provisions of the Act. 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.

If your devices are classified (see above) into either class II (Special Controls) or class III (Premarket Approval), they may be subject to such additional controls. Existing major regulations affecting your devices can be found in the Code of Federal Regulations, Title 21, Parts 300 to 895. A substanially equivalent determination assumes compliance with the current Good Manufacturing Practice requirements , as set forth in the Quality System Regulation (QS) for Medical Devices: General regulation (21 CFR Part 820) and that, through periodic (QS) inspections, the Food and Drug Administration (FDA) will verify such assumptions. Failure to comply with the GMP regulation may result in regulatory action. In addition, FDA may publish further announcements concerning your devices in the Federal Register. Please note: this response to your premarket notification submissions does not affect any obligation you might have under sections 531 through 542 of the Act for devices under the Electronic Product Radiation Control provisions, or other Federal laws or

2

Page 2 - Marlena Allen Piercy, Ph.D.

This letter will allow you to begin marketing your devices as described in your 510(k) premarket notification. The FDA finding of substantial equivalence of your devices to a legally marketed predicate device results in a classification for your devices and thus, permits your devices to proceed to the market. " " w

If you desire specific advice for your devices on our labeling regulation (21 CFR Part 801 and additionally 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4595. Additionally, for questions on the promotion and advertising of your devices, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its internet address "http://www.fda.gov/cdrh/dsmamain.html".

Sincerely yours,

sincerely yours,

[signature]

Celia M. Witten, Ph.D., M.D. Director Division of General and Restorative Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

3

Image /page/3/Picture/0 description: The image shows the logo for Karl Storz Endoscopy. The logo is in black and white and features the word "STORZ" in large, bold letters. Below the word "STORZ" is the phrase "Karl Storz Endoscopy" in a smaller font. The logo is simple and modern, and it is likely used to represent the company's brand.

Karl Storz Endoscopy-America, Inc.

500 Corporate Porne Culver City, California 90230-7600 Phone 310 558 1500

01 Free 800 421 08.13 Fax 340 410 5521

K9124997

510(k) Number (if known): Not yet assigned

Device Name: Monopolar Coagulating Electrodes for General and Plastic Surgery

Indications for Use:

The Monopolar Coagulating Electrodes are indicated for use in cutting, coagulating, and/or fulgurating tissue during endoscopic general and plastic electrosurgical procedures.

CONTINUE ON ANOTHER PAGE IF NEEDED)
Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use: (Per 21 CFR 801.109)(Division Sign-Off)(Division Sign-Off)OR Over-the-Counter Use:(Optional Format 1-2-96)
(Division Sign-Off)
Division of General Restorative Devices
510(k) Number K972497

(PLEASE DO NOT WRITE BELOW THIS LINE -

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