K Number
K974763
Device Name
DEROYAL INDUSTRIES DISPOSABLE SURGICAL TROCAR/CANNULA
Date Cleared
1998-07-10

(203 days)

Product Code
Regulation Number
884.1720
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The DeRoyal Industries Disposable Surgical Trocar/Cannula is a single patient use disposable device intended for use during operative and/or diagnostic surgery to puncture/penetrate the abdominal wall and to serve as a port of entry for laparoscopic instruments (i.e. laparoscope, forceps, scissors, aspiration/irrigation cannula, etc.).
Device Description
The DeRoyal Disposable Surgical Trocar/Cannula is a disposable single patient use device fabricated from surgical grade stainless steels, surgical grade aluminum, and biocompatible medical grade polymers. The device comes in 5, 8, 10/11, and 12 mm diameter cannulas. Cannula length ranges from 75 mm - 100 mm. The cannula diameter can be used with equivalent diameter instruments or scopes, but is also equipped with a detachable integrated reducer diaphragm on all large sizes to bring the compatible diameter down to 5 mm. The trocar/cannula is supplied with either a pyramidal tip cutting trocar with safety shield or with a blunt tip trocar/cannula without safety shield for use with open laparoscopic procedures. The cutting trocar/cannula has a tri-segmented safety shield which is comprised of three shield segments that retract and advance independently. The cannula body has a luer fitting to accommodate insufflation apparatus and an external lever for manual opening of the internal flapper valve for rapid desufflation. The cannula shaft is radiotranslucent.
More Information

Not Found

No
The device description focuses on mechanical components and materials, with no mention of software, algorithms, or data processing that would indicate AI/ML. The "Mentions AI, DNN, or ML" field is explicitly marked as "Not Found".

No.
This device is for surgical access, not for treating a condition, and thus is not a therapeutic device.

No

Explanation: The device is a surgical tool (trocar/cannula) used to access the abdominal cavity during operative and/or diagnostic surgery to serve as a port of entry for other laparoscopic instruments. It does not perform a diagnostic function itself, but rather facilitates diagnostic procedures.

No

The device description clearly details a physical, disposable surgical instrument made of stainless steel, aluminum, and polymers, with various physical components like cannulas, trocars, safety shields, and luer fittings. There is no mention of software as the primary or sole component.

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 surgical procedures (puncturing the abdominal wall and serving as a port for instruments). IVD devices are used to examine specimens (like blood, urine, or tissue) outside the body to provide information about a person's health.
  • Device Description: The description details a physical surgical instrument used for accessing the body cavity. It does not mention any components or functions related to analyzing biological samples.
  • Lack of IVD Characteristics: The information does not mention any of the typical characteristics of an IVD, such as:
    • Reagents or assays
    • Analysis of biological specimens
    • Providing diagnostic information based on laboratory testing

Therefore, the DeRoyal Industries Disposable Surgical Trocar/Cannula is a surgical instrument, not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

The DeRoval Disposable Surgical Trocar/Cannula is a single patient use disposable device intended for use during operative and/or diagnostic surgery to puncture/penetrate the abdominal wall and to serve as a port of entry for laparoscopic instruments (i.e., laparoscope, forceps, scissors, aspiration/irrigation cannula, etc.).

Product codes

85 HET

Device Description

The DeRoyal Disposable Surgical Trocar/Cannula is a disposable single patient use device fabricated from surgical grade stainless steels, surgical grade aluminum, and biocompatible medical grade polymers.

The device comes in 5, 8, 10/11, and 12 mm diameter cannulas. Cannula length ranges from 75 mm - 100 mm. The cannula diameter can be used with equivalent diameter instruments or scopes, but is also equipped with a detachable integrated reducer diaphragm on all large sizes to bring the compatible diameter down to 5 mm. The trocar/cannula is supplied with either a pyramidal tip cutting trocar with safety shield or with a blunt tip trocar/cannula without safety shield for use with open laparoscopic procedures. The cutting trocar/cannula has a tri-segmented safety shield which is comprised of three shield segments that retract and advance independently.

The cannula body has a luer fitting to accommodate insufflation apparatus and an external lever for manual opening of the internal flapper valve for rapid desufflation. The cannula shaft is radiotranslucent.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

abdominal wall

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)

Not Found

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

Not Found

Predicate Device(s)

K862611, K874879, K900487, K903419, K912398, K924035, K932282

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 884.1720 Gynecologic laparoscope and accessories.

(a)
Identification. A gynecologic laparoscope is a device used to permit direct viewing of the organs within the peritoneum by a telescopic system introduced through the abdominal wall. It is used to perform diagnostic and surgical procedures on the female genital organs. This generic type of device may include: Trocar and cannula, instruments used through an operating channel, scope preheater, light source and cables, and component parts.(b)
Classification. (1) Class II (performance standards).(2) Class I for gynecologic laparoscope accessories that are not part of a specialized instrument or device delivery system, do not have adapters, connector channels, or do not have portals for electrosurgical, lasers, or other power sources. Such gynecologic laparosope accessory instruments include: the lens cleaning brush, biopsy brush, clip applier (without clips), applicator, cannula (without trocar or valves), ligature carrier/needle holder, clamp/hemostat/grasper, curette, instrument guide, ligature passing and knotting instrument, suture needle (without suture), retractor, mechanical (noninflatable), snare, stylet, forceps, dissector, mechanical (noninflatable), scissors, and suction/irrigation probe. 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 § 884.9.

0

K974763

$\rho_{193}$

510(k) SUMMARY: DEROYAL INDUSTRIES, INC. DISPOSABLE SURGICAL TROCAR/CANNULA

  • (1) DeRoval Industries 200 DeBusk Lane Powell. TN 37849
    Camille Matlock Contact Person: (423) 938-7828 Telephone: Date Summary Prepared: December 18, 1997

  • Trade or Proprietary Name: none established (2)
    Common Name (s):

Disposable Surgical Trocar/Cannula

Disposable Surgical Blunt tip Trocar/Cannula

Classified Name:

Endoscope and accessories, & 876.1500, Class II

  • Auto Suture® Surgiport® Disposable Trocar (3) Predicates: & Sleeve (510(k) nos. K862611. K874879, K900487, K903419)
    Ethicon Endopath Disposable Surqical Trocar and Sleeve (510(k) nos. K912398, K924035, K932282)

  • (4) Description of Device:
    The DeRoyal Disposable Surgical Trocar/Cannula is a disposable single patient use device fabricated from surgical grade stainless steels, surgical grade aluminum, and biocompatible medical grade polymers.

1

K974763

p2017

The device comes in 5, 8, 10/11, and 12 mm diameter cannulas. Cannula length ranges from 75 mm - 100 mm. The cannula diameter can be used with equivalent diameter instruments or scopes, but is also equipped with a detachable integrated reducer diaphragm on all large sizes to bring the compatible diameter down to 5 mm. The trocar/cannula is supplied with either a pyramidal tip cutting trocar with safety shield or with a blunt tip trocar/cannula without safety shield for use with open laparoscopic procedures. The cutting trocar/cannula has a tri-segmented safety shield which is comprised of three shield segments that retract and advance independently.

The cannula body has a luer fitting to accommodate insufflation apparatus and an external lever for manual opening of the internal flapper valve for rapid desufflation. The cannula shaft is radiotranslucent.

  • (5) Intended Use:
    The DeRoval Disposable Surgical Trocar/Cannula is a single patient use disposable device intended for use during operative and/or diagnostic surgery to puncture/penetrate the abdominal wall and to serve as a port of entry for laparoscopic instruments (i.e., laparoscope, forceps, scissors, aspiration/irrigation cannula, etc.).
CharacteristicsPredicate DevicesDeRoyal Industries
Intended UseApplication in thoracic, gynecologic
laparoscopy, and other abdominal
procedures to establish a path of entry
for endoscopic instruments.Same
Pyramidal TipYesSame
Safety ShieldYesSame
Reducer to Accommodate
Smaller InstrumentsYesSame
SterilitySterileSame
MaterialsPolymers, silicone rubber, stainless steel,
and aluminum.Polymers, silicone rubber, fiberglass,
stainless steel, and aluminum.
  • (6) Technological Characteristics:

2

03073

The DeRoyal Disposable Surgical Trocar/Cannula has similar/same technological characteristics as the predicate devices in that they are comprised of similar design, materials, and are intended to be used as a port of entry for laparoscopic instruments.

Conclusion: (7)

The proposed device has the same intended use and the same basic technology as the legally marketed predicate devices identified in the premarket notification submission. The proposed device contains, in some combination, similar/same features, materials, and design as the predicate devices and does not pose any new questions concerning safety and effectiveness.

3

Image /page/3/Picture/0 description: The image shows the seal of the Department of Health & Human Services USA. The seal is circular and contains the words "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" around the perimeter. In the center of the seal is an abstract image of an eagle.

DEPARTMENT OF HEALTH & HUMAN SERVICES

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JUL 1 0 1998

Ms. Camille Matlock Regulatory Affairs DEROYAL Industries, Inc. 200 DeBusk Lane Powell. TN 37849

Re: K974763

Disposable Surgical Trocar/Cannula Dated: April 16, 1998 Received: April 17, 1998 Regulatory Class: II 21 CFR 884.1720/Procode: 85 HET

Dear Ms. Matlock:

We have reviewed your Section 510(k) notification of intent to market the device referenced above and we have determined the device is 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 device, 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 device is classified (see above) into either class II (Premarket Approval), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 895. A substantially equivalent determination assumes compliance with the Current Good Manufacturing Practice requirements, as set forth in the Ouality System Regulation (OS) 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 device in the Federal Register. Please note: this response to your premarket notification submission 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 regulations.

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

If you desire specific advice for your device 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) 594-4613. Additionally, for questions on the promotion and advertising of your device, 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/dsmaldsmamain.html".

Sincerely yours.

Lillian Yin, Ph.D.

Director. Division of Reproductive. Abdominal, Ear, Nose and Throat and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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K974763 510(k) Number (if known): Disposable Surgical Trocar/Cannula Device Name:

Indications for Use:

The DeRoyal Industries Disposable Surgical Trocar/Cannula is a single patient use disposable device intended for use during operative and/or diagnostic surgery to puncture/penetrate the abdominal wall and to serve as a port of entry for laparoscopic instruments (i.e. laparoscope, forceps, scissors, aspiration/irrigation cannula, etc.).

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Robert R. Satting
(Division Sign-Off)

Division of Reproductive, Abdominal, ENT, and Radiological Devices

510(k) Number K974763

Prescription Use (Per 21 CFR § 801.109)

OR

Over-The-Counter Use