K Number
K993089
Date Cleared
1999-10-14

(28 days)

Product Code
Regulation Number
878.4580
Reference & Predicate Devices
N/A
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The DeRoyal Disposable Rigid Light Handle and Adapter are indicated for use as accessories to a surgical lamp. The adapter is to be used, when necessary, to attach the light handle to the surgical lamp. The light handle is to be used to position the light without contaminating the gloved hand.

Device Description

The DeRoyal Disposable Rigid Light Handle and Adapter function in the same manner as predicate devices in that they are intended to be used as accessories to a surgical lamp which are used to position the light for illumination in various areas of the surgical field. The DeRoyal Disposable Rigid Light Handle and Adapter are made of materials commonly used for their purposes. The light handle contains a protective shield at the base which is used to prevent the gloved hand from contaminated surfaces. The protective shield may be folded and attached to the light handle to reduce space needed for packaging and storage.

AI/ML Overview

This 510(k) summary for the DeRoyal Disposable Rigid Light Handle and Adapter focuses on demonstrating substantial equivalence to predicate devices rather than proving performance against specific acceptance criteria through a dedicated study. As such, much of the requested information regarding detailed study design and results is not present in the provided document.

Here's an analysis based on the available information:

1. Table of Acceptance Criteria and Reported Device Performance

The document does not explicitly define quantifiable acceptance criteria with corresponding performance metrics from a specific study. Instead, it relies on a qualitative comparison to predicate devices, asserting that the new device functions "in the same manner" and shares similar characteristics.

CharacteristicAcceptance Criteria (Implied by Predicate)Reported Device Performance
Material (Light Handle)Plastic PolymersPlastic Polymers
Protective ShieldYesYes
RigidYesYes
Universally AdaptableYesYes
SterilitySterileSterile
DisposableYesYes
Packaged1 or 2 per Pack1 or 2 per Pack
Material (Adapter)Aluminum (or similar)Aluminum
FunctionalityPosition light without contaminating gloved hand; attach to surgical lampPosition light without contaminating gloved hand; attach to surgical lamp

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

Not applicable. The submission does not describe a formal "test set" or a performance study with a defined sample size for evaluating the device against acceptance criteria. The comparison is based on the inherent design features and intended use of the device relative to existing products.

3. Number of Experts Used to Establish Ground Truth and Qualifications

Not applicable. This type of information is typically relevant for studies involving subjective assessments or complex diagnostic imaging, which is not the case for this device.

4. Adjudication Method for the Test Set

Not applicable, as there was no formal "test set" requiring adjudication.

5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study

No. An MRMC study is not relevant for this type of device (a surgical light handle accessory). MRMC studies are typically used to assess the comparative diagnostic performance of readers using different methods or technologies, often in medical imaging.

6. Standalone (Algorithm Only) Performance Study

No. This device is a physical, mechanical accessory, not an algorithm or software-based system. Therefore, a standalone algorithm performance study is not applicable.

7. Type of Ground Truth Used

The "ground truth" for this submission is the established design and functionality of the legally marketed predicate devices (Charles Polo & Co. and Devon Industries). The claim of substantial equivalence is based on the new device having the same technological characteristics and intended use as these predicates. There is no external "ground truth" like pathology or outcomes data sought.

8. Sample Size for the Training Set

Not applicable. This is not a machine learning or AI-driven device that requires a training set.

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

Not applicable, as there is no training set for this device.

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K993089

OCT 1 4 1999

DeRoyal Industries, Inc.

DeRoyal Disposable Rigid Light Handle and Adapter

510(k) Summary

Summary of the Safety and Effectiveness Information Upon Which An Equivalence Determination Could Be Based

SUBMITTER INFORMATION

DeRoyal Industries, Inc. NAME: ADDRESS: 200 DeBusk Lane Powell, TN 37849

TELEPHONE: CONTACT: DATE OF PREPARATION: (423) 362-6217 Lois Marsh September 15, 1999

DEVICE NAMES

NAME: COMMON/USUAL NAME: CLASSIFICATION NAME (if known): DeRoyal Disposable Rigid Light Handle and Adapter Surgical Light Handle and Adapter Light, Surgical, Accessories (79FTA)

PREDICATE OR LEGALLY MARKETED DEVICES

Charles Polo & Co. and Devon Industries

DEVICE DESRIPTION

The DeRoyal Disposable Rigid Light Handle and Adapter function in the same manner as predicate devices in that they are intended to be used as accessories to a surgical lamp which are used to position the light for illumination in various areas of the surgical field.

Device Design/ Materials UsedPhysical Properties: The DeRoyal Disposable Rigid Light Handle and Adapter are made of materials commonly used for their purposes. The light handle contains a protective shield at the base which is used to prevent the gloved hand from contaminated surfaces. The protective shield may be folded and attached to the light handle to reduce space needed for packaging and storage.

DEVICE INTENDED USE

The DeRoyal Right Handle and Adapter are intended to be used as accessories to a surgical lamp. The universal adapter is used to attach the light handle to the surgical lamp when necessary while the light handle is used to position the lamp to the desired area without contaminating the gloved hand.

TECHNOLOGICAL COMPARISON WITH PREDICATE OR LEGALLYMARKETED DEVICE(S)

CharacteristicDeRoyal DeviceOther Devices
Material (Light Handle)Plastic PolymersPlastic Polymers
Protective ShieldYesYes
RigidYesYes
Universally AdaptableYesYes
SterilitySterileSterile
DisposableYesYes
Packaged1 or 2 per Pack1 or 2 per Pack
Material (Adapter)AluminumSimilar

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Image /page/1/Picture/1 description: The image is a circular seal for the U.S. Department of Health & Human Services. The seal features the department's name in a circular arrangement around the perimeter. In the center of the seal is a stylized image of three human figures, representing the department's focus on health and human well-being.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

OCT 1 4 1999

Ms. Lois Marsh Regulatory Affairs DeRoyal Industries, Inc. 200 DeBusk Lane Powell, Tennessee 37849

Re: K993089

Trade Name: DeRoyal Disposable Rigid Light Handle and Adapter Regulatory Class: II Product Code: FTA Dated: September 15, 1999 Received: September 16, 1999

Dear Ms. Marsh:

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 (Special Controls) or class III (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 requirement, 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 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.

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Page 2 - Ms. Lois Marsh

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) 594-4595. 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/dsmamain.html".

Sincerely yours,

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

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Page of

510(k) Number (if known):

Device Name:

DeRoyal Disposable Rigid Light Handle and Adapter

Indications for Use:

The DeRoyal Disposable Rigid Light Handle and Adapter are indicated for use as accessories to a surgical lamp. The adapter is to be used, when necessary, to attach the light handle to the surgical lamp. The light handle is to be used to position the light without contaminating the gloved hand.

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

(Division Sign-Off)
Division of General Restorative Devices K993089
510(k) Number.

OR
Over-The-Counter Use

Prescription Use (Per 21 CFR §801.109) OR

Over-The-Counter Use

§ 878.4580 Surgical lamp.

(a)
Identification. A surgical lamp (including a fixture) is a device intended to be used to provide visible illumination of the surgical field or the patient.(b)
Classification. Class II (special controls). The device, when it is an operating room lamp, a surgical instrument light, a surgical floor standing light, an endoscopic surgical light, a surgical light connector, a ceiling mounted surgical light, a surgical light carrier, surgical light accessories, a surgical lamp, a remote illuminator, or an incandescent surgical lamp, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 878.9.